3662 - Justification and Approval (JA) Under 250K_CNCPlasmaTable Signed.pdf

Simplified Acquisition Procedures (SAP)

DETERMINATION MEMORANDUM FOR LIMITED SOURCES

ACQUISITIONS <$250K

FAR 8.405-6 & FAR 13.106-3(b)(3)(i)

SOLICITATIONS MAY BE LIMITED TO ONE SOURCE ONLY IF THE CONTRACTING OFFICER DETERMINES THAT ONLY ONE SOURCE IS REASONABLY AVAILABLE. WHEN THE CUSTOMER DESCRIBES AN ITEM OR SERVICE, WHICH LIMITS THE AVAILABILITY TO ONE SOURCE, THE DETERMINATION MUST EXPLAIN WHY

THE ITEM OR SERVICE PROVIDER IS THE ONLY ONE THAT WILL MEET THE GOVERNMENT'S

REQUIREMENT. STATEMENTS SUCH AS "ONLY KNOWN SOURCE" OR "ONLY SOURCE WHICH CAN MEET THE REQUIRED DELIVERY DATE" ARE INADEQUATE TO SUPPORT A SOLE SOURCE PURCHASE. THIS FORM MAY BE USED TO DOCUMENT A LIMITED SOURCE DETERMINATION DESCRIBED IN FAR 8.405-6(a) OR (b) and FAR 13.106. THE CUSTOMER SHALL PROVIDE THE FOLLOWING INFORMATION:

1.PURCHASE REQUEST NUMBER 2. ESTIMATED AMOUNT:

BRAND

NAME BUY

YES

NO

NAME/CAGE CODE OF PROPOSED CONTRACTOR Fund Type

O&M

OTHER

3. BRIEF DESCRIPTION OF SUPPLIES OR SERVICES REQUIRED AND THE INTENDED USE:

4. UNIQUE CHARACTERISTICS THAT LIMIT AVAILABILITY TO ONLY ONE SOURCE, WITH

THE REASON NO OTHER SUPPLIES OR SERVICES CAN BE USED:

5. MARKET RESEARCH:

6. PROVIDE A STATEMENT OF ACTIONS, IF ANY, THE GOVERNMENT MAY TAKE TO

REMOVE OR OVERCOME ANY BARRIERS TO COMPETITION BEFORE FUTURE

ACQUISITIONS ARE REQUIRED:

6a. REQUESTING ACTIVITY NAME 6b. REQUESTING ACTIVITY SIGNATURE

7. I CERTIFY THAT THIS JUSTIFICATION IS ACCURATE AND COMPLETE TO THE BEST OF MY

KNOWLEDGE AND BELIEF, AND THAT COMPLETING THIS PURCHASE AS A LIMITED/SOLE

SOURCE IS IN THE BEST INTEREST OF THE GOVERNMENT. ADDITIONALLY, I APPROVE

THIS JUSTIFICATION TO LIMIT COMPETITION SUBJECT TO THE AVAILABILITY OF FUNDS

AND PROVIDED THAT THE SERVICES OR SUPPLIES HEREIN DESCRIBED HAVE OTHERWISE

BEEN AUTHORIZED FOR ACQUISITION.

7a. CONTRACTING OFFICER NAME 7b. CONTRACTING OFFICER SIGNATURE

November 2018