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FEDERAL SUPPLY SCHEDULE

LIMITED.SOURCES JUSTIFICATION

Acquisition Title:

Agency:

Acquisition Year: lzozt--l Author:

2. Description of ni Pearman, RN Director of Nursing

Nature: f, New Requirement f, Follow-on Requirement ffi Modification to Existing purchase Order/Contract Number: 75H70620F80249

Pricing: f, Firm-Fixed Price f Time& Materials I Cost

I Other:

Funds: E oMA fi Other Funds:

Name of Proposed Contractor(s)

Street Address:

City, State, Zip:

3. Description of Supplies or Services:

The estimated value of the proposed action, including all options, is g ,617.50 Briefly describe the supplies or servrbes to be provided, including make & model number where appropriate. lndicate whether the item to be procured is peculiar to one manufacturer (e.g., a pafticular brand name, product, or a ieature of a product, peculiar to one manufacturer). lf applicable, include quantities of suppties or period of pefiormance for seruices. provide information for any options included in the order. lf the action is a modification to an existing order, distinguish ctearly between the work covered by the basic order and the work to be obtained by the proposed modification.

X ORDER AGAINST FSS: Authority of the Multiple Award Schedule Program, Title llt of the Federat property and Administrative Services Act of 1949 (41 U.S.C. 251, et seg.); Title 40 U.S.C. 501, Services for Executive Agencies; and Section 803 of the National Defense Authorization Act of 2002 (Pl 107-107) and implemented by FAR 8.404-6. Mark the applicable exception and for each discuss how the cited authority applies in accordance with FAit AlaOS€GXatirl.

ffi An urgent and compelling need exists, and following the procedures would result in unacceptable delays (EAB

8.405-6(a)(1XiXA));

Urgent need for RN services to be extended. Patient care and patient safety will be effected if these services lapse.

The modification is a temporary remedy to prevent lapse in critical services.

Services, modification of period of performance end date from 8l1gt21 to 11t30t21.

I only one source is capable of providing the supplies or services required at the level or quality required because thesuppliesorservicesareuniqueorhighiyspeciaiized@;or

I ln the interest of ecoromy and effi

:::::lfl:'?il::i:ji9l1^"jg"j"*T llace.!

in accordanc-e with the appric"or"-rEJ"i"rsuppry schedure orderingprocedures' The original order or BPA must not have been previously issued under sole-source or limited sourcesprocedures (FAR B.a0S-6(aX1)ffi); or

[Anitempeculiartoonemanufacturercanbeaparticularo'"non"

::: ::::f:l:::? ,1:j":11:T: item, whether available on one or more schedute contracts, is an item pecutiar toone man ufactu rer. (EAB_B_405-6(b) ;

Actions to lncrease Competition:

Cheyenne River Health Center is currently working on an lDlQ contract to complete the services.

Any other facts supporting the justification:

8. Technical / Requirements Certification: By my signature below, I certify that the supporting data under my review which is included in this Limited-Sources Justification is accurate and comntereaccurate and

Program Manager

Name: Jonni Pearman

Position Title: Director of Nursing

Email address: Jonni.Pearman@ihs.gov

Phone: 605-964-7724

Program Manager Supervisor (or one level above program Manaoer)

Name: Captain Jon Schuchardt

Position Title; Acting CEO

Email address: Jon.Schuchardt@ihs. gov

Signature l l rt t , t

V/ru6'^^J \l lza lul rination. By m

Date:

9. Best Value By my signature below, aft subject to this Limited-Sources JustificatiJn represents the best vatue for the Governm"nt ".'r-"t'roil:.;;ii';.ff.i6:]i;constitutes a fair and reasonable price. The basis for my determination is as follows:

10' contracting officer's Approval (Required for proposed contract not to exceed $700,000 (value ""t"rt"t"a in"lffiall options)): I hereby certify that this justification is accurate and complete to the best of my knowledge. I approve this solesource justification subject to availability of funds, and provided that the services and supplies herein described have othenruisebeen authorized for acquisition.

Name: Phone:

Signature: Date:

11. Legal Review:

All J&As equal to or greater than $68 mittion must have a tegat review from the General Law Division of the office of the General Counsel prior to sending it to the Department.

12. oPDlv competition Advocate Approval (Required for proposed contract over g700,000 but not exceeding $13s million value calculated including all options)):

(The below approval paragraph is required if the cu

Based on the foregoing justification, I hereby approve the procurement of (state supplies/services being procured) on an other than full and open competition basis pursuant to the authority of (state the full statutory authority anO fAn cite and tiile, consistent with paragraph 4, e.g. 41 U.S.C. 251), as implemented by FAR 8.405-6), subject to the availabiiity of funds, and provided that the services herein described have othenryise been authorized for acquisition.

I have reviewed this justification and find that it adequately supports other than full and open competition.

Name: Phone:

Signature: Date:

13. Office of Small and Disadvantaqed Business I have reviewed this justification and find that it adequately supports other than full and open competition.

Name: Phone:

Signature: Date:

14. OPDIV HCA Approval (Required for pro calculated inc alloptions)):

Name: Phone:

Signature: Date: