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

Kristin Perry kristin.perry@dhw.idaho.gov

Format phone number as (555)555-5555

(208)334-5603

Department of Health and Welfare

Tobacco and vaping intervention programs

9/19/2023

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

American Lung Association

124,085.77$

Yes No

Describe the property you are seeking:

Tobacco and vaping intervention program for middle and high schools in Idaho.

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:

Services available through American Lung Association would provide tobacco intervention and cessation for Idaho schools using a unique combination of their INDEPTH, Not on Tobacco, and NOT for Me vaping intervention programs. These programs would help support Alternative to Suspension solutions for Idaho schools as prioritized in Project Filter’s strategic plan by training facilitators for implementation and sustainability.

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

The American Lung Association (ALA) is the only entity that can provide the services needed to coordinate and implement alternative to suspension programs for schools. The Department’s Project Filter has clearly defined its goals to provide these specific services in their strategic plan. ALA’s proposal to support middle and high schools across Idaho to implement the INDEPTH tobacco and vaping intervention program and the Not on Tobacco (N-O-T) Teen Cessation program for middle and high school students statewide meets the goals of Project Filter. No other vendor is able to provide the unique and critical services needed.

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?

Many resources simply recommend the INDEPTH program which is evidence-based and owned by American Lung Association. Other resources have materials available for schools to use but DO NOT provide services for trainings for statewide educational staff. This service is unique because ALA does indeed have a training program established for the implementation of these alternative to suspension programs in schools. Furthermore, there are no other local (in Idaho) entities that would be able to coordinate trainings and support in the schools with a local representative and the ability to travel around the state when needed.

Lung Association Letter_SSA.pdf 190.03KB

Proposed Lung Association Budget Letter (1).pdf 208.17KB

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