Specified_or_Sole_Source_Selection_Form_-_Fillable.pdf

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Attached to
Surplus
Solicitation number
Request-2025-025
Issued by
Alachua County, Graceville City, Florida

About this file

The document is a Specified or Sole Source Selection Form from Gainesville Regional Utilities (GRU), designed to justify procurements through either a sole source or specified source selection method. The form provides checkboxes for three specific sole source scenarios: replacement parts only available from the original equipment manufacturer (OEM), services requiring copyrighted drawings or specifications exclusively from the OEM or authorized distributor, and unique goods or services covered under an active U.S. patent or copyright.

The form requires detailed documentation, including an explanation letter from the manufacturer and signatures from the requestor, department head, and executive team. While no specific project details are filled in on this template, the form is clearly structured to provide transparency and justification for procurement decisions that deviate from standard competitive bidding processes. The form is dated for revision on 21 August 2024 and appears to be a standard internal document used by GRU to document and approve non-competitive procurement methods.

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Text version

Rev. 21 Aug 2024

GAINESVILLE REGIONAL UTILITIES

SPECIFIED OR SOLE SOURCE SELECTION

PROJECT NAME: Date:

CHECK ONLY ONE METHOD OF SOURCE SELECTION

SOLE SOURCE:

This is the sole source provider because:

Replacement parts only available from the original equipment manufacturer (OEM)

(Example: Provide explanation letter from the manufacturer)

Services will require copyrighted drawings or specification documents only available from the OEM or authorized OEM service center or distributor.

(Example: Provide explanation letter from the manufacturer)

A unique good or service covered under an active U.S. patent or copyright.

(Example: Provide explanation letter from the manufacturer that includes but is not limited to Patent/Trademark and/or Copyright Number)

SPECIFIED SOURCE:

JUSTIFICATION FOR SPECIFIED SOURCE (REQUIRED):

Requestor Name: Title:

Signature:

Department Head Signature

Executive Team Signature

Fillable Form

PROJECT NAME:
Date:
CHECK ONLY ONE METHOD OF SOURCE SELECTION:
This is the sole source provider because:
undefined:
undefined_2:
undefined_3:
JUSTIFICATION FOR SPECIFIED SOURCE REQUIRED 1:
JUSTIFICATION FOR SPECIFIED SOURCE REQUIRED 2:
JUSTIFICATION FOR SPECIFIED SOURCE REQUIRED 3:
Requestor Name:
Title:
Check Box1: Off
Check Box2: Off
Check Box3: Off
Check Box4: Off
Check Box5: Off

File details come from the government source that posted it. Updated .