Signed PO Business Cards HIV.pdf
PDF 84 KB Posted
- Contract number
- 25-416CMS-BOSS4-P-75951
- Issued by
- Illinois
About this file
This document is a Purchase Order issued by the Illinois Department of Public Health (DPH) for the HIV/AIDS Section, with Transitions, NFP (a vendor located in Rock Island, IL) as the contracted service provider. The purchase order is part of a master contract (Contract/PO #9100001912) and is specifically release order 25-416CMS-BOSS4-P-75951:15, spanning from August 25, 2025 to December 31, 2025.
The purchase order covers 10 individual line items, each priced at $48.00, totaling $480.00. Each line item appears to be for a different employee in the HIV/AIDS Section, with quantities of 1.00 and using either "EA" (each) or "TS" (task) as the unit of measurement. There are no discounts, taxes, or freight charges applied. The delivery calendar is set at 14 days after receipt (A.R.O.), and the payment terms are marked as "NA". The purchase order was approved by Misty Roberts, the buyer, and digitally signed by Sameer Vohra and Cynthia Maduka representing the state agency.
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Text version
25-416CMS-BOSS4-P-75951:15
Vendor Number: V00001217 Transitions, NFP
1512 4th Ave Rock Island, IL 61201 null null
Purchase Order
DPH - Public Health
25-416CMS-BOSS4-P-
75951:15
Contract/PO #:
Release Order Number
Master Contract? Y
S H I P
T O
Jacob Whited 525 W Jefferson St 1st Floor Springfield, IL 62761
US
Email: jacob.whited@illinois.gov
(217) 557-0011
VENDOR INSTRUCTIONS:
PURCHASE ORDER REQUIREMENTS - STATE OF ILLINOIS AGENCIES
Prior to commencement of billable work, delivery of supplies or rendering of any service on a Purchase Order:
--Initial Purchase Order/Contract - All parties, including the State and vendor, must fully execute the contract in its entirety.
--Release from an existing Purchase Order/Contract - The vendor must receive a Purchase Order signed by the State Agency and attached in BidBuy. Note, for any additional requirements see specific State Agency instruction.
PURCHASE ORDERS REQUIREMENTS - OTHER PURCHASING ENTITIES
B I L L
T O
Jacob Whited 525 W Jefferson St 1st Floor Springfield, IL 62761
US
Email: jacob.whited@illinois.gov
(217) 557-0011
Solicitation (Bid) No.: N/A
Shipping Method:
Shipping Terms:
Release Begin Date: 08/25/2025 Release End Date: 12/31/2025
V E N D O R
Freight Terms:
Payment Terms: NA
Delivery Calendar Day(s) A.R.O.: 14
Master Con/Ref #: 9100001912
Item # 1
Class-Item 646-31
.Iyesha J. Duckworth, HIV Section
Quantity UOMUnit Price Discount % Total Discount
Amt.
Tax Rate Tax Amount Freight Total Cost
1.00 EA$ 48.00 0.00 % $ 0.00 $ 0.00 $ 0.00 $ 48.00
Item # 2
Class-Item 646-31
Santita Odom, HIV/AIDS Section
Quantity UOMUnit Price Discount % Total Discount
Amt.
Tax Rate Tax Amount Freight Total Cost
1.00 TS$ 48.00 0.00 % $ 0.00 $ 0.00 $ 0.00 $ 48.00
Item # 3
Class-Item 646-31
Richa Parikh, HIV/AIDS Section
Quantity UOMUnit Price Discount % Total Discount
Amt.
Tax Rate Tax Amount Freight Total Cost
1.00 TS$ 48.00 0.00 % $ 0.00 $ 0.00 $ 0.00 $ 48.00
Item # 4
Class-Item 646-31
Jeffrey P. Maras, HIV/AIDS Section
Quantity UOMUnit Price Discount % Total Discount
Amt.
Tax Rate Tax Amount Freight Total Cost
1.00 EA$ 48.00 0.00 % $ 0.00 $ 0.00 $ 0.00 $ 48.00
Item # 5
Class-Item 646-31
Kortney A. Leatherwood, HIV/AIDS Section
Quantity UOMUnit Price Discount % Total Discount
Amt.
