JOTFOC_2117407P45197_MSA_Parts_Signed.pdf

PROJECT/TASK

NUMBER

CODE

ONE LEVEL ABOVE CONTRACTING OFFICER TELEPHONE NUMBER DATE

SIMPLIFIED ACQUISITION PROCEDURES (SAP)

JUSTIFICATION FOR OTHER THAN FULL AND OPEN COMPETITION (J&A)

SOLICITATIONS MAY BE LIMITED TO ONE SOURCE ONLY IF THE CONTRACTING OFFICER DETERMINES THAT ONLY ONE SOURCE IS REASONABLY AVAILABILE. THIS DETERMINATION MUST BE SUPPORTED WITH FULL JUSTIFICATION FOR SOLE SOURCE FROM CUSTOMER. WHEN THE CUSTOMER DESCRIBES AN ITEM WITH A PURCHASE DESCRIPTION WHICH LIMITS THE AVAILABILITY TO ONE SOURCE, THE JUSTIFICATION MUST EXPLAIN WHY THE ITEM IS THE ONLY ONE THAT WILL MEET THE GOVERNMENT’S REQUIREMENT. STATEMENTS SUCH AS “ONLY KNOWN SOURCE” OR “ONLY SOURCE WHICH CAN MEET THE REQUIRED DELIVERY DATE” ARE INADEQUATE TO SUPPORT A SOLE SOURCE PURCHASE. THE CUSTOMER SHALL PROVIDE THE FOLLOWING INFORMATION:

PURCHASE REQUEST OR REQUISTION NUMBER ESTIMATED AMOUNT (OVER $3,000 BUT NOT EXCEEDING $150,000)

BRIEF DESCRIPTION OF SUPPLIES OR SERVICES REQUIRED, AND THE INTENDED USE

UNIQUE CHARACTERISTICS THAT LIMIT AVAILABILITY TO ONLY ONE SOURCE, WITH THE REASON NO OTHER SUPPLIES OR SERVICES CAN BE USED.

REASON THAT SUGGESTED SOURCE IS THE ONLY SOURCE WHICH CAN PROVIDE THE SUPPLIES OR SERVICES

EXPLAIN WHY AN ADEQUATE PURCHASE DESCRIPTION OR OTHER INFORMATION SUITABLE TO SOLICIT BY FULL AND OPEN COMPETITION HAS NOT BEEN

DEVELOPED OR ARE NOT AVAILABLE

PROVIDE A STATEMENT OF ACTIONS, IF ANY, THE GOVERNMENT MAY TAKE TO REMOVE OR OVERCOME ANY BARRIERS TO COMPETITION BEFORE FUTURE

ACQUISITIONS ARE REQUIRED

SIGNATURE AND TITLE OF CUSTOMER

TELEPHONE NUMBER

DATE

SIGNATURE OF CONTRACTING OFFICER TELEPHONE NUMBER DATE

Sheet1

SOLICITATIONS MAY BE LIMITED TO ONE SOURCE ONLY IF THE CONTRACTING OFFICER DETERMINES THAT ONLY ONE SOURCE IS REASONABLY AVAILABILE THIS DETERMINATION MUST BE SUPPORTED WITH FULL JUSTIFICATION FOR SOLE SOURCE FROM CUSTOMER WHEN THE CUSTOMER DESCRIBES AN ITEM WITH A PURCHASE DESCRIPTION WHICH LIMITS THE AVAILABILITY TO ONE SOURCE THE JUSTIFICATION MUST EXPLAIN WHY THE ITEM IS THE ONLY ONE THAT WILL MEET THE GOVERNMENTS REQUIREMENT STATEMENTS SUCH AS ONLY KNOWN SOURCE OR ONLY SOURCE WHICH CAN MEET THE REQUIRED DELIVERY DATE ARE INADEQUATE TO SUPPORT A SOLE SOURCE PURCHASE THE CUSTOMER SHALL PROVIDE THE FOLLOWING INFORMATION: Mine Safety Appliances Incorporated P.O. Box 426 Pittsburgh, PA 15230 POC:Linda Betti (412)967-3272

The Self Contained Breathing Apparatus M7 are aboard cutters and shore bases throughout the United States Coast Guard. Semi-Annual inspections are performed and parts are needed to maintain proper usage and safety measures.