Sole_Source_ACDHH_Advocacy_Services_Approved_05-09-23.pdf

Page 1 of 2 SPO Form 103 Standard Work (Rev 03.21.22)

Standard Work

Owner State Procurement Office, Compliance Unit

Form Number SPO Form 103 ‐ Sole Source (SS) Procurement Authorization Version Revised 3/21/2022

Form Completion Process

Process Standard Work/Instructions for completion and submittal of the SPO 103 form. The form is available on the SPO website: For Agencies > Resources > Standard Forms and Documents.

No. Action Action Detail/Key Points

Sections I through III to be completed by the requesting State Governmental Unit

SECTION I - State Governmental Unit Request

1 State Governmental Unit Name of the requesting State Governmental Unit (SGU; agency, board, or commission)

2 Requestor Name of the requestor 3 Email Email of the requestor 4 Title Job title of the requestor 5 Telephone Telephone number of the requestor

SECTION II - Background

6 Service(s)/Material(s) Description of service(s)/material(s) or Contract title (eProcurement Label) 7 Supplier Name of supplier(s) 8 Contract ID eProcurement contract number (if available)

9 Sole Source Type Select applicable option:

‐ Authorization request ‐ Authorization modification request https://spointra.az.gov/resources/standard-forms-and-documents

Page 2 of 2 SPO Form 103 Standard Work (Rev 03.21.22)

10 Requesting Term Specify contract term or extension period, as applicable, based on the SS 11 Estimated Cost Forecasted expenditures for the duration of the SS Term or extension period

SECTION III - Justification

12 Rationale Select applicable option in accordance with R2‐7‐E301(A):

‐ There is only a single source for the material(s) or service(s) ‐ No reasonable alternative source exists

Provide details of the procurement need, reason for the single source, and how the proposed procurement is advantageous to the State

Detail information regarding the rationale selected in the previous section; State Governmental Unit use of the material(s) or service(s); if mandatory state contracts were explored; the limitation which led to sole source; and how the State would benefit from the procurement.

Describe the procurement process, efforts to locate other sources/evidence of one source, and determination that the price is fair and reasonable

Detail strategy for the proposed procurement, considered competition, reason for selecting specific supplier, and negotiations strategy.

A notice was posted in the State's eProcurement system to registered vendors with an invite to comment on the sole-source request for three (3) working days, and it was determined that no reasonable alternative source exists for the procurement need.

Check the box confirming the sole source request notice was posted in the State's eProcurement system for three (3) working days prior to the request.

16 Signature Signature of the authorized requestor 17 Date of Request Specify the date of request

Section IV to be completed by the Procurement Authority:

SECTION IV - Approval

18 Determination

Select applicable option in accordance with A.A.C R2-7-E301(D):

- Request Authorized Pursuant to R2-7-E301

- Request Authorized with Conditions/Restrictions R2-7-E301

- Request Returned for Additional Information

- Request Denied

19 Approved Expiration Date Specify date or term of expiration

20 Comments, conditions, or restrictions (as applicable) Complete as needed

21 Print Name Printed name of the approver 22 Title Job title of the approver 23 Signature Signature of the approving authority 24 Date of Approval Specify the date of approval 25 Use section as necessary Used by any party in case the fields within the form were insufficient

STATE GOVERNMENTAL UNIT NOTICE: This is an official written determination in response to a procurement authorization request.

A copy of the form shall be maintained by the State Governmental Unit and the State Procurement Office.

Upon completion, Requestor shall forward the signed form to the Contract Owner.

Contract Owner shall upload the signed approval version of this form in the eProcurement system.

If anticipated expenditure is above State Governmental Unit's delegation, forward document to SPOCompliance@azdoa.

gov.

Page 1 of 4 SPO Form 103 - Sole Source Procurement Authorization (Rev 03.21.22)

Procurement Determination:

Sole Source Authorization A.A.C. R2-7-E301

SECTIONS I THROUGH III MUST BE COMPLETED BY THE REQUESTOR

USE ADDITIONAL PAGE AS NECESSARY

SECTION I - State Governmental Unit Request

1. State Governmental Unit

2. Requestor 3. Email

4. Title 5. Telephone

SECTION II - Background

6. Service(s)/Material(s)

7. Supplier

8. Contract ID

9. Sole Source Type

10. Requesting Term 11. Estimated Cost

Arizona Commission for the Deaf and the Hard of Hearing

Shari Bura s.burda@acdhh.az.gov

Business Operations Coordinator 602-542-3363

‐ Authorization request

The contract shall continue (5) years $500,000

Page 2 of 4 SPO Form 103 - Sole Source Procurement Authorization (Rev 03.21.22)

SECTION III - Justification

12. Rationale

13. Provide details of the procurement need, reason for the single source, and how the proposed procurement is advantageous to the State

‐ There is only a single source for the material(s) or service(s)

Page 3of4

1(.o.oib.tho proei.ntMnt proc:.s, dolls toklcateotber sou�idenceofone SOO'ot,. anddm.11ia.dio.,thatfhe price Is blr

The State Procurement Officer sent the notice to registered vencors on the electronic system to invite comments on the sole-souroe request for three working dars. No responses were received per tf\c SOiicitation. The determination that tho pt1co is fait and reasonable pricing is supported by relevant. hrS1orical price data.

SPO Form 103 • Sole Source Procurement Autho<izotion ;Rev 03.21.22)

5/1/2023

Page 4 of 4 SPO Form 103 - Sole Source Procurement Authorization (Rev 03.21.22)

TO BE COMPLETED BY PROCUREMENT AUTHORITY

SECTION IV - Approval

18. Determination

19. Approved Expiration Date

20. Comments, conditions, or restrictions (as applicable)

21. Print Name 22. Title

23. Signature 24. Date of Approval

25. Use section as necessary

STATE GOVERNMENTAL UNIT NOTICE: This is an official written determination in response to a procurement authorization request.

A copy of the form shall be maintained by the State Governmental Unit and the State Procurement Office.

Upon completion, Requestor shall forward the signed form to the Contract Owner.

Contract Owner shall upload the signed approval version of this form in the eProcurement system.

If anticipated expenditure is above State Governmental Unit's delegation, forward document to SPOCompliance@azdoa.gov.

- Request Authorized Pursuant to R2-7-E301

5 years of contract end date

Jessica Klein Deputy SPA

05/09/2023 https://azadoagov.na1.echosign.com/verifier?tx=CBJCHBCAABAAEeRfW9P1n6163WCWpndfutfOS1savQd3

Exhibit A

BPM005364 - ACDHH Solicitation

The Arizona Center for Disability Law (ACDL) is part of a unique nationwide network (NORN-National Disability Rights Network) of congressionally mandated, legally-based disability rights agencies. An agency just like the ACDL exists in every U.S. state and territory.

NORN is the nonprofit membership organization for the federally mandated Protection and Advocacy (P&A) Systems and Client Assistance Programs (CAP). Collectively, the P&A/CAP network is the largest provider of legally based advocacy services to people with disabilities in the United States.

This is advantageous toward the State because ACDL is a unique agency. Its legal staff includes attorneys and advocates who are highly knowledgeable about the various legal rights, including the Americans with Disabilities Act and other federal and state disability rights laws, available to persons who are deaf and hard of hearing. In addition, Center staff have a wealth of experience in creating educational materials for persons who are deaf and hard of hearing. Currently, the Center has over 35 self-advocacy guides in circulation, covering topics ranging from employment rights under the Americans with Disabilities Act to how to obtain assistive technology and voting rights.