Sole Source.pdf

State of Colorado Contract Management Information

Sole Source Justification and Certification

A state agency or institution of higher education (IHE) shall complete this form before entering into a sole source procurement under CRS §24-103-205 and Procurement Rule R-24-103-205-01 for the purchase of goods over $10,000 and services over $25,000 and for sole source personal services contracts with a value over $100,000 in accordance with CRS §24-102-205(3)(a)(VI). Sole Source Justification and Certification Forms are not required:

./ Under circumstances outlined in §CRS 24-101-105 and related rules; and/ or

./ For interagency or inter-governmental agencies.

Procurement Rule R-24-103-205-01 states the following two criteria must be met for a sole source procurement:

./ There is only one good or service that can reasonably meet the need, and ./ There is only one vendor who can provide the good or service.

SECTION 1- SOLE SOURCE DETAILS: This section is to be completed by the Program Manager.

Agency /IHE:

Arapahoe Community College

Department: _ EMS Academy Division: HPS

Address: 5900 S. Sante Fe Drive, Littleton, CO 80160 t 1 Program Manager Name: _ Dennis Edgerly, Med., EMTP

Department Approving Official Name: /iJm 11 e/ J)e lfc,·e.r Contractor/Vendor

Signature /{µ.«r,:f W Signatu~~LK __

Vendor Name: Laerdal Medical Corporation Phone:

Vendor Address: 226 FM 116 l Gatesville, TX 76528 eMail: www.laerdal.com

Have you procured goods and/ or services from this vendor in the past 2 years?

If Yes, explain:

XYes

1) ACC purchases and maintains many Laerdal Products including SimMan, SimMom, And SimBaby for the Nursing and EMT Programs. It is essential to these programs that we purchase and maintain repair and maintenance parts. Laerdal is a Sole Source provider for replacement parts for these Simulation products.

2) Over the past 2 years I have posted several Sole Source documents and have never receive a protest.

Goods and/ or Services to be Procured:

Start Date: End Date:

Estimated Total Dollars (include breakdown of goods/ services): $ _$2_,_3_48_._7_1 ______ _ Goods $ $2,348.71 Services $

Determination of Sole Source:

1. What type of Market Research was conducted? 5· e e ( lJ ~ bov e ·

2. If applicable, obtain manufacturer statement affirming good/service is not available through a distributor/reseller or other source. This document is to verify that Laerdal Medical Corporation is the sole manufacturer and sole world-wide distributor of the parts listed below:

200-03150 Airway/Tongue 205-03240T Intubation Head w/Cric (Tan) 200-02.850T Face Skin w/Straps 380410 Post Set, ECG/Defib

Sole Source Justification and Certification Effective May 20, 2010

Justification of Sole Source:

Provide a detailed explanation of Vendor's sole source status -what is the basis for identifying this as a sole source - why can't the goods/services be purchased through another vendor.

Conflict of Interest

Do you have an actual or potential conflict of interest in this purchase request?

If yes, please explain on attached sheet.

Pricing Evaluation

Reference the price/cost analysis guidance when responding to the following questions:

1. Were prices/rates compared to established catalog prices or market prices?

2. Were prices/rates compared to historical prices/rates for similar goods/services procured before?

3. If no to 1 or 2 above, was a cost/price analysis completed?

4. If no to 1, 2 or 3 above, is the cost "fair and reasonable" (as required by Fiscal Rules)?

J Yes

)<. Yes y Yes

'>c Yes

><-. Yes

Provide an explanation of fair and reasonable prices/rates per CRS §24-103-403: -

SECTION 2 -APPROVAL AND CERTIFICATION FOR . .c.QNTRACTS: To be _co!!!l?Jeted_b@ocurement_oHice. __ _

*** Approved for one time purchase as described on this request***

What was the result of the BIDS posting? Provide BIDS web statistics:

Another Response: . , No . Yes Solicitation # :

Certification - for Sole Source Personal Services Contracts over $100,000:

Total Hits:

By signing below, we hereby certify in accordance with CRS §24-102-205(3)(a)(YI) that we have determined that the agency or IHE has complied with CRS §24-102-205(S)(a) and has posted a sole source personal services contract on BIDS for not less than three business days.

Purchasin~

Siwature Printed Name ~ · Approved: (%~ Ce a±-:: (\!\~ 15" i atJ I X:

' I Date Purchasing Director or Delegate Siwature Printed Name

Sole Source Justification and Certification Effective May 20, 2010

~ Laerdar helping save Jives

This document is to verify that Laerdal Medical Corporation is the sole manufacturer and sole world-wide distributor of the parts listed below:

200-03150 Airway/Tongue

205-03240T Intubation Head w/Cric (Tan) 200-02850T Face Skin w/Straps 380410 Post Set, ECG/Defib

Laerdal Medical is also the sole authorized provider of LLEAP software, parts, post-sales support, education and warranty services for the above items.

Sincerely, Amber Carothers Account Manager Laerdal Medical Corporation 254-404-7012 Amber.carothers@laerdal.com

Laerdal Medical Corporation, 167 Myers Corners Road, PO Box 1840, Wappingers Falls, NY 12590-8840 Customer Service (8 00) 431-1055, Customer Service Fax (800) 227-1143,www.laerdal.com