Significant Procurement Notification Form.pdf

Amar Greasham <agreasham@azdot.gov>

Fwd: Significant Procurement Notification Form

ProcurementCompliance - ADOT <procurementcompliance@azdot.gov> Sat, Aug 30, 2025 at 4:39 AM To: Amar Greasham <AGreasham@azdot.gov>

Good day. Please utilize this email as your Significant Procurement Disclosure posting on SPO's website. Incorporate this document in your Pre-Solicitation documents.

Best Regards, Compliance Team

PROCUREMENT

1655 W. Jackson Street, MD 100P Phoenix AZ 85007

602.712.7466

602.712.8584 | azdot.gov

---------- Forwarded message --------- From: Google Forms <forms-receipts-noreply@google.com> Date: Mon, Jul 7, 2025 at 10:04 AM Subject: Significant Procurement Notification Form To: <procurementcompliance@azdot.gov>

Thanks for filling out Significant Procurement Notification Form Here's what was received.

Edit response

9/2/25, 9:15 AM State of Arizona Mail - Fwd: Significant Procurement Notification Form https://mail.google.com/mail/u/0/?ik=8414e44835&view=pt&search=all&permmsgid=msg-f:1841880378378852935&simpl=msg-f:1841880378378852935 1/5 https://www.google.com/maps/search/1655+W.+Jackson+Street?entry=gmail&source=g http://azdot.gov/ mailto:forms-receipts-noreply@google.com mailto:forms-receipts-noreply@google.com mailto:procurementcompliance@azdot.gov mailto:procurementcompliance@azdot.gov https://docs.google.com/forms/d/e/1FAIpQLSdxSzWnNvO30KUubljXrDSub3gfqJ1GX15weZF0kbYkDUx3Qw/viewform?usp=mail_form_link https://docs.google.com/forms/d/e/1FAIpQLSdxSzWnNvO30KUubljXrDSub3gfqJ1GX15weZF0kbYkDUx3Qw/viewform?edit2=2_ABaOnueTo6oNuk1ZaTaxATepUAQCIcJoxV-OvzHT15Cj0furfxwtUdQ2dFI0B4gXu7mJcvI

Significant Procurement Notification Form The following information is required to be provided to the State Procurement Administrator by all state governmental units (SGU; agencies, boards, and commissions) as per Standard Procedure 003 - Significant Procurement Role (SP 003 link).

Notes about this Google Form to provide notification of a SPR:

• You will receive a copy of your response via email

• You may edit your response after it is submitted in two ways. To ensure there's no duplication of efforts, please do one of the following:

1) Once you submit the form, you may click on "Edit you response" in the same browser; or

2) If some time has passed and it's necessary to make edits, please check your email for the original submission as it will have an "Edit response" link. If you don’t remember when you originally submitted your SPR notification, you may check the date and time on the spreadsheet via https://spo.az.gov/contracts/significant-procurement-roles and match it to the email.

• If your entry needs to be deleted, email SPOCompliance@azdoa.gov to provide an explanation for the deletion. If accepted, SPO Compliance will delete the entry.

Please contact the State Procurement Office (SPO) at SPOCompliance@azdoa.gov for any questions.

Email * procurementcompliance@azdot.gov

What is the name of the person leading the procurement? *

9/2/25, 9:15 AM State of Arizona Mail - Fwd: Significant Procurement Notification Form https://mail.google.com/mail/u/0/?ik=8414e44835&view=pt&search=all&permmsgid=msg-f:1841880378378852935&simpl=msg-f:1841880378378852935 2/5 https://spointra.az.gov/resources/standard-procedures https://spo.az.gov/contracts/significant-procurement-roles https://spo.az.gov/contracts/significant-procurement-roles mailto:SPOCompliance@azdoa.gov mailto:SPOCompliance@azdoa.gov mailto:procurementcompliance@azdot.gov mailto:procurementcompliance@azdot.gov

Elizabeth Blakley

Which agency is the procurement for? If it is a mandatory statewide contract, select your agency. *

Transportation, Dept. of

What is the title of the procurement? *

BPM007046 Sonita Rest Area Asphalt and Concrete Demolition

What is the procurement type? *

RFQ - Request for Quotation

✓ IFB - Invitation for Bid

RFP - Request for Proposal

CI - Competition Impracticable (SPO Form 101)

Emergency Procurement (SPO Form 102)

SS - Sole Source (SPO Form 103)

NPTQ - Not Practicable to Quote (Determination Template D301(4))

9/2/25, 9:15 AM State of Arizona Mail - Fwd: Significant Procurement Notification Form https://mail.google.com/mail/u/0/?ik=8414e44835&view=pt&search=all&permmsgid=msg-f:1841880378378852935&simpl=msg-f:1841880378378852935 3/5

Other:

What is the date when the first procurement disclosure statement (PDS) was signed (i.e. SPO Form 120 or SPO Form 130)? *

MM

07 /

DD

03 /

YYYY

What is the actual date or estimated date that the purchased materials will be delivered or the purchase of services or construction will begin, per A.R.S. § 41- 753(D)? *

MM

09 /

DD

04 /

YYYY

What is your name (if different from above)?

Robyn Caillouette

What is your e-mail address (if different from above)?

rcaillouette@azdot.gov

Create your own Google Form

9/2/25, 9:15 AM State of Arizona Mail - Fwd: Significant Procurement Notification Form https://mail.google.com/mail/u/0/?ik=8414e44835&view=pt&search=all&permmsgid=msg-f:1841880378378852935&simpl=msg-f:1841880378378852935 4/5 mailto:rcaillouette@azdot.gov https://docs.google.com/forms?usp=mail_form_link

Does this form look suspicious? Report 9/2/25, 9:15 AM State of Arizona Mail - Fwd: Significant Procurement Notification Form https://mail.google.com/mail/u/0/?ik=8414e44835&view=pt&search=all&permmsgid=msg-f:1841880378378852935&simpl=msg-f:1841880378378852935 5/5 http://null/