PES Inc SSA July 2023 60K total.pdf

Request for Sole Source Authorization_updated 7/2015 Page 1

Request for Sole Source Authorization (SSA) Division of Purchasing (DOP)

Email Completed Request Form to DOP at purchasing@adm.idaho.gov

X New Request (Answer Questions 1-5)

Request to Renew SSA# (Answer Questions 6-8)

(Check this box to request an additional term for the same goods/services)

Request to Amend SSA# (Answer Questions 9-10) (Check this box to request a change to the goods/services, term, or other conditions of the SSA)

Agency Purchasing Representative (Name): Cassandre DiBonaventura

E-mail/Phone: Cassandre.DiBonaventura@dhw.idaho.gov, 208-334-6543

Name of Agency: Health and Welfare

Request for the Purchase of: A mobile pediatric resuscitation system for pre-hospital providers.

Requested Supplier (vendor name): Pediatric Emergency Standards, Inc.

Cost Estimate (attach quote): $14,999.04

Desired Term: Start Date: 10/01/2022 to End Date: 09/30/2026 (For one-time purchases, please enter a one-year term from the date on which you wish to place the order)

Do you anticipate the need for renewals? Yes No

Sole Source History (renewals and amendments):

Provide a history of the sole source including: SSA number, date issued, term, cost, and brief description for original SSA and each renewal/amendment; and total value to date. See SSA Instructions for examples.

IDAPA 38.05.01.045 provides that sole source purchase shall be used only if a requirement is reasonably available from a single supplier.

NEW REQUESTS (complete #1-5)

1. Describe the Product or Service.

A mobile pediatric resuscitation system for pre-hospital providers.

2. Describe your Agency’s Business Need for the requested product or service.

In order to support the federal requirement of Emergency Medical Services for Children (EMSC) Performance Measure 03: Use of Pediatric-Specific Equipment, we are requesting the Handtevy Pediatric System to assist selected pre-hospital Emergency Medical Services (EMS) agencies to improve pediatric emergency care by providing accurate

DOP use only:

SSA#

mailto:purchasing@adm.idaho.gov mailto:Cassandre.DiBonaventura@dhw.idaho.gov DiBonaventura, Cassandre - CO 9th Typewriter for year one. $60,000.00 four year total.

DiBonaventura, Cassandre - CO 9th Typewriter

CDI 07/18/23

Request for Sole Source Authorization_updated 7/2015 Page 2 dosing and equipment with the intent that there will be better outcomes for pediatric patients who are in emergent situations.

3. Justification: Check each box that applies and attach required documentation.

X Sole source provider of a licensed or patented good or service (attach provider’s letter)

Sole manufacturer AND distributor (attach manufacturer’s letter)

Sole provider of factory-authorized/warranty service (attach provider’s letter)

Sole provider of items that are compatible with existing equipment, systems, programs, etc.

Other (attach description and justification)

4. Describe what makes this Product or Service unique.

Pediatric Emergency Standards (PES), DBA Handtevy, provides customized and tailored systems of care to the pre-hospital arena intended primarily for acute pediatric care. PES is the only company who provides both an electronic (Handtevy Mobile) and durable system of care that is built to reflect local protocols and pharmacology. The reason why the EMSC Program needs this vendor and their product is because it will assist Idaho’s pre-hospital EMS agencies with medication management such as dosing and pediatric equipment to improve pediatric emergency care. Additionally, the application is integrated with electronic patient care reporting (ePCR) software used by EMS agencies such as ESO Solutions, Inc. and ImageTrend Elite which the Department’s Bureau of Emergency Medical Services and Preparedness already contracts with.

5. Provide a list of other suppliers contacted and describe the method for determining that there are no other possible suppliers.

The only other supplier in the industry who serves pediatric patient populations primarily is Armstrong Medical, who owns the rights to the Broselow Tape/System. The Broselow Tape is a generic resource that does not tailor specifically to the protocol and pharmacology of an end user. There is not any other system of care that is fully tailored/customized to local protocol and pharmacology, provides electronic and durable options for implementation with tie-ins to ePCR technology, and provides a Commission on Accreditation for Pre-Hospital Continuing Education (CAPCE) approved pre-hospital pediatric educational platform.

REQUEST TO RENEW (complete #6-8) Note: each agency seeking authorization to renew a current SSA must conduct a business/financial analysis every 5 years, at a minimum, documenting estimated costs (as well as other factors) related to maintaining the current provider versus switching/migrating to a new provider/alternative solution, if one is available.

6. Confirm your Agency’s continuing Business Needs.

7. Justification: Check each box that applies and attach required documentation .

Sole source provider of a licensed or patented good or service (attach provider’s letter)

Sole manufacturer AND distributor (attach manufacturer’s letter)

Sole provider of factory-authorized/warranty service (attach provider’s letter)

Sole provider of items that are compatible with existing equipment, systems, programs, etc.

Other (attach description and justification)

8. Describe the steps taken to confirm that the product/service continues to qualify as a sole source; include a list of suppliers contacted.

Request for Sole Source Authorization_updated 7/2015 Page 3

REQUEST TO AMEND (complete #9-10)

9. Describe (with specificity) the requested modifications to the scope of work, product requirements, cost or other proposed changes to your current SSA.

10. Describe your Agency’s business need for the requested modifications.

Agency Certifications:

I certify that the Agency has sufficient appropriation balances for payment of the requested product/service.

(Checking this box takes the place of a DA-1 or IPRO request.)

I am aware that Idaho Code and IDAPA require procurements to be competitively bid unless specifically exempt;

that the statements contained in this Request are complete and accurate, based on my professional judgment and independent investigation; that no personal advantage will accrue to me or any member of my immediate family as a result of this direct procurement; and that based on my analysis of my agency’s business need and research into available products or services, no other vendor can provide the same or similar product or service to meet my agency’s need.

End-User/Program Agency Requestor:

Signature Date

Printed Name Title

Agency Purchasing Representative:

Printed Name Title

Upon approval by the Administrator, the Agency may proceed with the purchase and issue its own purchase order or contract document for this acquisition. The Division of Purchasing’s SSA number noted above (with Administrator approval, below) is the only authorization needed for the Agency to proceed with this purchase. Agency purchases from this sole source authorization shall not exceed the dollar amount listed above unless approved in writing by the Division of Purchasing.

APPROVED REJECTED

DOP ADMINISTRATOR:

07/14/2023

Melissa Ball Program Supervisor

Request for Sole Source Authorization_updated 7/2015 Page 4

Printed Name

Additional Conditions which apply to this approval:

The Agency must consult with its legal counsel regarding terms and conditions prior to entering into a contract with the approved supplier.

The Agency must complete a business/financial analysis prior to any additional renewals of this SSA.

Other (specify):