3771 Eastwood Drive
Jackson, Mississippi 39211
Phone 601-432-8000  Fax 601-713-6380

Request for Exception to Master Cellular Agreement
Exception Description (40 characters): 
[Example:  Phone for agency director]	
Contact Information	
Agency/Institution: 
Address: 
	Contact Person: 
Phone: 
Fax: 
Email Address:  	
MAGIC Customer Number (only required from state agencies)
 	Division/Dept: 

Handmail:  Yes   No	
Exception Request Summary	
Reason for Requested Exception:  (Select one):    Coverage  	 Functionality
	
If Coverage:
(1)	Detail geographical areas and type usage (voice, data, both) for which coverage is an issue.  If within Mississippi, provide county names and portion of county in which coverage is inadequate.  Provide the names and/or job titles of the effected employees.

(2)	Coverage issues documented via:    User’s direct experience	 Vendor coverage maps	 Vendor certification
Attach any documentation.
	
If Functionality:
(1)	Detail agency’s functional requirements and any solutions currently being used.

(2)	Has agency contacted AT&T and C Spire Wireless about similar functionality available under the Master Cellular Agreement?
   Yes   No
If Yes, detail the functionality that AT&T and C Spire Wireless cannot provide:

	
Details of Requested Exempted Services	
Service Type or Device	Quantity	Monthly  or Purchase Fee	Fiscal Year Total	

				
TOTAL*:				
Progress to Date:  What has been done related to this project, including any communication with ITS staff (data/voice/procurement/other)?

Vendors Contacted:   (Note: attach written estimates or other information received from vendors)

Critical Factor(s): (in the selection of a vendor/brand/solution for this acquisition)
	
Planned Acquisition Method	
Describe the manner in which this procurement will be conducted in fulfillment of state law
   2 quotes, if under $50,000
   Competitive Procurement conducted by ITS (required for state agencies if over $50,000 and IHLs if over $250,000)
   Competitive Procurement conducted by Local Government Entity
 	
By my signature, I acknowledge: (1) this agency/institution certifies that the coverage and/or functionality outlined above is required to fulfill the mission and responsibilities of the agency or institution; (2) this agency/institution will follow all applicable laws for public purchasing in the acquisition, including developing open specifications, advertising according to public law, and ensuring a thorough and equitable evaluation of all responses; (3) this agency/institution will negotiate any and all applicable contracts and contract amendments arising from this procurement, with signature authority for the State being delegated by the ITS Executive Director to the executive of this agency/institution; and (4) any protests resulting from this procurement will be heard by the ITS Executive Director and/or ITS Board, in accordance with the ITS Protest Procedure and Policy.  *NOTE: Any exceptions > $75,000 also require WCC approval.

_______________________________________						___________________________________
Name (Agency Head/ Institution President/CIO) Title					Signature			Date