IVHM Medical Director Emergency Purchase Statement-Signed~2.pdf

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EMERGENCY PURCHASE STATEMENT

State of Illinois Chief Procurement Office for General Services Emergency Purchase Statement V.26.1 Page of

EMERGENCY PURCHASE STATEMENT

Page of State of Illinois Chief Procurement Office for General Services Emergency Purchase Statement v.26.1 Emergency Purchases are conducted pursuant to 30 ILCS 500/20-30 and 44 Ill. Adm. Code 1.2030.

Emergency Purchase Details Emergency Condition (select the appropriate option from the drop-down menu below):

Provide a description and reasons for needing this emergency purchase:

Provide the conditions and circumstances that led to the need for this emergency purchase:

Reason for selection of this particular vendor:

Description of supplies or services to be provided:

Emergency procurements shall be made with as much competition as is practicable under the circumstances, and agencies shall utilize best efforts to include contractors certified under the Business Enterprise Program in its emergency procurement process. 30 ILCS 500/20-30(a).

Describe the actions taken by the agency to make the emergency purchase with as much competition as is practicable under the circumstances:

List the actions taken by the agency that constitute its best efforts to include contractors certified under the Business Enterprise Program in this emergency purchase:

Is there an active State contract available for the required supplies or services?

If Yes is checked above, explain why the existing contract does not meet the need:

This emergency contract was awarded on the earliest of these dates: (choose one) *Pursuant to 44 Ill. Admin. 1.2030 (f)(5), if Estimated is indicated, an Emergency Final Cost form will be submitted by the State agency and published by the State Purchasing Officer no later than the tenth day of the succeeding month. If Actual is chosen and the total cost differs from the amount on this statement, an Emergency Final Cost form must be submitted and published within the same timeframe.

Select the type of funding to be used:

Signature This emergency purchase was made with as much competition as is practicable under the circumstances. Best efforts were utilized to include contractors certified under the Business Enterprise Program in the process.

I am authorized to make this emergency purchase, and I know and understand the contents of this statement and all statements herein are true and correct to the best of my knowledge.

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