Single Source - Brand Name Justification Form ATI System update (003).pdf

SINGLE SOURCE /BRAND NAME JUSTIFICATION FORM

(SIMPLIFIED ACQUISITIONS UNDER $150,000)

PLEASE READ THE FOLLOWING INFORMATION CAREFULLY AS

MISUSE OF THIS FORM MAY RESULT IN SUSBTANTIAL DELAYS IN

THE PROCUREMENT PROCESS:

The Government is required to ensure that the procurement of goods and services is adequately competitive. In the event that a certain good or service is only available from a certain source, or that a specific brand of a product is required, adequate justification must be provided. This form must be completed in its entirety and all answers filled out as completely as possible. If clarification is needed, consult FAR 13.106-1(b)(1) and related subparts. Please select the appropriate justification by placing an X in the appropriate box below.

OR

For the following questions, please provide all information available, as specifically as possible.

1. What is the good or service required? (Please provide all model numbers and other identifiers as they are available.)

This purchase requires a Single Source Justification. The good or service requested can only be procured through one specific entity because of its manufacture or other specifications. By checking this box, the requester asserts that adequate market research has been performed to reach this determination.

This purchase requires a Brand Name Justification. Due to pre-existing equipment or technical specifications, a specific brand of the given good or service is required to satisfy the need. By checking this box, the requester asserts that adequate market research has been performed to reach this determination.

2. What market research was conducted to come to the conclusion that a Single Source/Brand

Name justification is necessary?

3. Are there any substitutes or equivalent items that could meet mission requirements? If no, please explain.

4. What is the specific reason for this Single Source/Brand Name Justification? Please include all applicable technical orders, executive orders, Air Force regulations, and any other documentation.

5. FAR 6.302 et seq. identifies the following circumstances which permit other than full and open competition. Please select the option most applicable and then explain.

There is only one responsible source and no other supplies or services will satisfy agency requirements (FAR 6.302-1).

There is an unusual and compelling urgency such that injury to the agency may result (FAR

6.302-2).

A particular source is necessary for Engineering, Developmental, or Research Capability purposes (FAR 6.302-3).

A particular source is mandated by International Agreement (FAR 6.302-4).

A particular source is authorized or required by Statute (FAR 6.302-5).

A particular source is mandated by National Security concerns (FAR 6.302-6).

A particular source is mandated by Public Interest (FAR 6.302-7).

Other

Explain:

6. Please provide any additional information that may be helpful in purchasing this good or service.

http://farsite.hill.af.mil/reghtml/regs/far2afmcfars/fardfars/far/06.htm#P83_11341

CONTRACTING OFFICER’S DETERMINATION

The above justification is accurate and complete to the best of my knowledge and belief.

Date: ___________

The above justification is accurate and complete to the best of my knowledge and belief.

Date: ___________

I have determined, in accordance with FAR 13.106-1(b)(1), that the circumstances of this contract action deem only a Single Source/Brand Name (circle/underline one) is reasonably available.

1512994640C Underline

1512994640C Cross-Out

Group11: Brand Name