4.01a Sole Source Justification Mantenance VTC 1 redacted.pdf

PINST 4200.85D, Encl (1) 1 of 3

JUSTIFICATION FOR SOLE SOURCE (Simplified Acquisitions <$250K)

The service or material listed on ___________________ is sole source and competition is precluded for reasons indicated below. There are no substitutes available for this material or service.

Restricted to the following source. Provide __________________ name. (If a sole source manufacturer distributes via dealers, ALSO provide dealer information.)

Manufacturer:

Manufacturer POC & phone #:

Mfr. Address:

Dealer / Rep:

Dealer / Rep address / phone #:

____ Description of the item or service required, the estimated cost, and required delivery date.

____ Specific characteristics of the material or service that limit the availability to a sole source

(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.

____ The requested material or service represents the minimum requirements of the government.

NAVSUPINST 4200.85D, Encl (1) 2 of 3

CHECK & FILL IN ALL APPLICABLE BLANKS BELOW

____ The material/service must be compatible in all aspects (form, fit and function) with existing systems presently installed/performing. 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

____ These are “direct replacements” parts/components for existing equipment.

____ Other information to support a sole source buy:

NAVSUPINST 4200.85D, Encl (1) 3 of 3

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

COMPLETE AND CORRECT TO THE BEST OF MY KNOWLEDGE. I UNDERSTAND THAT THE

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

Alviso, CA 95002

3236 Cove Road, Roanoke, VA 24017