Formal Solicitation Requirements Form

This form may be requested by Purchasing for contracts over $25,000 in order to assist in the creation of a formal solicitation document (RFP, RFQ, RFO, RFI, or ITB). This form is required for contracts over $1 million.

1. Description of Product or Service Requested

(If you are requesting a specific product, provide detailed description/part numbers in itemized format. If requesting a service, provide a statement of work and length of service.)

2. Contract Timeline

  1. Required Product Delivery Date:(Date)
  2. Multiple Product Delivery Dates:1st Date, 2nd Date, 3rd Date
  3. Service for 1 Year Beginning on (Date)
  4. Service for 2 Years Beginning on (Date)
  5. Service for 3 Years Beginning on (Date)
  6. Service from X Date to Y Date
  7. Optional Extension for X Years
  8. Other ______

3. Projected Costor Revenue over the Life of this Contract (including all possible extensions) $______

4. Cost Center(s) that will be used for this Contract

  1. Cost center 1: (BU-Fund-DeptID-Program-Project)
  2. Cost center 2:(BU-Fund-DeptID-Program-Project)
  3. Cost center 3: (BU-Fund-DeptID-Program-Project)

5. Account(s)that will be used for this Contract

  1. Account 1: (Expense or Revenue Account)
  2. Account 2: (Expense or Revenue Account)

6. Project Manager (person responsible for overseeing the contract)

  1. Name: ______
  2. Title: ______
  3. Email: ______

7. Contact for Questions about this Purchase

  1. Name: ______
  2. Title: ______
  3. Email: ______

8. Evaluation Criteriafor Solicitation (RFP, RFQ, RFO)

Check all criteria that apply and assign weight percentage (criteria weights must total 100%):

__List purchase price(%)

__ Reputation of the vendor and of the vendor’s goods or services (%)

__ Quality of the vendor’s goods or services(%)

__ Extent to which the goods or services meet UHS’ needs (%)

__The vendor’s past performance with UHS (%)

__ Impact on the ability of UHS to comply with laws and rules relating to Historically Underutilized Businesses (HUBs)(%)

__ Impact on the ability of UHS to comply with laws and rules relating procurement of goods and services from persons with disabilities for purchases with state funds(%)

__ Total long-term cost to UHS of acquiring vendor’s goods and services (%)

__ Use of material in construction or repair to real property that is not proprietary to a single vendor unless UHS provides a written justification in the request for bids of the unique material specified(%)

__ Ability of the vendor’s proposal to meet the requirements of the institution’s solicitation document, so that any vendor proposal that is non-responsive to the criteria set forth in the solicitation document shall be rejected (%)

__Any other relevant factor that a private business entity would consider in selecting a vendor (describe) (%)

9. List of suggested vendors to receive notice of the solicitation with contacts:

  1. Vendor name, contact name, contact email
  2. Vendor name, contact name, contact email
  3. Vendor name, contact name, contact email
  4. Vendor name, contact name, contact email
  5. Vendor name, contact name, contact email
  6. Vendor name, contact name, contact email

10. Is a pre-proposal meeting or walk-through required for this solicitation?(Yes or No)

If there will be a pre-proposal meeting or walk-through, will vendors be required to attend in order to submit a proposal? (Yes or No)

If vendors are required to attend, provide an explanation for why attendance is mandatory:

11. List of evaluation committee members (minimum of5)

  1. Name, title, email address
  2. Name, title, email address
  3. Name, title, email address
  4. Name, title, email address
  5. Name, title, email address
  6. Name, title, email address
  7. Name, title, email address

Note: If you are purchasing a product that is widely available (i.e., commodity), an evaluation committee may not be required because the only criteria for selection will be price.

12. Is the Project Manager (named above) aware of any information that was shared with a potential respondent in the past yearthat might give the respondent a competitive advantage in responding to the solicitation?

(Yes or No)Signature of Project Manager:Date:

If yes, explain:

13. Will this contract require Board of Regents approval? (Yes or No) (See BOR Policy 55.01, Contracts:

If yes, has the Board approved? (Yes or No) If the Board has approved, attach documentation of Board approval.

14. Date submitted to Purchasing:

Note: A meeting may be required between the department and the appropriate Buyer in Purchasing to complete the form. Contact your Buyer, if needed.

For Purchasing Use Only

Solicitation Type: (RFP, RFQ, RFO, RFI, ITB)

Revised 10-10-17Page 1