Tax Rate Tax Amount Freight Total Cost
1.00 EA$ 48.00 0.00 % $ 0.00 $ 0.00 $ 0.00 $ 48.00
Item # 6
Class-Item 646-31
Kimberly Cleveland, .HIV/AIDS Section
Quantity UOMUnit Price Discount % Total Discount
Amt.
Tax Rate Tax Amount Freight Total Cost
1.00 EA$ 48.00 0.00 % $ 0.00 $ 0.00 $ 0.00 $ 48.00
Item # 7
Class-Item 646-31
Cheryl A. Ward, HIV/AIDS Section
Quantity UOMUnit Price Discount % Total Discount
Amt.
Tax Rate Tax Amount Freight Total Cost
1.00 TS$ 48.00 0.00 % $ 0.00 $ 0.00 $ 0.00 $ 48.00
Item # 8
Class-Item 646-31
Olumuyiwa Olawumi, HIV/AIDS Section
Quantity UOMUnit Price Discount % Total Discount
Amt.
Tax Rate Tax Amount Freight Total Cost
1.00 TS$ 48.00 0.00 % $ 0.00 $ 0.00 $ 0.00 $ 48.00
Item # 9
Class-Item 646-31
Dusty Freezeland, HIV/AIDS Section
Quantity UOMUnit Price Discount % Total Discount
Amt.
Tax Rate Tax Amount Freight Total Cost
1.00 EA$ 48.00 0.00 % $ 0.00 $ 0.00 $ 0.00 $ 48.00
Item # 10
Class-Item 646-31
Blaire Long, HIV/AIDS Section
Quantity UOMUnit Price Discount % Total Discount
Amt.
Tax Rate Tax Amount Freight Total Cost
1.00 TS$ 48.00 0.00 % $ 0.00 $ 0.00 $ 0.00 $ 48.00
$ 480.00
$ 0.00
$ 0.00
APPROVED
By:
Phone#:
Misty Roberts
(217) 685-4368
BUYER
The undersigned agree to the Terms and Conditions as acknowledged by the Vendor and maintained in the State of Illinois' e-procurement system. This agreement consists of all terms as maintained in the state's e-procurement system inclusive of attached documents. The Vendor affirms that the Certifications and Financial Disclosures and Conflicts of Interest are true and accurate as of the date of the Vendor's execution of this Agreement. State documents will prevail in the event of a conflict between State and Vendor documents and information. The undersigned agree to the Terms and Conditions of this agreement:
OFFICIAL SIGNATURES:
Vendor Name: _______________________________
Vendor Signature: _________________________________
Printed Name: ______________________________
Title: _____________________________________
Phone #: ___________________________________
Email:______________________________________
Date: ______________________________________
State of Illinois Agency or Other Purchasing Entity Procuring State Agency or Entity: __________
Official Signature: _________________________________
Printed Name: ______________________________
Title: _____________________________________
Designee Signature: ________________________
Printed Name: ______________________________
Title: _____________________________________
Date: ______________________________________
Legal Signature: _________________________________
Printed Name: ______________________________
Title: _____________________________________
Date: ______________________________________
Fiscal Signature: _________________________________
Printed Name: ______________________________
Title: _____________________________________
Date: ______________________________________
FOR STATE OF ILLINOIS USE ONLY:
Acq. Type: ________________Source Sel. Method: _______________ Using Agency Funding Source:__________________________________ Detailed Expenditure Object Code:_____________________________ Approp. Acct Code: ___________________________________________ Award Code: __________________________________________________ Original Proc. Method:________________________________________ Subcontractors Disclosed:_____________________________________ Subcontractors Utilized:______________________________________ Publication Date:____________________ Financing Needed:_______ IPG Cert/Disclosure Yes_________ No__________________________
| 2025-09-16T11:46:34-0500 | |
| Sameer Vohra by Cynthia Maduka |
File details come from the government source that posted it. Updated .