Travel Nurse Services

REV 10/19/2021 Page 1 of 2 PROCUREMENT JUSTIFICATION FORM (PJF) This form must accompany all contract requests and sole source requisitions (RQS) over $5,000 submitted to the Division of Procurement Services. INSTRUCTIONS: Please provide the requested information in the white spaces below. All responses (except signatures) must be typed; no hand-written forms will be accepted. See the guidance document posted with this form on the Division of Procurement Services intranet site (Forms page) for additional instructions. PART I: OVERVIEW Department Office/Division/Program: DHHS Riverview Psychiatric Center Department Contract Administrator or Grant Coordinator: Shawn Belanger / Stacy Martin (If applicable) Department Reference #: RPC-23-039 Amount: (Contract/Amendment/Grant) $ 828,000.00 Advantage CT / RQS #: CT 10A 20221221000000001734 CONTRACT Proposed Start Date: 12/19/22 Proposed End Date: 12/31/23 AMENDMENT Original Start Date: Effective Date: Previous End Date: New End Date: GRANT

Project Start Date: Grant Start Date: Project End Date: Grant End Date: Vendor/Provider/Grantee Name, City, State: SHC Services, Inc. dba Supplemental Health Care Cottonwood Heights, UT Brief Description of Goods/Services/Grant: Travel Nurse Services PART II: JUSTIFICATION FOR VENDOR SELECTION Mark an X before the justification(s) that applies to this request. (Check all that apply.) A. Competitive Process G. Grant B. Amendment H. State Statute/Agency Directed C. Single Source/Unique Vendor I. Federal Agency Directed D. Proprietary/Copyright/Patents J. Willing and Qualified E. Emergency K. Client Choice F. University Cooperative Project L. Other Authorization DocuSign Envelope ID: DECF62F6-A454-4757-A995-82B9F10D1CEA DEPARTMENT OF ADMINISTRATIVE AND FINANCIAL SERVICES a) DIVISION OF PROCUREMENT SERVICES SU Wu Le) BAUS} Procurement Justification Form (PJF) REV 10/21/2021 Page 2 of 2 Please respond to ALL of the questions in the following sections. PART III: SUPPLEMENTAL INFORMATION 1. Provide a more detailed description and explain the need for the goods, services or grant to supplement the response in Part I. The purpose of this agreement is to provide temporary nursing staff coverage required to cover extended leave of absences, vacations or unexpected vacancies in State-line positions. The RN II positions are vital in the operation of the Departments Riverview Psychiatric Center (RPC) for continuity of care for its patients. 2. Provide a brief justification for the selected vendor to supplement the response in Part II. Reference the RFP number, if applicable. The current travel nurse contractors are unable to supply the needed number of positions for the Departments RPC to meet the Consent Decree. The Department selected this vendor because it has 40years of experience in providing qualified healthcare individuals to organizations in need of travel contracts. This includes placing over 10,000 nurses annually. They are uniquely positioned to provide resources to the Department in the tight timeframe requested. 3. Explain how the negotiated costs or rates are fair and reasonable; or how the funding was allocated to grantee. Costs for RN II positions have been pre-negotiated and a regional analysis was performed to determine the base rate. 4. Describe the plan for future competition for the goods or services. RFP 201807138 will expire on 12/31/23. DRPC20222: Temporary Nursing Services will be completed in 2023. PART IV: AMERICAN RESCUE PLAN ACT (ARPA) / MAINE JOBS & RECOVERY PLAN (MJRP) Does this request utilize ARPA/MJRP funds? Yes If Yes, please attach the approved Business Case(s). No If No, proceed to Part V PART V: APPROVALS The signatures below indicate approval of this procurement request. Signature of requesting Departments Commissioner (or designee): Typed Name: Date: Signature of DAFS Procurement Official: Typed Name: Date: DocuSign Envelope ID: DECF62F6-A454-4757-A995-82B9F10D1CEA Dec-22-2022 Kathy Paquette 1/26/2023 DocuSigned by: 66738ED17E0C4B2... DocuSigned by: 41C2BA36FAF44CD...