HQVRTC Sole Source Brand Justification (Final).pdf

Local use only Revis on: October 2016

Department of Transportation - National Highway Traffic Safety Administration

SIMPLIFIED ACQUISITIONS SOLE SOURCE OR BRAND NAME JUSTIFICATION

(Under $250K)

(1) Requester: (2) Estimated Cost: (3) Requisition Number:

(4) Description of Required Supplies or Services:

(5) Authority Permitting a Sole Source Acquisition:

(6) Describe why only one source can perform the required work:

Only one responsible source and no other supplies or services will satisfy agency requirements

Unusual and compelling urgency

Authorized or required by statute

Exclusive licensing agreements or proprietary information

Industrial Mobilization

Brand Name (NOTE: In accordance with FAR 11.105(a)(1), you must identify the particular brand name, product, or feature is essential to the Government’s requirements, and market research which indicates other companies’ similar products, or products lacking the particular feature, do not meet, or cannot be modified to meet the agency’s needs.)

(7) Rationale for determination in (6) above.

(Please attach Performance Work State (PWS), Statement of Work (SOW) or specifications and any other supporting documentation.)

(8) Describe the informal market survey and the results, or state why a market survey was not conducted.

Local use only Revis on: October 2016

Requisition Number: _____________________________

(9) I determine the circumstances of this acquisition deem only one source reasonably available:

Requisition’s Signature ____________________________________

Telephone No. _________________ Date _____________

(10) Review and Approvals of Sole Source or Brand Name justification:

Contract Specialist Signature________________________________________

Telephone No. _________________ Date ____________

Contracting Officer’s Signature ________________________________________

Telephone No. _________________ Date __11/29/2022__________

Small Business Specialist Signature ______________________________________________ (Review and Approval required if over $25,000)

Telephone No. _________________ Date ____________

11/29/22

11/29/2022