Sole Source Signet_Redacted.pdf

NAVSUPINST 4200.85D, Encl (1) 1 of 2

JUSTIFICATION FOR SOLE SOURCE (Simplified Acquisitions <$150K)

The service or material listed on is sole source and competition is precluded for reasons indicated below. There are no substitutes available for this material or service.

Restricted to the following source. Provide original manufacturer’s name. (If a sole source manufacturer distributes via dealers, ALSO provide dealer information.)

Manufacturer: ______________________________________________________________

Manufacturer POC & phone nr. ____________________________

Mfr. address _________________________________________________________________

Dealer / Rep _________________________________________________________________

Dealer / Rep address / phone nr. ___________________________________________________

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

____ Specific characteristics of the material or service that limit the availability to a sole source (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.

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

NAVSUPINST 4200.85D, Encl (1) 2 of 2

CHECK & FILL IN ALL APPLICABLE BLANKS BELOW

____ The material/service must be compatible in all aspects (form, fit and function) with existing systems presently installed/performing. Describe the equipment/function you have now and how the new item/service must coordinate, connect, or interface with the existing system.

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

____ These are “direct replacements” parts/components for existing 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. I UNDERSTAND THAT THE

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

OPEN COMPETITION.

Signature Title ____________________________

Activity ______________________________ Date ____________________________

Contracting Officer Signature

Date ________________________________ SAP Sole Source