SEPS Emergency Purchase Statement form for 90 day emergency contract - approved~1.pdf

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EMERGENCY PURCHASE STATEMENT

State of Illinois Chief Procurement Office Emergency Purchase Statement Version 20.1 .\CPO Letterhead\CPO Letterhead.png

EMERGENCY PURCHASE STATEMENT

Statement Page of State of Illinois Chief Procurement Office Emergency Purchase Statement Version 20.1 .\CPO Letterhead\CPO Letterhead.png Emergency Purchase Details Emergency Category (select the appropriate option from the drop-down menu below):

Reason for selection of this particular vendor:

Description of supplies or services to be provided:

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

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

Actual or Estimated*:

*Actual end date and cost will be reported later.

Select the type of funding to be used:

Signatures I am making this statement and providing it to the CPO Office, the Auditor General, and the Procurement Policy Board in compliance with the Illinois Procurement Code and within 10 days after award of the contract.

I have authorized the emergency procurement in accordance with the requirements of the Illinois Procurement Code (30 ILCS 500) and the applicable administrative rule. I know and understand the contents of this statement and all statements herein are true and correct to the best of my knowledge.

EMERGENCY PURCHASE EXTENSION

Extension Page of State of Illinois Chief Procurement Office Emergency Purchase Statement Version 20.1 .\CPO Letterhead\CPO Letterhead.png Extension Justification Actual or Estimated*:

Actual or Estimated*:

Select the type of funding to be used:

Describe the scope of the original emergency (supply, service, etc.):

Describe the scope of the extension (supply, service, etc.). Show justification for extending the original emergency contract, and explain why the extension need cannot be met through a competitive process:

Was authorization to proceed verbally given?

Term of emergency procurement shall not exceed 90 days. Contract may be extended beyond 90 days if CPO determines additional time is necessary; however, prior to execution of extension, CPO must hold a public hearing and provide written determination *Actual end date and cost will be reported later.

Signatures I am requesting an extension of the requested emergency contract. I know and understand the contents of this statement and all statements herein are true and correct to the best of my knowledge.

EMERGENCY PURCHASE FINAL COST AND TERM

Final Cost and Term Page of State of Illinois Chief Procurement Office Emergency Purchase Statement Version 20.1 .\CPO Letterhead\CPO Letterhead.png Final Costs and Term I am reporting the final costs and term for the referenced emergency contract to the CPO and the Auditor General.

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