SOLE_SOURCE.pdf

NA VSUPINST 4200.85D

XX MONTH 200X

JUSTIFICATION FOR SOLE SOURCE (Simpliffe,~ Acquisitions <$150k)

The service or material listed on Procurement Request (PR) number 1300766963 is sole source and competition is precluded for reasons indicated below. There are no substitutes available for this service/material.

The following firms were contacted and have indicated that they cannot provide an item/service that will meet the needs of the Government.

Company Reason -

Person Contacted Date of Call

Company Reason:

Person Contacted Date of Call

Company Person Contacted Date of Call Reason:

Restricted to the following source. Provide original manufacturer's name. (If a sole source information manufacturer distributes via dealers, 41,§Q provide dealer information.)

. l . Electro ~ulse ~boi:atory,INC. J POC: t ~illi~l11A. Reset~r .. Manufacturer.'''"·~·····-• . . .. .. . .... ··-~ . ...• , 1805 Route 33 P.O. Box278 Neptune, New Jersey 07754-0278

Manufacturer's Address: ·i·~·(·-;vil~~;·::~:;;w=ms ~·~·:J;-·• .,1 ,;;~;;:~~~;:·e~ Manufacturer s Dealer/Rep. --····-;;.-"''''ii-""'.-::• .• ,,-.,._,,,,"··-"- hone -···-····-··--··"

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

M n

CHECK & FILL IN ALL APPLICABLE BLANKS BELOW

The requested material or service represents the minimum requirements of the government.

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

A patent, copyright or proprietary data limits competition. The proprietary data is: (Explain) NIA

M These are "direct replacements" parts/components for existing equipment.

Pi Other informatiob to support a sole-source buy: (Explain)

I CERTIFY THAT '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 JUSTIFICATION PRECLUDES THE USE OF FULL AND

OPEN COMPETITI<i>N.

Activity:~;,!:~::~~

Contracting Officer's Signature: _____________ _ Date: _______ _

SAP SOLE SOURCE