Sole Source Justification Form - PBOA[2].pdf

Financial Services Department 1204 NE 201st Avenue, Fairview, OR 97024

Phone: 503-661-7200 | Fax: 503-667-6932 www.reynolds.k12.or.us

Sole Source Justification Form

Date: Department:

Prospective Contractor: Cost:

Describe the goods or services to be purchased:

For the reason(s) below, this purchase cannot reasonably be competitively solicited:

The efficient use of existing goods or services requires our purchasing compatible goods or services, and there is a single provider for those goods and services. Describe:

The goods or services required for the exchange of software or data with other public or private agencies are available from only one source. Describe:

☐ The goods or services are for a pilot or experimental project. Describe:

Other findings. Describe other factors that support the conclusion that the goods or services are available from only one source:

Continued →

Finance Department | Revised 4/8/2022

What unique features/functionality is required that only this source can provide?

What steps were taken to verify that goods or services with similar features and functionality are not available from other sources?

By signing this form, I am recommending this purchase as a sole source based upon an objective review of the goods and services required and the purchase is in the best interest of the District.

I certify that I have no conflict of interest in making this recommendation.

DEPARTMENTAL AUTHORIZATION

Name: Title:

Signature: Date:

FINAL AUTHORIZATION

Name: Title:

Signature: Date:

Must be Cabinet member

Submit completed form to procurement@rsd7.net

PROCUREMENT & CONTRACTING USE ONLY

Date of Advertisement: