lsj.pdf

NAVOCEANO 4200/12 (08-11) PAGE 1 OF 3

JUSTIFICATION FOR SOLE SOURCE

(<SIMPLIFIED ACQUISITION THRESHOLD (<$150,000))

Requisition/Document Number:

1. The service or material listed on the above requisition is sole source, and competition is precluded for reasons indicated below. There are no substitutes available for this material or service.

2. 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 number:

Manufacturer address:

Dealer/Rep.:

Dealer/Rep. address/phone number:

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

(a) Description:

(b) Estimated cost (total value, base plus options): Base $ Options $

(c) Required delivery or start date:

NAVOCEANO 4200/12 (08-11) PAGE 2 OF 3

(<SIMPLIFIED ACQUISITION THRESHOLD (<$150,000))

Requisition/Document Number:

4. Specific characteristics of the material or service that limit the availability to a sole source (unique features, function of the item, etc.).

(a) Detailed description as to why only the identified source/sources can furnish the stated requirements to the exclusion of other sources:

(b) Description of market research conducted, including the results, or a statement as to the reason no market research was conducted:

Note: When restricting to an item peculiar to one manufacturer (e.g., a particular brand name, product, or a feature of a product peculiar to one manufacturer), an ordering activity must justify its action. Brand name specifications shall not be used unless the particular brand name, product, or feature is essential to the Government’s requirements and market research indicates other companies’ similar products, or products lacking the particular feature, do not meet or cannot be modified to meet the agency’s need.

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

CHECK AND 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.

NAVOCEANO 4200/12 (08-11) PAGE 3 OF 3

(<SIMPLIFIED ACQUISITION THRESHOLD (<$150,000))

Requisition/Document Number:

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

These are “direct replacements” parts/components for existing equipment. Explain:

Other information to support a sole source purchase:

6. TECHNICAL AND REQUIREMENTS CERTIFICATION:

I CERTIFY THAT STATEMENTS CHECKED AND INFORMATION PROVIDED ON THIS FORM

ARE ACCURATE AND COMPLETE TO THE BEST OF MY KNOWLEDGE. I UNDERSTAND

THAT THE PROCESSING OF THIS SOLE SOURCE JUSTIFICATION PRECLUDES THE USE OF

FULL AND OPEN COMPETITION.

TECHNICAL COGNIZANCE (The end user may perform this technical certification.)

Signature Title Code Phone Date

CONTRACTING OFFICER APPROVAL

Signature Phone Date

Klein Associates TextField2:

Carol Morrissey / 603=893-6131 X-272 TextField2:

11 Klein Drive Salem, New Hampshire 03079-1249 TextField2:

Klein Associates / Carol Morrisey TextField2:

Klein Associates 11 Klein Drive Salem, New Hampshire 03079-1249 / Tel: 603-893-6131 X272 TextField2:

K5000 Towfish SN: 337

Est. $67,295.00 TextField2:

This is known to be unique and proprietary to Klein.

TextField2:

No market research was conducted, due to the fact that this item is unique and proprietary to Klein Associates.

TextField2:

K5000 SN 337 - Without new transducers installed, K5000 towfish will not function as designed. New transducers will return system to 100% operational status.

TextField2:

Klein Associates is the original manufacture of these items. The parts/components used to repair units is the same used when unit was originally built.