SOLE SOURCE_25Q2618.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) ç19t1_____ 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 Appliances - The Safety Company Manufacturer FCC & Phone Nr. Derek Edwards , 1-600-672-2222 Mfr. Address 1000 Cranberry Woods Drive, Cranberry Township, PA 16066 Manufacturers Dealer/Rep N/A Dealer/Rep Address/Phone Number N/A

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

RESPIRATOR, LENS WESTERN SAFETY 206-264-0608 INSP-4 CARTRIDGE, TWO LAYERS LAMINATED, 0.12" THK UNTEMPERED GLASS FOR MSA ABRASIVE AIR BLAST HOOD, P/N 481742 3LENS/CA, 12CA/PG, PG=BX xSpecific 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.

and use 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 p.qNssTMw PPPM. nh1fl22. hss nnnrnveri the snecific item described above for sole source as t conforms to

J19Awa$ 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.

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

CHECK & FILL IN ALL APPLICABLE BLAIIKS BELOW

)CThe 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.

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

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

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

COMPETITION.

Magatlanes. Franz Adam C Ach,m C

Signature SIq.d b Activity Industrial Hygiene Branch

Title Chemical Engineer Date 7/16/2025

Contracting Officer Signature Date

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