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Simplified Acquisition Procedures (SAP)

DETERMINATION MEMORANDUM FOR SOLE SOURCE ACQUISITIONS

OVER THE MICRO-PURCHASE THRESHOLD BUT NOT EXCEEDING

THE SIMPLIFIED ACQUISITION THRESHOLD

FAR 13.106-3(b)(3)(i)

SOLICITATIONS MAY BE LIMITED TO ONE SOURCE ONLY IF THE CONTRACTING OFFICER DETERMINES THAT ONLY ONE SOURCE IS REASONABLY AVAILABLE. WHEN THE CUSTOMER DESCRIBES AN ITEM OR SERVICE, WHICH LIMITS THE AVAILABILITY TO ONE SOURCE, THE DETERMINATION MUST EXPLAIN WHY

THE ITEM OR SERVICE PROVIDER 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. THIS FORM MAY BE USED IN LIEU OF THE DETERMINATION DESCRIBED IN FAR 13.106. THE CUSTOMER SHALL

PROVIDE THE FOLLOWING INFORMATION:

1.PURCHASE REQUEST NUMBER 2. ESTIMATED AMOUNT:

BRAND

NAME BUY

YES

NO

NAME/CAGE CODE OF PROPOSED CONTRACTOR Fund Type

O&M

NGREA

OTHER

3. BRIEF DESCRIPTION OF SUPPLIES OR SERVICES REQUIRED AND THE INTENDED USE:

4. UNIQUE CHARACTERISTICS THAT LIMIT AVAILABILITY TO ONLY ONE SOURCE, WITH

THE REASON NO OTHER SUPPLIES OR SERVICES CAN BE USED:

5. MARKET RESEARCH:

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6. PROVIDE A STATEMENT OF ACTIONS, IF ANY, THE GOVERNMENT MAY TAKE TO

REMOVE OR OVERCOME ANY BARRIERS TO COMPETITION BEFORE FUTURE

ACQUISITIONS ARE REQUIRED:

I CERTIFY THAT THIS JUSTIFICATION IS ACCURATE AND COMPLETE TO THE BEST OF

MY KNOWLEDGE AND BELIEF, AND THAT COMPLETING THIS PURCHASE AS A SOLE

SOURCE IS IN THE BEST INTEREST OF THE GOVERNMENT. ADDITIONALLY, I APPROVE

THIS JUSTIFICATION TO LIMIT COMPETITION SUBJECT TO THE AVAILABILITY OF FUNDS

AND PROVIDED THAT THE SERVICES OR SUPPLIES HEREIN DESCRIBED HAVE

OTHERWISE BEEN AUTHORIZED FOR ACQUISITION.

7a. CONTRACTING OFFICER NAME 7b. CONTRACTING OFFICER SIGNATURE

capable of displaying 4 waveforms simultaneously with a high contrast and NVG friendly screens (allowing for military in field use), ZOLL Rectilinear Biphasic defibrillator with synchronization capability (a waveform that provides more current than any biphasic waveform used in other defibrillators on the market today), Real CPR Help expansion pack (ZOLL introduced Real CPR Help technology in 2002, and it’s standard on every professional defibrillator ZOLL sells), continuous vital sign monitoring, ability to receive and manage 12 lead ECGs, and a Five year warranty.