81944580-31155-81944580FORTUS_Sole_Source_(2).pdf

NAVSUPINST 4200.85D, Encl (1) 1 of 2

JUSTIFICATION FOR SOLE SOURCE/BRAND NAME (Simplified Acquisitions <$150K)

The service or material listed on <document number> is sole source and competition is precluded for reasons indicated below. There are no substitutes available for this material or service.

Restricted to the following source. Provide original manufacturer’s name. (If a sole source manufacturer distributes via dealers, ALSO provide dealer information.)

Manufacturer: ______________________________________________________________

Manufacturer POC & phone nr. _________________________________________________

Mfr. address _________________________________________________________________

Dealer / Rep _________________________________________________________________

Dealer / Rep address / phone nr. ___________________________________________________

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

____ 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.

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

NAVSUPINST 4200.85D, Encl (1) 2 of 2

CHECK & FILL IN ALL APPLICABLE BLANKS BELOW

____ The material/service must be compatible in all aspects (form, fit and function) with existing systems presently installed/performing. Describe the equipment/function 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 ___________

____ These are “direct replacements” parts/components for existing 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. I UNDERSTAND THAT THE

PROCESSING OF THIS SOLE SOURCE JUSTIFICATION PRECLUDES THE USE OF FULL AND

OPEN COMPETITION.

Signature _____________________________ Title ____________________________

Activity ______________________________ Date ____________________________

Contracting Officer Signature _________________________________________

Date ________________________________ SAP Sole Source