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<br />SOLE SOURCE JUSTIFICATION FORM <br />(for items costing $1,000 or more) <br /> <br />Appendix C <br /> <br />Vendor: <br /> <br />Item(s): <br /> <br />Estimated expenditure for above item(s): $ <br /> <br />INITIAL ALL ENTRIES BELOW THAT APPLY TO THE PROPOSED PURCHASE. ATTACH A MEMO CONTAINING <br />JUSTIFICATION AND SUPPORT DOCUMENTATION. <br /> <br />1. <br /> <br />Sole source request is for the original manufacturer or provider, there are no area <br />distributors. <br /> <br />2. <br /> <br />The parts/equipment are not interchangeable with similar parts of another manufacturer. <br /> <br />3. <br /> <br />This is the only known item or service that will meet the specialized needs of this <br />department or perform the intended function. <br /> <br />4. <br /> <br />The parts/equipment are required from this source to permit standardization. <br /> <br />5. <br /> <br />None of the above apply. A detailed explanation and justification for this sole source <br />request is contained in attached memo. <br /> <br />The undersigned requests that competitive procurement be waived and that the vendor identified as the supplier of the material or <br />service described in this sole source justification be authorized as a sole source for the material or service. <br /> <br />Departtnent Head/Authorized Personnel <br /> <br />Department/Division <br /> <br />Date <br /> <br />F-€:> <br /> <br />29 <br />