Request Form to Division of Purchasing (DOP).pdf

Request Form to Division of Purchasing (DOP)

Name:*

E-mail:*

Phone:*

Agency Name*

Property being Purchased:*

Submission Date

Fiscal Year

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

Type of Request*

Name of Requested Vendor*

Desired Term (in years):*

Anticipated Total Cost (for full desired term):*

Do you anticipate the need for renewals?*

Property*

Justification*

Sole Source Authorization

Cassandre DiBonaventura cassandre.dibonaventura@dhw.idaho.gov

Format phone number as (555)555-5555

(208)334-6543

Department of Health and Welfare

A mobile pediatric resuscitation system for pre-hospital providers.

7/18/2023

New Renew (Agency wishes to extend an existing sole source authorization) Amend (Check this box to request a change to the goods/services, term, or other conditions of the SSA) Both Renew and Amend

New

Pediatric Emergency Standards, Inc.

60,000.00$

Yes No

Describe the property you are seeking:

A mobile pediatric resuscitation system for pre-hospital providers.

Check all that apply:

Sole source provider of a licensed or patented good or service Sole manufacturer AND distributor Sole provider of factory-authorized/warranty service Sole provider of items that are compatible with existing equipment, systems, programs, etc.

Other https://adminrules.idaho.gov/rules/current/38/380501.pdf

Business Need*

Description*

Alternatives*

Requestor was asked to upload a letter from the requested manufacturer/supplier

Requestor was asked to upload any additional documents/information that could help support the sole source request

File Upload

Agency Certification*

Signature

Approval

Describe the Agency’s business need for the requested property:

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 dosing and equipment with the intent that there will be better outcomes for pediatric patients who are in emergent situations.

Describe what makes the identified property unique. Why is it the only property that could meet your business need?

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.

Describe the research you conducted to identify other potential property/sources. What potential alternatives did you find and why will they not meet the Agency’s business needs?

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.

PES Inc Letter July 2023.pdf 255.57KB

PES Inc Quote.pdf 275.04KB

PES Inc SSA July 2023 60K total.pdf 395.86KB

By submitting this form, I certify that the information provided above is true and accurate to the best of my knowledge, supports the requirement for a sole source procurement, and is in the best interest of the State:

Approver

Administrator intends to approve (pending legal notice and appeal period).

The following conditions apply to this authorization:

SSA Number*

DOP Signature*

DOP Printed Name*

Title*

Date*

Notes

This SSA is only an authorization; a contract must be executed as detailed herein.

The Agency is authorized to issue a contract for an amount up to the anticipated total cost identified above.

DOP will issue and administer a contract pursuant to this SSA.

The Agency is responsible for requesting renewals and amendments to this SSA as appropriate.

The Agency must submit an SSA Business/Financial Analysis with it’s next request to renew the SSA.

Any agreement resulting from this SSA must be in writing, must comply with Idaho laws and policies, and must comply with best practices in contracting to the greatest extent practical. It is recommended that the Agency consult with its legal counsel.

Other:

Sign