Commonwealth of Pennsylvania
EMERGENCY PROCUREMENT ("EP") APPROVAL REQUEST


If either of the following two conditions exist, an EP is not required and should not be requested:

1. Material/Service available from DGS/OA statewide contract.
2. Estimated Cost of the material/service is within the Small, No-bid Procurement threshold identified in the Procurement Handbook, Part I, Chapter 7.

Agency requests approved to proceed with an emergency procurement under Section 516 of the Commonwealth Procurement Code (62 Pa. C.S. § 516).
 
                                                    Status:  


Requesting Agency Information
Agency/Bureau:*
Contact Person:*
Street Address:*
City, State, ZipCode*
City*
State: Pennsylvania Zip Code*
Contact Tel#:*
Contact Email:*
Confirm Email:*
Description of Material  
or Service  
or IT:*



For IT-Services and IT-Materials, please choose IT.
Material Group  
or Product Category:*

Estimated $ Amount:*  
Length of EP:*      
Delivery Location:*
City*
State: Pennsylvania Zip Code*
Choose only one Basis for the Emergency Purchase
Threat to public health, welfare, or safety
Identify the threat and provide an explanation as to what created threat:
Provide a brief explanation of the need for the material and/or service:
State the consequence if the procurement is not done on emergency basis:
Indicate whether approval was obtained from DGS:

If Yes Provide the following:
a. Name of person granting approval:
b. Date of approval:
Circumstances outside the control of the agency create an urgency of need, which does not permit the delay in using more competitive methods
 Note: Verbal approval will not be provided for this basis. Agency cannot proceed with emergency procurement until this form is completed and approved by DGS/OA.
Identify the Circumstances:
Why are those circumstances outside of the control of Agency?
Provide a brief explanation for the urgent need:

Information Required
For ALL EP's, provide the following information:
Brief description of selection process
Full Supplier information:
(if known at the time of
submission of form)
Name:
Address:
Telephone#:
SAP Vendor#
For EP's that are NOT a threat to public health, welfare, or safety, provide the following information
Include a list of the solicited suppliers, their contact information, and their quotations:
Funds have already been encumbered for this request(Yes/No):

If applicable, what has been done previously to procure this material/service? (Also provide the previous SAP/SRM PO number and/or Contract Number):
NOTE: If any Agency only intends to solicit a quote from one supplier, the following section, "Supplemental Single Source Information" must be completed

Supplemental Single Source Information Required
This section of the EP APPROVAL REQUEST Form is only required to be completed if the following is applicable:

1. Category of Emergency is due to "Circumstances outside the control of the agency create an urgency of need, which does not permit the delay in using more competitive methods."
2. It is not practical for the agency to obtain two or more quotes.
Is only a single supplier capable of providing the material or services? If yes, please explain. If not applicable, leave blank and respond in the next block.
Explain why it is not practical to obtain two or more quotes for this emergency procurement.
If timing is a factor, what is the time factor and why? If yes, please explain.
Are there compatibility requirements or compliance requirements? If yes, please explain
NOTE: If the purpose of the emergency procurement is to prevent a lapse in contracted services, one of the following must be checked. Include status of the new contract/purchase order and note any special conditions of the emergency procurements.
DGS/OA will not accept delay in new contract being executed as a basis for an EP unless the Agency can provide detailed, justifiable explanation for the delay.





Agency Approvals
IMPORTANT*:The printed names on this form shall constitute the signatures of these individuals. Agencies must insure that these individuals review the completed form and give their consent to apply their printed name on this form. No handwritten signatures shall be required in order for the form to be considered "signed" by those individuals whose names appear in the signature section of the form
Requesting Authority (Agency Head or Designee reviewing and approving this request). Requesting Authority signature connotes concurrence with the Agency EP request to procure the material and/or service
Title:*
Signature:*
Date:* imgCal.GIF
If you wish to receive a copy of the approval/disapproval/returned for correction e-mails, please provide your e-mail address below



 
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Approval Process:
E-mail:
By clicking this button, the form will be submitted to
DGS/OIT depending upon the category selected.