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/OBH/SFS/Sarah Miller & Sara Wade Department Contract Administrator or Grant Coordinator: Jeanne Garza / Patricia Wall (If applicable) Department Reference #: SFS-22-007A Amount: (Contract/Amendment/Grant) Original: $0.00 Amendment A: $27,000.00 Revised Total $27,000.00 Advantage CT / RQS #: CT 10A 20210505 ** 3070 CONTRACT Proposed Start Date: 7/1/2021 Proposed End Date: 6/30/2023 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: Peter Donnelly South Portland ME 04106 Brief Description of Goods/Services/Grant: State Forensic Service 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 DEPARTMENT OF ADMINISTRATIVE AND FINANCIAL SERVICES a) DIVISION OF PROCUREMENT SERVICES SU Wu Le) BAUS} Kathy Paquette 12/1/2022 Procurement Justification Form (PJF) Please respond to ALL of the questions in the following sections. PART ili: SUPPLEMENTAL INFORMATION 4. Provide'a more detaileddescription and explain the need forthe goods, services or grant.to.supplement.the. response in. Part 1: Amendment to include additional funding and added deliverabies related to assignment as interim Clinical Director for the Office of Behavioral Health. Documents will be transferred to the Not Subject to MAAP Service Contract. The State Forensic Service is required by statute (MRS Title 15 101-D, 3309-A, 3318-A, 3318-B) to conduct court ordered evaluations in criminal cases. These evaluations, by statute, must be conducted by licensed psychologists and/or psychiatrists. The Department is responsible for ensuring that examiners conducting such evaluations are qualified to do so. See 34-B MRS 1212. 2. Provide a brief justification for the selected vendor.to supplement the response in Part ll. Reference the RFP.number, if. applicable: Existing provider with expertise in the field deemed appropriate for emergency placement as interim Clinical Director. 3. Explain how the negotiated costs or rates are fair and reasonable; or how the funding was allocated to grantee. The rates and avenue of procurement have been negotiated between the Commissioner's Office, State Forensic Services, the Office of Behavioral Health and the Division of Contract Management. 4. Describe the.plan for future competition for the goods or services. This is a short-term service with no anticipation of continuation at this time. PART IV: AMERICAN RESCUE PLAN ACT (ARPA) / MAINE JOBS & RECOVERY PLAN (MJRP) Does. this request. utilize ARPA/MJRP funds?. O 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 quest. Signature of requesting Department's. Commissioner. (or. designee): Typed.Name: Signature of:DAFS. Procurement Official: Xe Typed Name: Date: REV 10/24/2021 Page 2 of 2 DocuSigned by: 41C2BA36FAF44CD...