Justification for Sole Source.pdf

NAVSUP FLC San Diego Justification for Sole Source / Brand Name Sole Source (Simplified Acquisitions < $250K (Revised January 2020)

PLEASE CHECK ALL APPLICABLE BOXES AND FILL IN ALL APPLICABLE BLOCKS BELOW. A NARRATIVE MUST

BE ADDED TO ALL APPLICABLE SECTIONS. IF A SECTION DOES NOT APPLY, TYPE “N/A” IN THE BOX.

Requisition Number / Document Number:

The material and/or service listed on this form is (please mark one): Sole Source Brand Name Sole Source

Restricted to the following manufacturer or source:

Manufacturer Name:

Manufacturer POC and Phone Number:

Manufacturer Address:

Dealer Name (if applicable):

Dealer POC and Phone Number (if applicable):

Dealer Address (if applicable):

1. Description of the item(s) or service(s) required and the estimated cost(s):

Item# MFG Name MFG Part# Description Qty U/I Unit Price Ext Price

Note: If additional items are required, please list on a separate spreadsheet using the same information as above

2. Required Delivery Date (RDD) or Period of Performance (POP):

3. Specific characteristics of the material or service that limit the availability to a sole source/brand product (unique features, function of the item, etc.). Describe in detail why only this source/brand can furnish the requirements to the exclusion of other sources/brands.

4. The requested material or service represents the minimum requirements of the Government.

JUSTIFICATION FOR SOLE SOURCE or

BRAND NAME SOLE SOURCE

(For Simplified Acquisitions < $250K)

Hartings

RDD 01 SEP 2026

NAVSUP FLC San Diego Justification for Sole Source / Brand Name Sole Source (Simplified Acquisitions < $250K (Revised January 2020)

5. The material or service must be compatible in all aspects (form, fit and function) with existing systems presently installed/performing. Describe the equipment and/or functionality you have now and how the new item/service must coordinate, connect or interface with the existing system.

6. A patent, copyright or proprietary data limits competition:

7. The items are “direct replacement” parts/components for existing equipment. Provide the information about the Next

Higher Assembly (NHA)/equipment which the replacement parts are going into (e.g. description, model, part number, Original Equipment Manufacturer (OEM), etc.).

8. Other information to support sole source/brand name sole source procurement. The rationale must then justify

"either" substantial duplication of cost to the Government that is not recovered through competition or unacceptable delays in fulfilling the mission of the agency.

REQUIRING ACTIVITY TECHNICAL or REQUIREMENTS CERTIFICATION

I certify that the statements checked, and information provided above, are complete and correct to the best of my knowledge. I understand that the processing of this sole source/brand name sole source justification precludes the use of full and open competition.

Name: Title:

Digital Signature: Date:

Note: NAVSUP FLC San Diego policy is that sole source justifications must be signed by at least an E-7 or above

NAVSUP FLC SAN DIEGO CONTRACTING OFFICER CONCURRENCE

Name: Title:

Digital Signature: Date: