Inner Tite Sole Source (1).pdf

Revised April 2024

Sole Source Purchase Justification and Approval Form

Department: Date:

Purchased by:

Item(s) to be purchased: _____

Check if: Item(s) is an addition to existing approved sole source supplier.

Purchased from: Company Name:

JDE Vendor #: Total Amount:

If item(s) are not on the current company-wide approved sole source list, complete the following sections:

Name of Manufacturer of Item(s):

Sole Source Supplier Information:

Company: Phone:

Address: Fax:

City: State: Zip: Website:

Contact Person: Email:

Sole Source/Brand Exclusive Capabilities (Mark the one(s) that best describes). See Sole Source SOP, Section 11 - Definitions, for complete description of exclusive capabilities below.

☐ 1.) Only one supplier can satisfy specification requirements and/or technical requirements.

☐ 2.) The compatibility with the existing equipment, facilities, or service is an important consideration;

Identify existing equipment: __________________________________________________________

☐ 3.) Technical services associated with the assembly, installation, or servicing of equipment of a highly technical or specialized nature.

☐ 4.) An item is purchased for testing or trial use.

☐ 5.) A statutory or market-based monopoly.

☐ 6.) Scarcity of supply in the market.

☐ 7.) Existence of exclusive rights (patent, copyright, or license).

☐ 8.) Need to avoid violating warranties and guarantees where service is required.

☐ 9.) The Authority has a rental contract with a purchase option.

☐ 10.) When alternative sources result in excessive costs.

☐ 11.) Emergency purchases where time is of the essence and impact of delay is significant. *

☐ 12.) Continuation of prior work associated with additional items, service, or work required, but not knownto have been needed at the time the original order was placed with the vendor.

13.) Relating to IT:

☐ a.) Manufacture directs the Authority to purchase all upgrades to their system from the manufacturer’s partner associated with mid-range or large systems purchased by the Authority.

☐ b.) Common Operating Environment (SCADA, PLC, GIS, Phones, Cisco, Security, FOB, etc.), item is proprietary.

Scope of Work: Description / Name of Brand/Materials/Services to be provided.

Detailed Justification for Not Bidding: Potential competition is thoroughly researched, documented, and deficiencies found are documented regarding the reason(s) for not bidding.

The Purchasing Department must provide public notice of the intended sole source purchase or contract through a posting to the Georgia Procurement Registry. The purpose of publicizing the sole source is to allow the free market to act as a check and balance on invalid sole sources by allowing suppliers to protest a sole source 1) if suppliers believe and can document that they also meet the requirements of the sole source; or 2) if suppliers believe the sole source requirements are unjustifiably restrictive.

The total posting period for a sole source notice is for a minimum of five (5) business days and up to fifteen (15) calendar days depending on the estimated value of the contract.

The estimated amount of purchase: Less than $100,000 Greater than $100,000

If total amount is equal to or greater than $100K, a Board Presentation is required.

Signatures for Sole Source Justification Form:

Print Name Signature Date

Employee

Department Manager

CEO

Note: Sole Source will expire three (3) years after approval date.

* The expiration rule does not apply to Emergency Purchases.

(Please return this form to ccwa_solesource@ccwa.us)

*** List and attach any additional documentation *** Attachments:

(1.)

(2.) ___________________________________________________________

(3.)

mailto:ccwa_solesource@ccwa.us