5-Complete with Docusign Complete with Docusig (2).pdf

Sole Source Justification Application

Rev. 9/2025

C I T Y C O L L E G E S O F C H I C A G O

Sole Source Justification Application

Why are you requesting a Sole Source Waiver?

☐Only one known source that can provide the commodity or service. Procurement of public utility services.

☐Compatibility (e.g. CCC requires a specific piece of equipment to be compatible with an existing equipment system).

☐Public safety concerns.

☐Limited or proprietary systems (i.e. additional licenses, updates, specialized replacement parts, etc.).

☐A professional expert is requested.

☐Sales territories or product availability within limited geographic boundaries.

☐Other _______________________________________________________

If your request does not meet any of these criteria, STOP, consult with Procurement services to identify an alternative procurement method.

Name of requestor:

Department/School:

Project title:

Email address:

Contract or Board Report number:

Vendor:

Value of initial term, or if a renewal, value of this renewal $:

(Attach the proposal received)

Number of potential/remaining renewals:

Length of each renewal in months:

Value of all/remaining renewals:$

Actual Estimated

Choose one of the following:

New Sole Source Sole Source renewal Change Order or Amendment to an existing Sole Source

Provide a description of the supplies or services required

Margaret Sarti msarti@ccc.edu

Child Development Laboratory Schools

Pearson Assessment - ESI-3 Screener for Early Childhood Pearson

17,265.92

Per our funder, DFSS, our laboratory schools are required to completed the ESI-3 screener with students to identify children who may need special education services. NCS Pearson, Inc. (“Pearson”) is the sole source/single supplier within the United States of America for the ESI-3™ Early Screening Inventory-Third Edition.

As the Sole Source/Single Supplier, Pearson has been granted copyright or exclusive rights to the aforementioned product, and these products and related materials are not available from any other source by lawful means. A Sole Source letter from NCS Pearson is included for reference.

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Select the type of funding to be used: Educational Funds Capital Funds Grant Funds

Other (Explain):

This purchase is economically only available from a single source because it is:

Art or Entertainment Services or Athletic Events Compatibility with existing/current equipment, accessories, replacement parts or service Critical changes to the existing contract are necessary and best accomplished by the original contract holder Federal/CCC Grant requires contract with specific vendor

(attach Grant Award Agreement) Item is copyrighted or patented and the item is only available from the holder

Copyright or Patent Number(s):

Items are needed for trial use or testing

Media for advertising

Organization memberships (Dues, fees, conference charges including mandated travel and related expenses)

Public utility regulated services

Radio and television broadcast rights software license/ upgrade/maintenance

Other (Explain):

Has CCC purchased these supplies/services in the past? Yes No

If yes, STARTING WITH THE MOST RECENT CONTRACT AND WORKING BACKWARD, for the entire relationship with this vendor for this supply or service, list each term, value, short description and type of procurement of each:

Term Term From: Term To: Value Description Vendor Selection

One Two

Three Four Five Six

Seven Eight Nine Ten

If more than 10 years, explain:

ESI-3™ Early Screening Inventory-Third Edition

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C I T Y C O L L E G E S O F C H I C A G O

Business Rationale

1. Provide a detailed explanation of the need for the supplies or services:

2. What are the unique features of the supplies or services that are not available in any other product or by any other vendor?

Provide specific, quantifiable factors/qualifications:

3. If professional services, what are the unique qualifications the vendor possess?

Provide specific. measureable factors/qualifications:

4. Were alternative supplies or services evaluated? Yes No

a. If yes, what were they and why were they unacceptable? If no, why were alternatives not evaluated? Please be specific with regard to features, characteristics, requirements, capabilities and compatibility:

5. What efforts were made to get the best possible price?

Per the Head Start Performance Standards, 1302.33 Child screenings and assessments, programs must complete or obtain a current developmental screening to identify concerns regarding a child’s developmental, behavioral, motor, language, social, cognitive, and emotional skills within 45 calendar days of when the child first attends the program or, for the home-based program option, receives a home visit. The Department of Family Support and Services requires that we administer the ESI-3 to preschool students. This screening tool is copyrighted by NCS Pearson.

Our funder requires this specific screener be completed with our preschool students.

The ESI-3 is copyrighted by NCS Pearson and cannot be purchased through any other vendor (sole source letter attached for reference).

Discussed pricing and price locking with Pearson Assessment representative. Pearson will not enter into a contract with pricing terms because prices are subject to change.

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6. Will this purchase obligate the CCC to this vendor for future purchases such as maintenance, licensing or continuing needs? Yes No If yes, please provide details regarding future obligations and/or needs:

7. Why is the price for this purchase considered to be fair and reasonable?

8. If this is a renewal, describe why circumstances are such that competitive selection is still not an alternative since awarding the original contract:

9. What will be the financial or other impact to CCC if this sole source is not approved and a competitive solicitation is required?

Department/College Representative Signature Required I know and understand the contents of this Sole Source /Bid Waiver Justification and attest that all statements are true and correct.

Department/College Representative Signature Printed Name Date

Department/College Representative Signature Printed Name Date

VC/ College President Signature

Procurement Approval and Signature

Printed Name Date

Printed Name Date

Pearson will not enter into a contract with pricing terms because prices are subject to change and we cannot purchase from any other vendors due to copyright.

We will not be in compliance with our vendor and will not be able to screen students to determine if they require a referral for an evaluation for special education services.

We will not be in compliance with our vendor and will not be able to screen students to determine if they require a referral for an evaluation for special education services.

Hollie Ware-Jaye 12/10/2025 | 3:59:55 PM CST

12/10/2025 | 2:51:14 PM CST

Margaret Sarti

2/13/2026 | 9:55:32 AM CSTNicholas Gibb