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 |  |  |  |  |  |  |  | STATE PROCUREMENT OFFICE
 |  |  |  |  |  |  |  | REQUEST FOR CONTRACT EXTENSION
TO: |  |  |  | Chief Procurement Officer
FROM:
 |  |  |  | Name of Requesting Department
Pursuant to HAR chapter 3-122, [NAME], the Department requests approval for the following:
1.  Describe the goods, services or construction procured, cite solicitation or contract number, and  total contract amount      (including all supplemental agreements).
2.  [NAME] the method of procurement used for the above contract:
 |  |  | Competitive Sealed Bidding (HRS §103D-302 and HAR chapter 3-122, Subchapter 5)
 |  |  | Competitive Sealed Proposals (HRS §103D-303 and HAR chapter 3-122, [NAME])
 |  |  | Professional Services (HRS §103D-304 and HAR chapter 3-122, [NAME])
3.  Vendor/Contractor/Service Provider Name:
4.  Total term of contract (including initial and all supplementals): |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | Start: |  |  |  |  |  |  |  | End:
5.  Prior SPO-003 Request for Contract Extension: |  |  |  |  |  |  |  |  |  |  |  |  |  | Yes | No |  |  |  |  | No
If yes, prior SPO-003 Request for Contract Extension (CE) Number:
Prior extension time: |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | Prior Extension Amount:
 | From: |  |  |  |  |  |  |  |  |  |  | To: |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | $
6.  Current request extension time: |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | Extension Amount:
 |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | Current Extension Amount:
 | From: |  |  |  |  |  |  |  |  |  |  | To: |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | $
7.  Explain in detail why a contract extension is necessary and, if applicable, why a new contract cannot be executed prior to      current contract expiration.  If a new solicitation is being done, explain what progress (including a timeline) has been made.
8. Identify the primary responsible staff person(s) conducting and managing this procurement.  (Appropriate delegated     procurement authority and completion of mandatory training required).     *Point of contact (Place asterisk after name of person to contact for additional information.)
Name |  |  |  |  |  |  |  |  |  | Division/Agency |  |  |  |  |  |  |  | Phone Number |  |  |  |  |  |  |  | E-mail Address
All requirements/approvals and internal controls for this expenditure is the responsibility of the department.
I certify that the information provided is to the best of my knowledge, true and correct.
 | Department Head Signature |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | Date
For Chief Procurement Officer Use Only
Chief Procurement Officer (CPO) Comments:
 |  | Approved |  |  |  |  |  |  | Disapproved |  |  |  |  |  |  | No Action Required |  | No Action Required
 |  |  |  |  |  |  |  |  |  |  |  |  |  |  | Chief Procurement Officer Signature |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | Date