signed po r 344004_10142026153020.pdf
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- Attached to
- Release State Use/Facilities for Persons with Severe Disabilities IL|27-416CMS-BOSS4-P-98493
- Contract number
- 27-416CMS-BOSS4-P-98493
- Issued by
- Illinois
About this file
This is a Purchase Order (Release Order Number 27-416CMS-BOSS4-P-98493:60) issued by the State of Illinois Department of Corrections to Shelby County Community Services, Inc., located in Shelbyville, Illinois. The order is based on Master Contract 9100002225 and is administered by the State of Illinois through buyer Amanda Crisman. The shipping and billing contact is Michelle Grogan at the Department of Corrections in Sheridan, Illinois.
The purchase order covers the supply of trash can liners for a one-year period from July 31, 2026, to July 30, 2027. Item #1 specifies 75 cases of 15" X 9" X 23" clear liners (0.9 mil) for 7.5 to 10 gallon cans at $33.99 per case, totaling $2,549.25. Item #2 specifies 200 cases of 23" X 10" X 39" clear liners (1.35 mil) for 33 gallon cans at $56.78 per case, totaling $11,356.00. The combined order total is $13,905.25 with no discounts, taxes, or freight charges applied. Delivery is required within 30 calendar days after receipt of order, with a release end date of June 30, 2027.
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Text version
27-416CMS-BOSS4-P-98493:60
DOC - Corrections Release Order Number
Purchase Order
Vendor Number: V00005019 Shelby County Community Services, INC.
E 1810 W South 3rd N Shelbyville, IL 62565
D sccsprod@sccsil.org o (217) 774-2924
R
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
--Please see specific requirements provided by the purchasing entity.
27-416CMS-BOSS4-P-
98493:60
Master Contract? Y
Master Con/Ref #: 9100002225
Contract/PO #: P-98493
Michelle Grogan s 4017 E. 2603rd Road
H Melissa Morsch Sheridan, IL 60551
I US
p Email: Michelle.grogan@illinois.gov
(815) 496-2181
T
Michelle Grogan
B 4017 E. 2603rd Road Melissa Morsch Sheridan, IL 60551
L US
L Email: Michelle.grogan@illinois.gov
(815) 496-2181
T
I Shipping Method: I Freight Terms:
I Shipping Terms: Payment Terms: I I Solicitation (Bid) No.: N/A I I Release Begin Date: 10/13/2026 Release End Date: 06/30/2027 Delivers' Calendar Day(s) A.R.O.: 30 I
Item # 1
Class- Item 665-24
Year 1 (7/31/26-7/30/27) Liner, can, 15" X 9" X 23" .9 mil +/- 10% tolerance.
For 7.5 to 10 gallon can.
Complete with twist ties. Weight/case: 17 lbs. Color: Clear 500/cs
Quantity I Unit Price I UOM I Discount % 'Total Discount I
I Tax Rate I hex Amount' Freight I Total Cost I
Amt.
75.00 $33.99 CV 0.00% $0.00 $0.00 $0.00 $2,549.25
Item #2
Class-Item 665-24
Year 1 (7/31/26-7/30/27) Liner, can, 23" X 10" X 39" 1.35 mu ýi- 10% tolerance.
For 33 gallon can.
Weight/case 29 lbs. Color: Clear. 250/cs.
Quantity I Unit Price I UOM I Discount % 'Total Discount'
Tax Rate I Tax Amount Freight I Total Cost Amt.
200.00 $56.78 CV 0.00% $0.00 $0.00 $0.00 $ 11,356.00
TAX: $0.00
FREIGHT: $0.00
TOTAL: $ 13,905.25
The undersigned agree to the Terms and Conditions as acknowledged by the Vendor and maintained in the State of Illinois a-procurement system. This agreement consists of all terms as maintained in the states 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 Vendors 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 Stete Agency or Entity: ___________
Official Signature:
(Ai(iiv'
Printed Name: CA...9 ( Title:
Designee Signature: ?._A CI1Jj.i1?. ('cjcil Printed Name: ________________________________
Title:
Dale:
Legal Signature:
Printed Name: ________________________________
Title:
Date:
Fiscal Signature:
Printed Name: ________________________________
Title:
Date:
FOR STATE OF ILLINOIS USE ONLY
Acq. Type: _________________Source Sal. 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 CertlDisclosure Yes_________ No__________________________
APPROVED
By: Amanda Crisman
Phone#: (815) 496-2181
BUYER
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