N4523A-0141-7914_Redacted.pdf

JUSTIFICATION FOR SOLE SOURCE (SAP <$150k) Ref: FAR 13.106 and NAVSUP 4200.85D Chapter 5 Para. 2.b.(5)

The service or material listed on (Document number) N4523A-0141-7914 is sole source and competition must be restricted to one source, or to only one brand name for reasons indicated below. There are no substitutes available for this material.

Restricted to the following source or brand name. Provide original manufacturer's name.

(If a sole source manufacturer distributes via dealers, ALSO provide dealer information.)

Manufacturer: Mine Safety Equipment _ Manufacturer POC & Phone Nr. Derek Edwards , 1-800-672-2222 Mfr. Address 1000 Cranberry Woods Drive, Cranberry Township, PA 16066 _ Manufacturers Dealer/Rep N/A _ Dealer/Rep Address/Phone Number N/A _

_X_Description of the item or service required, the estimated cost, and required delivery date.

4240-01-426-5454_RESPIRATOR, LENS WESTERN SAFETY 206-264-0808 INSP-4 CARTRIDGE, TWO LAYERS LAMINATED, 0.12" THK UNTEMPERED GLASS FOR MSA ABRASIVE AIR BLAST HOOD, P/N 481 /CA, MINE SAFETY & APPLIANCES CO FSCM 55799 SOLE SOURCE,300-PG, Required deliverly Date – 7/31/20

_X_Specific characteristics of the material or service that limit the availability to a sole source or particular brand name (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.

Per NAVSEA and OSHA an employer can only order and use respirators approved by the command Respiratory Protection Program Manager (RPPM) that have been certified by NIOSH and _ approved in the configuration it was submitted to NIOSH for evaluation and testing. The _ PSNS&IMF RPPM, C/106.22, has approved the specific item described above for sole source as it conforms to the NIOSH approved configuration for a respirator used at PSNS&IMF. _ OSHA 29 CFR 1910.134(d)(1): _ The employer shall select and provide an appropriate respirator based on the respiratory__ hazard(s) to which the worker is exposed to and workplace and user factors that affect _ respirator performance and reliability. _ OSHA 29 CFR 1910.134(d)(1)(ii): _ The employer shall select a NIOSH-certified respirator. The respirator shall be used in _ compliance with the conditions of its certification. _

___The requested material or service represents the minimum requirements of the government

CHECK & FILL IN ALL APPLICABLE BLANKS BELOW

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

NIOSH approval is a complete system approval. System means face piece, hood, filtering _ cartridge, breathing tubes, air hoses, valves, dust covers, nose cups and any other part _ that makes up a specific respirator that was submitted by the manufacturer to NIOSH for _ certification and is listed on the manufacturers NIOSH approved configuration list for _ that specific respirator. Any deviation from the NIOSH approval/certification negates the NIOSH approval which then causes us to be out of compliance with OSHA. _

___A patent, copyright, or proprietary data limits competition. The proprietary data is:

___These are “direct replacements” parts/components for existing brand name equipment.

___Other information to support a sole-source buy:

I CERTIFY THAT STATEMENTS CHECKED, AND INFORMATION PROVIDED ABOVE, ARE COMPLETE AND CORRECT TO THE BEST OF MY KNOWLEDGE AND DO NOT CONTAIN CLASSIFIED INFORMATION. I UNDERSTAND THAT THE PROCESSING OF THIS SOLE-SOURCE JUSTIFICATION PRECLUDES THE USE OF FULL AND OPEN

COMPETITION.

Contracting Officer Signature________________________________ Date__________________

FISCPS 4200/180 (Rev. 10/1/10)

CHECK & FILL IN ALL APPLICABLE BLANKS BELOW