LETTER OF INTENT

To:	Indiana Department of Administration

Procurement Division Room W468, IGCS

From:	Indiana Department of Health

2 North Meridian Street

Indianapolis, IN 46204

Date:	Click here to enter a date.

Solicitation:

Was there a previous procurement completed by IDOA? ☐ Yes ☐ No

Previous solicitation number: Previous solicitation number, if applicable.

Current contract number: Previous solicitation number, if applicable.

Federal Funds:

Are federal funds going to be used for this procurement? ☐Yes ☐ No

If yes, have all requirements/restrictions associated with the federal funding been incorporated into this solicitation and the specifications? ☐ Yes ☐ No

Indiana Office of Technology:

Will this procurement include information technology goods or services? ☐Yes ☐ No

If no, state “N/A”. If yes, please provide the IOT Deputy CXO’s (or higher) information that has been involved in the discussions to this point.

IOT Representative: IOT Deputy CXO’s (or higher) name and title.

E-mail: IOT Representative email address.

Phone: IOT Representative phone number.

Description of Services:

Provide a detailed description of the services being requested.

Description of Information Technology Goods or Services:

N/A

Scope of Work:

Provide a scope of work for the services requested.

Performance Bond Amount: N/A

Performance Bond Justification: N/A

RFP MAQ and Cost Evaluation:

Are the RFP cost evaluation points requested to be less than 30 points or in excess of 40 points? ☐ Yes ☐ No ☐ N/A (if a Bid)

Are the MAQ points requested to be less than 40 or in excess of 50 points? ☐Yes ☐ No

(The standard allocation is 45 points for MAQ and 35 for cost)

If yes, please specify the requested point breakdown for the Cost and Management Assessment/Quality criteria, and provide a detailed rationale explaining why a deviation from the standard point allocation is requested. All requests will be reviewed by the IDOA Commissioner.

Agency Max Budget Approved: N/A

Estimated Annual Contract Cost:

Estimated Initial Contract Length: Length of initial contract term, in years.

Contract Effective Date: Click here to enter text.

Applicable UNSPSC or short category description:

Agency Contact Person: Primary contact name and title.

E-mail: Primary email address.

Phone: Primary phone number.

Agency Head, or Designee, Approval
(This signature can be done electronically)	Date

If signed by Designee, please provide name:

Chief Financial Officer Approval
(This signature can be done electronically)	Date

If signed by Designee, please provide name:

IOT Chief Information Officer
(This signature can be done electronically)	Date

If signed by Designee, please provide name:

NOTE: If information technology goods or services are not included, please state “N/A” in the above signature.

Agency head, or their designee, and CFO will also sign the solicitation Recommendation Letter that results from this process.

--------------------------------------------------------------

IDOH Internal Approvals (in order below, prior to Chief of Staff signature)

_________________________________________________________	______________________________

Michelle Wright, Director of Procurement and Payables	Date

_________________________________________________________	______________________________

Mohan Ambaty, Chief Information Officer	Date

_________________________________________________________	______________________________

Bob Davis, Chief Data Officer	Date

Attach a copy of the agreement and/or federal law, regulation or policy associated the source of these federal funds. If there are preferences that must be removed, also provide an analysis of that justification.

United Nations Standard Products and Services Code (UNSPSC): http://www.unspsc.org/