ࡱ> VYU nbjbj22 4@P_P_`         8Xd4 1(((:1<1<1<1<1<1<1$3U6``1 ('@(((`1  u1T)T)T)(  :1T)(:1T)T)V/@z0D(/ &11010x6T)6z06 z0((T)(((((`1`1T)(((1((((6((((((((( :  Instructions: Please provide information, using the format shown here, on the requesting agencys letterhead and submit to CMS Bureau of Strategic Sourcing staff. In the event a requesting agencys contract request letter is missing information, it may be returned to the requesting agency for amendment prior to being placed on the agenda for State Use Committee vote. STATE USE CONTRACT REQUEST LETTER Ron Wilson Date: ____________________ Deputy Director CMS BOSS, State Use Program 1000 E Converse St Springfield, IL 62702 Agency Name: __________________________ Agency Contact: __________________ Contact Phone Number: _______________ Contact Email: _________________________ Contracting Qualified Not-For-Profit Vendor: _____________________________________ Requisition #:__________________________________________________ _____________ Proposed Contract: (please complete information in the appropriate box)   FORMCHECKBOX  New  FORMCHECKBOX  Renewal Proposed Start Date: ___________________ Renewal Start Date: ___________________ Proposed End Date: ___________________ Renewal End Date: ___________________ Proposed Initial Term Length: ____________ Renewal Term Price: $_________________ Proposed Initial Term Price: $_____________ # Renewals Remaining: ________________ Proposed Renewal Terms (# terms, length of term):________________________________ Proposed Renewal Price per Term: $____________________________________ This procurement is for:  FORMCHECKBOX  Supplies  FORMCHECKBOX  Services  FORMCHECKBOX  Facilities  FORMCHECKBOX  Other (please describe) _________________________________________________ Specific Description of the Services/Commodities to be provided under Contract, including quantity if relevant: ___________________________________________________________________________ ___________________________________________________________________________ Location where Services/Commodities will be provided under the Contract. If the procurement is for Services or Facilities maintenance (e.g., janitorial), please describe your agencys expectations of the vendor (e.g., frequency of services, tasks to be performed, square footage being cleaned, what consumables will be provided etc.): If your agency has utilized this vendor to perform the same or similar services in the past, please describe your agencys satisfaction with the vendors past performance: Provide the name/contact information of the procurement staff responsible for negotiating the proposed price, if different from the agency contact. ___________________________________________________________________________ Explain the economic benefit of utilizing the State Use vendor. Also, for the Committees review required by 30 ILCS 500/45-35(c)(8), please demonstrate that you have done one or more of the following (and provide a detailed description of research completed) to show the contract price is not substantially more than if competitively bid (Attach additional pages as needed):  FORMCHECKBOX  Performed recent market research for comparable supplies or services in the area where services will be provided. Whether research is recent will depend largely upon the supply or service being procured, as pricing may be more likely to change in certain areas over others.  FORMCHECKBOX  Researched other nearby jurisdictions contracts for pricing of similar supplies/services (e.g., State of Missouri, State of Wisconsin, State of Indiana, State of Kentucky, State of Michigan, City of Chicago, etc.). Information on such Federal Government contracts may be found at abilityonecatalog.gov.  FORMCHECKBOX  Examined the previous contracts pricing (if competitively bid) and compared it to the new contract pricing, taking into account consumer price index data and prevailing wages for the area where services (as defined by Section 25-60[b] of the Illinois Procurement Code) are to be provided. ___________________________________________________________________________ ___________________________________________________________________________ Subcontractor Utilized:  FORMCHECKBOX  Yes  FORMCHECKBOX  No Description of Services/Commodities to be provided by Subcontractor: ___________________________________________________________________________ ___________________________________________________________________________ Anticipated Price of Subcontractor Services Per Term: $___________________________ Please ask the State Use Committee to review this file and advise if approval is granted to proceed with this procurement in accordance to 30 ILCS 500/45-35. _____________________________________ _____________________________________ _____________________________________ CC: ___________________________ CC: ____________________________      t u    ( ) * + }o}}}}}aa}a}Soh cCJOJQJ^JaJhCJOJQJ^JaJhr>6CJOJQJ^JaJ hr>6h cCJOJQJ^JaJhh;CJOJQJ^JaJhr>6hr>6OJQJ^Jh cOJQJ^Jhr>6h cOJQJ^J#hr>6h c5CJOJQJ^JaJ&h7hr>656CJOJQJ^JaJh7h76h7h756hFph cu  ) * + , } ~ ! 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