D-20-ON-0029_FBO_Limited_Sources_Document.pdf

LIMITED SOURCES DOCUMENTATION (DEC 2018)

Required for Limited Source Acquisitions Over $10,000 but not Exceeding $250,000

Acquisitions that do not allow for competition to the maximum extent practicable must be documented in accordance with Federal Acquisition Regulations (FAR) 13.106-3/b) for open market purchase orders or FAR 8.405-6(0 for Federal Supply Schedule (GSA) orders. Limited source documentation is required in the following circumstances: (1) when soliciting fewer than the minimum number of sources (at least three sources) required by FAR 13.104/b ), 8.405-1/ c), or 8.405-2( c)(2), whichever is applicable; and (2) when using brand name only specifications.

This template may be used for the documentation described in FAR 8.405-6/bl/2)/i) or 13.106-1 (b)/1 ). The customer shall provide the following information:

Purchase Request Number:

D-20-ON-0029

Brand Name Only Description:

Estimated Amount (inclusive of options):

TBD

Recurring Requirement:

Delivery Date or Period of Performance:

11/01/2019 to 11/15/2019

FSS Contract Number (if applicable):

Not ApplicableDYES 181 NO DYES 181 NO

Brief description of supplies or services required and the intended use:

Incinerate unwanted medication collected during National Drug Take Back Initiative-17

Unique characteristics that limit availability to only one source, and any justification that no other supplies or services can be used or that urgent and compelling circumstances exist - include all critical delivery or performance dates and impact to the government if dates are not met:

Pope Douglas Solid Waste Management (located in Alexandria, MN) is the primary burn site approved by the Minnesota Pollution Control Agency to incinerate collected drugs.

Pope Douglas Solid Waste Management works well with the U.S. Government payment process.

Describe in detail any market research conducted. Include results and state whether any vendors expressed interest:

Pope Douglas Solid Waste Management (located in Alexandria, MN) is the primary burn site approved by the Minnesota Pollution Control Agency.

The Contracting Officer hereby certifies that:

A Only one source is reasonably available;

B. An order for the supplies or services will not be placed unless the price is determined to be fair and reasonable; and C. If brand name specifications are used for the basis of this determination and the acquisition exceeds $25,000, this Limited Source

Documentation will be made available together with the solicitation in the Governmentwide Point of Entry (FedBizOpps) in accordance with FAR 5.102(a)(6), on GSA e-Buy in accordance with FAR 8.405-6/dl, or on the NASA SEWP V Quote Request Tool pursuant to 40 U.S.C. 11302(e).

Office Code DateSignat�tomer

Signature and title of contract specialist Office Code

Telephone Number

Telephone Number Date

Signature of contracting officer Office Code Telephone Number Date