Q0048- JA-Redacted.pdf

(Revised )

JUSTIFICATION FOR SOLE SOURCE / BRAND NAME SOLE

SOURCE (Simplified Acquisitions < $ 50K)

AUTHORITY: 41 U.S.C. 1901 - Simplified Acquisition Procedures FAR 13.106(b): Soliciting From A Single Source

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

NARRATIVE MUST BE ADDED TO ALL APPLICABLE SECTIONS. CHECKING A BOX IS NOT SUFFICIENT.

Funding Document Number:

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

Sole Source Brand Name Source

Restricted to the following source or manufacturer:

Manufacturer:

Manufacturer POC and Phone Number:

Manufacturer Address:

Dealer POC and Phone Number (if applicable):

Dealer Address (if applicable):

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

*** If additional items are required, please provide on a separate spreadsheet

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

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.

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

The material or service must be compatible in all aspects (form, fit and function) with existing systems presently

(Revised 201 ) 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 items are 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.).

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.