Coal Purchase Limited Source Justification.pdf

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LIMITED SOURCE JUSTIFICATION

1. Requesting Activity 1a. Last Name 1b. First Name 1c. MI This form is used to provide the Contracting Officer with sufficient information to make a decision on limiting competition sources in accordance with Federal Acquisition Regulations part 6.302 Fill in the requestor information. Requesting Activity is defined as the individual making the request for purchase. This should not be filled out by the Resource Advisor or a representative. In Individual provided in this field should be the area expert who can answer any follow up questions regarding this request.

1d. Rank / Grade 1e. Squadron 1f. Office 1g. Phone 1h. E-mail

2. Item(s) and/ or Service(s) description Provide description of item(s) requested for purchase. If applicable state brand, make, model, and any other pertinent information

3. Reason(s) for restricting competition Provide justifiable reason(s) for limiting competition. The justifiable reasons are, but not limited to, compatibility with existing equipment, regulation requiring specific item or brand, prohibitive costs on re-training personnel to use differing types of items, or any other reasonable basis. List all regulations and directives applicable to this justification

4. Mission impact if item(s) or service(s) is not procured from limited source Explain direct impact on the mission if this purchase is not done based on limited source

6. Certification and Approval The undersigned certifies item(s) and /or service(s) requesting to be procured represent the minimum needs of the Government and that all information contained within this document is accurate to their best knowledge.

5. Attachments List all attached any applicable literature to support the limited source justification.

6a. Requestor Signature 6b. Date Signed 6d. Squadron Commander Signature 6e. Date Signed 6c. Name and rank of Squadron Commander 341 CONS LSJ Form (Oct 2012)

LIMITED SOURCE JUSTIFICATION

7. Continuation Page Provide any additional information necessary to support your request for Limited Source .

341 CONS LSJ Form (Oct 2012) This form is used to provide the Contracting Officer with sufficient information to make a decision on limiting competition sources in accordance with Federal Acquisition Regulations part 6.302 Limited Source Justification Form used to request procurement of items or servises based on limited source as described within FAR 6.302. This document is designed to provide the Contracting Officer enough information to make a determination as necessary by FAR 6.303, 13.106, or any other applicable FAR part.

Unlawful reproduction of this form, or parts thereof, without criditing its original author is prohibited. Seriously, give me a break and don't claim my work as you own.

Oleg Perchine Limited Source Justification Form oleg.perchine@us.af.mil 15 Oct 12

341 CONS

15 Oct 12