Sole Source-Name Brand Only Determination - signed BD.pdf

Simplified Acquisition Procedures (SAP)

DETERMINATION MEMORANDUM FOR SOLE SOURCE ACQUISITIONS

OVER THE MICRO-PURCHASE THRESHOLD BUT NOT EXCEEDING

THE SIMPLIFIED ACQUISITION THRESHOLD

FAR 13.106-3(b)(3)(i)

SOLICITATIONS MAY BE LIMITED TO ONE SOURCE ONLY IF THE CONTRACTING OFFICER DETERMINES THAT ONLY ONE SOURCE IS REASONABLY AVAILABLE. WHEN THE CUSTOMER DESCRIBES AN ITEM OR SERVICE, WHICH LIMITS THE AVAILABILITY TO ONE SOURCE, THE DETERMINATION MUST EXPLAIN WHY

THE ITEM OR SERVICE PROVIDER IS THE ONLY ONE THAT WILL MEET THE GOVERNMENT'S

REQUIREMENT. STATEMENTS SUCH AS "ONLY KNOWN SOURCE" OR "ONLY SOURCE WHICH CAN MEET THE REQUIRED DELIVERY DATE" ARE INADEQUATE TO SUPPORT A SOLE SOURCE PURCHASE. THIS FORM MAY BE USED IN LIEU OF THE DETERMINATION DESCRIBED IN FAR 13.106. THE CUSTOMER SHALL

PROVIDE THE FOLLOWING INFORMATION:

1.PURCHASE REQUEST NUMBER 2. ESTIMATED AMOUNT:

BRAND

NAME BUY

YES

NO

NAME/CAGE CODE OF PROPOSED CONTRACTOR Fund Type

O&M

NGREA

OTHER

3. BRIEF DESCRIPTION OF SUPPLIES OR SERVICES REQUIRED AND THE INTENDED USE:

4. UNIQUE CHARACTERISTICS THAT LIMIT AVAILABILITY TO ONLY ONE SOURCE, WITH

THE REASON NO OTHER SUPPLIES OR SERVICES CAN BE USED:

5. MARKET RESEARCH:

6. PROVIDE A STATEMENT OF ACTIONS, IF ANY, THE GOVERNMENT MAY TAKE TO

REMOVE OR OVERCOME ANY BARRIERS TO COMPETITION BEFORE FUTURE

ACQUISITIONS ARE REQUIRED:

I CERTIFY THAT THIS JUSTIFICATION IS ACCURATE AND COMPLETE TO THE BEST OF

MY KNOWLEDGE AND BELIEF, AND THAT COMPLETING THIS PURCHASE AS A SOLE

SOURCE IS IN THE BEST INTEREST OF THE GOVERNMENT. ADDITIONALLY, I APPROVE

THIS JUSTIFICATION TO LIMIT COMPETITION SUBJECT TO THE AVAILABILITY OF FUNDS

AND PROVIDED THAT THE SERVICES OR SUPPLIES HEREIN DESCRIBED HAVE

OTHERWISE BEEN AUTHORIZED FOR ACQUISITION.

7a. CONTRACTING OFFICER NAME 7b. CONTRACTING OFFICER SIGNATURE

NOS Amphenol / JAE NK-27-22C Male 27-Pin Circular Cord Mound Connector with Cable Clamp HDPE Conduit, Orange, 4", 550' Underground Warning Tape: Orange, 6" Roll width, 4 mil thick, polyethylene Flux Dispensing Pen, No Clean Solder Tin for Electronics Repair, Lead-Free Self Laminating Tag, Caution, Yellow Rhino 5200 label tape 3/4" x 18' White on Black print Cable Tie: 8 in Nominal Lg, 2 in Nominal Max. Bundle Dia., Outdoor Use, 100 pk