SOLE-SOURCE-FORM RE 3RD PARTY REIMB WITH TAPI.PDF

Office ©f Procurement Serviices
GOODS AND SERVFICES
SOLE SOURCE FORM
This form is to be used when an agency believes an acquisition is a sole source and the acquisition dollar amount is above
$5,000. The Chief Procurement Officer can approve purchases up to $100,000. Board of Supervisors approval is required if
the acquisition is over $100,000. This form must be submitted for approval to: Office of Procurement Services I 320 W.
Lincoln I Phoenix, AZ 85003. Fax number: 602.258.1573. The signed form must be retained in the purchasing file. Unless
approved by the Board of Supervisors in a formal agenda item or the Chief Procurement Officer in a formal Contract a SS
form is valid from July 1 thru June 30th of each Fiscal Year.
DEPARTMENT NAME DEPARTMENT RX#
Disease Control, Office Community Wellness and Health Promotion
Department Contact Contact Phone Number
Machrina Leach +1(602) 506-6662
PROPOSED CONTRACT VENDOR NEED IDENTIFIED Date: Oct 29,2018
Company: The Arizona Partnership for Immunizations REQUESTED DELIVERY
Address: 700 East Jefferson St Date:
City, State: Phoenix, AZ QUOTED PRICE: 1,700,000
Zip/Postal Code: 85034
Phone: (602) 288-7568 Accounting String: 265-0860-8612-1000-CHIM
Fax: (602) 218-3901
Contact Name: Patty Gast
Material / Service Information
, r
Is this a Technology Procurement? Yes (II' No
Continue to provide Public Health Immunization Clinics with the ability to provide
Needs Statement: immunizations to commercially insured clients, Allows Maricopa County to receive
Describe in detail the material or service to be procured and reimbursement for the cost of vaccines and administration for clients with current
how onl y it meets your needs, health insurance as well as receive reimbursement for the administration fee for clients
with the Arizona Health Care Cost Containment System (AHCCCS).
The Arizona Partnership for Immunizations (TAPI) is a state wide non-profit coalition
Features/Requirements; that has over 400 private and public partners. They work closely with the Arizona
Identify the major features/capabilities that are required. What Department of Health Services (ADHS) which houses the Arizona State Immunization
unique design/performance feature(s) make this material or Registry (ASIIS) which Is the depot for all immunizations administered in Arizona. They
vendor the only one that can meet your requirements? Provide have a longstanding partnership with commercial and AHCCCS health plans that cover
a brief explanation as to why only these features or this vendor the majority of lives In Arizona. They also have contracts in place with these health
can meet your requirements. Identify the manufacturer/model plans, commercial and public. TAPI currently provides billing services for the majority
or your existing equipment, service or system if applicable. of Health Departments in Arizona.
TAPI is the only non-profit of its kind in the State of Arizona. Billing for local county
health departments is very unique compared to other for-profit or non-profit health
Competing Brands/Vendors Investigated: care institutions. TAPfs large number of long term partnerships with ADHS,
Did you consider other materials or vendors with similar commercial and public health plans/Insurers and county health departments makes
capabilities? Indicate specific competitor's brands/models or them very successful in billing for reimbursements. TAPI has created the contracts and
vendors that were investigated and describe why they do not process.that have made receiving reimbursements for immunizations successful and
meet your requirements. You need to state that - to the best of has allowed Maricopa County to meet its statutory mandates to administer vaccines.
your knowledge - these are the only companies making this
material, equipment or providing this service. List sales
representatives and their phone numbers so the Procurement
Officer can contact them to verify that other materials,
equipment or services do not meet your requirements.

THIS PROCURIVIENT IS A SOLE SOURCE BECAUSE (attach additional page if needed):
TAPI has been successfully billing and receiving reimbursement for Maricopa County for 9 years. They have established policies and procedures that
'ensure timely reimbursement for local health departments. They are nationally recognized by the Centers for Disease Control for their billing program.
They are a non-profit organization that has worked with almost 400 partners in the immunization community for over 20 years. They only receive a
percentage of total reimbursements for immunization services and only take a percentage of the vaccine cost that is above what we pay. We are able to
receive 100% of our cost for privately purchased vaccines that are reimbursed. There is no other non-profit organization that has the extensive
partnerships in Arizona or the contracts in place to assure reimbursements for immunization services. Continuing to utilize TAPI for the billing of
immunization services would ensure continued revenue be received and Maricopa County would be able to maintain providing immunizations to clients
with health insurance,
SEARCH
MC1 -349 -A states: Any request by a Using Agency that a Procurement be restricted to one potential Contractor shall be accompanied by
an explanation as to why no other would be suitable or acceptable to meet the need. The Using Agency requesting sole source
Procurement shall provide written evidence to support a sole source determination. A requirement for a particular proprietary item does
not alone justify a sole source Procurement if there is more than one potential Respondent for that item.
A search was conducted consisting of: (check all that apply) RESULTS
E Market research l"— Public notice given, list IR no alternatives were identified
E' Other vendors contacted 1.5.--< Other I-- no alternatives were deemed acceptable
' because (explain below):
Describe the search from above in detail:
Searched the Internet for other non-for profit billing agencies in agencies.
PRICE
The estimated cost of this Procurement is: C 5_ $100k (6" > $100k
MC1-347 States: The Chief Procurement Officer may make the determination that the sole source method set forth in
MC1-349 shall be used if a Commodity or Service is available from only one vendor, and the purchase is estimated to Cost
no more than $100,000.
Price has been fairly and reasonably established by: r Comparison to public sector contract pricing
r— Comparison to previous comparable purchases E Discount off published catalog pricing
1 from a different vendor E Market survey
r Independent estimate rg Other, explain:
Describe methodology and results (attach any written supporting data, e.g., survey or market analysis):
As TAPI is the sole source of this service as needed by N1CDPH, there were no providers with whom to compare costs.

CONFLICT OF INTEREST STATEMENT
The submitting department a grees that there is no real or potential conflict of interest in recommendin g this material or
service as a sole source procurement.
NOTE: If a real or potential conflict exists, contact the Procurement Officer listed on your Requisition.
CERTIFICATIONS
I certify:
1) I recog nize thatthe Maricopa Count y Procurement Code re quires the use of competitive solicitations unless
exempted by law. I have reviewed the information and materials relevant to this procurement of goods and services,
and am requestin g approval of an exception to the competitive process for the reasons described;
2) the price to be paid to the proposed sole source vendor is fair, reasonable, and provides the best value to Maricopa
County; and
3) this re q uest for an exception to the competitive solicitation process is not the result of inade quate advance plannin g
or for purposes of securing the services of a preferred vendor.
Agency Head or Appointing Authority Signature (R uired)
Max Porter e/Pirir ii..., i. aii
it.—......c
Printed ame Si nature Date
Office of Procurement Services
go 5 -Pon_
rV d-a Reeti44sition-to-eP5-
Not Approved. Reasoning:
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Printed Name k rure Date
Email Save

Order Confirmation
Ad Order Number Customer Payor Customer PO Number
0008837830 OFFICE OF PROCUREMENT SVC OFFICE OF PROCUREMENT SVC TAPI Notice
Sales Rep. Customer Account Payor Account Ordered By
bgrady 5063967MC 5063967MC Cheryl Renscheler
Order Taker Customer Address Payor Address Customer Fax
bgrady 320 W. LINCOLN ST. 320 W. LINCOLN ST.
PHOENIX AZ 85003 USA PHOENIX AZ 85003 USA Customer EMail
Order Source
lislam@mail.maricopa.gov
Customer Phone Payor Phone
6025063967 6025063967 Special Pricing
Tear Sheets Proofs Affidavits Blind Box Promo Type Materials
0 0 1
Invoice Text Ad Order Notes
Net Amount Tax Amount Total Amount Payment Method Payment Amount Amount Due
$3.64 $0.00 $3.64 Invoice $0.00 $3.64

Ad Number Ad Type Production Method Production Notes
0008837830-01 C-ABG M Liner Internal
External Ad Number Ad Attributes Ad Released Pick Up
No 0008832076
Ad Size Color
1 X 26 li
WYSIWYG Content
Run Date Product Placement Rate Sched Cst Disc/Prem Color Pickup Tax Subtotal
11/01/2018 C-ABG P-ABG Legals $0.47 per Inch $0.91 $0.00 $0.00 $0.00 $0.00 $0.91
11/01/2018 P-azcentral P-ABG Legals $0.00 per Inch $0.00 $0.00 $0.00 $0.00 $0.00 $0.00
11/08/2018 C-ABG P-ABG Legals $0.47 per Inch $0.91 $0.00 $0.00 $0.00 $0.00 $0.91
11/08/2018 P-azcentral P-ABG Legals $0.00 per Inch $0.00 $0.00 $0.00 $0.00 $0.00 $0.00
11/15/2018 C-ABG P-ABG Legals $0.47 per Inch $0.91 $0.00 $0.00 $0.00 $0.00 $0.91
11/15/2018 P-azcentral P-ABG Legals $0.00 per Inch $0.00 $0.00 $0.00 $0.00 $0.00 $0.00
11/22/2018 C-ABG P-ABG Legals $0.47 per Inch $0.91 $0.00 $0.00 $0.00 $0.00 $0.91
11/22/2018 P-azcentral P-ABG Legals $0.00 per Inch $0.00 $0.00 $0.00 $0.00 $0.00 $0.00