1.4 1301270867 SSJ (KO SIGNED).pdf

NAVSUP Fleet Logistics Centers

Source: FLCPS July 2023 Page 1 of 3

The service or material listed on is a sole source or brand name requirement.

Competition is precluded for reasons indicated below.

Estimated TOTAL Cost: $Required Delivery Date (RDD):

Restricted to the following source. If sole source provide original manufacturer's information below. If brand name provide manufacturer's name and dealer information below.

Manufacturer:

Manufacturer POC:

Manufacturer Phone #:

Mfr. address:

Dealer / Rep :

Dealer / Rep Phone #:

Dealer / Rep address:

Sole Source Requirement Brand Name Requirement

Description of the item or service required:

The requested material or service represents the minimum requirements of the government (select Y/N):

Select One:

Source: FLCPS July 2023 Page 2 of 3

Specific characteristics of the material or service that limit the availability to a sole source or brand name. For example, the material/service must be compatible in all aspects (form, fit and function) with existing systems presently installed/performing. (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. Choose the appropriate box(s) below and describe the equipment/function you have now and how the new item/service must coordinate, connect, or interface with the existing system.

A patent, copyright or proprietary data limits competition. The proprietary data is (If applicable, include patent/ copyright drawing numbers, technical manual (TM) numbers, etc)

These are “direct replacements” parts/components for existing equipment as specified below. (NOTE: Identify main unit or existing equipment and why no other parts will work.)

Other information to support a sole source or brand name buy:

Source: FLCPS July 2023 Page 3 of 3

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

OR BRAND NAME JUSTIFICATION PRECLUDES COMPETITION TO THE MAXIMUM EXTENT

PRACTICABLE

Signature:

Title: Email:

Printed Name:

Date :

Activity:

Document Number

FLCPS Contracting Officer Signature:

Printed Name:

Date: