Signed po r335442_08202026132346.pdf
PDF 283 KB Posted
- Attached to
- Release State Use/Facilities for Persons with Severe Disabilities IL|25-416CMS-BOSS4-P-75628
- Contract number
- 25-416CMS-BOSS4-P-75628
- Issued by
- Illinois
About this file
Summary
This is a Purchase Order Release issued by the State of Illinois Department of Corrections (DOC) to Elm City Rehabilitation Center, Inc., vendor number V00001985, located in Jacksonville, Illinois. The purchase order is designated 25-416CMS-BOSS4-P-75628:342 and is a release from Master Contract 9100001941. The State's procurement contact is Michelle Grogan, and the order was approved by Amanda Crisman, Buyer, on August 19, 2026. The document was officially executed by Ryan Woods, the State of Illinois representative, on August 19, 2026.
The purchase order covers dental floss loops designed to promote safety in clear packaging with mint flavoring, specified as 30 loops per bag with a note indicating a package change to 144 packages of 30. The order quantity is 6.00 units at a unit price of $604.80, resulting in a total contract amount of $3,628.80 with no discounts, taxes, or freight charges applied. The release period extends from August 19, 2026, through June 30, 2027, with a delivery requirement of 20 calendar days after receipt of order. Payment terms are listed as not applicable.
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Text version
25-416CMS-BOSS4-P-75628:342
DOC - Corrections Release Order Number
Purchase Order
Vendor Number: V00001985 Elm City Rehabilitation Center, Inc.
E 1314WWalnut N Jacksonville, IL 62650
D ECC@elmcity.org o (217) 245-9504
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.
25-416CMS-BOSS4-P-
75628:342
Master Contract? Y
Master Con/Ref #: 9100001941
Contract/PO #: P-75628
Michelle Grogan s 4017 E. 2603rd Road Melissa Morsch
H Sheridan, IL 60551
I US
p Email: Michelle.grogan@illinois.gov
(815) 496-2181
Michelle Grogan
B 4017 E. 2603rd Road Melissa Morsch Sheridan, IL 60551
L US
L Email: Michelle.grogan@illinois.gov
(815) 496-2181
T
Shipping Method: I Freight Terms:
Shipping Terms: I Payment Terms: NA Solicitation (Bid) No.: N/A i I Release Begin Date: 08/19/2026 Release End Date: 06/30/2027 DeIiver' Calendar Day(s) A.R.O.: 20 I
Item # 1
Class- Item 652-85
DENTAL FLOSS LOOPS, DESIGNED TO PROMOTE SAFETY. CLEAR PACKAGING, MINT FLAVOR. 30 LOOPS/BAG. 100 pkgs of 30.
(PLEASE NOTE package change 144 pkgs of 30)
Quantity I Unit Price I UOM I Discount % Total Discount!
I Tax Rate I ITax Amountl Freight Total Cost I Amt.
6.00 $ 604.80 CV 0.00% $0.00 $0.00 $0.00 $3,628.80
TAX: $0.00
FREIGHT: $0.00
TOTAL: $3,628.80
25-416CMS-BOSS4-P-75628:342
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 #:
Date:
State of Illinois Agency or Other Purchasing Entity Procuring State Agency or Entity: ___________
Official Signature:
Printed Name: '.]OJ') 00d5 Title: t,t3L1.X (T&i_-(' Designee Signature: ___________________________
Printed Name:
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
APPROVED
By: Amanda Crisman
Phone#: (R1t 496-21 91
BUYER
File details come from the government source that posted it. Updated .