0217-4676 Sole Source_Redacted.pdf

JUSTIFICATION FOR SOLE SOURCE (SAP <$150k)

Ref: FAR 13.106 and NAVSUP 4200.85D Chapter 5 Para. 2.b.(5)

The service or material listed on (Document number) 02174676 is sole source and competition must be restricted to one source, or to only one brand name for reasons indicated below.

There are no substitutes available for this material.

Restricted to the following source or brand name. Provide original manufacturer's name.

(If a sole source manufacturer distributes via dealers, ALSO provide dealer information.)

Manufacturer: Mine Safety Appliances

Manufacturer POC & Phone Nr.1-866-672-1001

Mfr. Address_1000 Cranberry Woods Dr., Cranberry TWP, PA 16066

Manufacturers Dealer/Rep

Dealer/Rep Address/Phone Number x_ _Description of the item or service required, the estimated cost, and required delivery date.

100 EA, MSA Abrasi-Blast Respirator with constant flow control valve and CEJN fitting, web belt, and shoulder length hood similar to P/N 481808, small hycar dual exhalation valve face piece, P/N 472668 and Breathing tube w/ spring, P/N 801758 x _Specific characteristics of the material or service that limit the availability to a sole source or particular brand name (unique features, function of the item, etc.).

Describe in detail why only this suggested source can furnish the requirements to the exclusion of other sources.

PSNS is required to maintain a respirator protection program, in order to maintain NIOSH

(National Institute of Occupational Safety and Health) approval or the respirator system, all components must be from the same manufacturer. Respirators, full lens, sandblast lens adapters, cartridge receptacles, valve covers, breathing tube assemblies, fittings and components are all part of the MSA Ultravue Supplied Air Respirator.

x The requested material or service represents the minimum requirements of the government

CHECK & FILL IN ALL APPLICABLE BLANKS BELOW

x The material/service must be compatible in all aspects (form, fit and function) with existing systems presently installed. Describe the equipment you have now and how the new item/service must coordinate, connect, or interface with the existing system.

PSNS currently has MSA respirators, filters, hoses and various components that make up the breathing air system. Per Federal Regulation Volume 37, number 59 dated 25 March 1972 Title

30 Part 11 and 29CRF1910.134 all components must be from the same manufacturer.

A patent, copyright, or proprietary data limits competition. The proprietary data is:

x These are “direct replacements” parts/components for existing brand name equipment.

Other information to support a sole-source buy:

I CERTIFY THAT STATEMENTS CHECKED, AND INFORMATION PROVIDED ABOVE, ARE COMPLETE AND CORRECT

TO THE BEST OF MY KNOWLEDGE AND DO NOT CONTAIN CLASSIFIED INFORMATION. I UNDERSTAND THAT

THE PROCESSING OF THIS SOLE-SOURCE JUSTIFICATION PRECLUDES THE USE OF FULL AND OPEN

COMPETITION.

Title Date

Contracting Officer Signature Date

FISCPS 4200/180 (Rev. 10/1/10)