Redacted_A02_-_Justification_Breathing_Simulator_Signed_Final_20190227.pdf

Version 2, MAY 2018 PREVIOUS VERSION IS OBSOLETE

JUSTIFICATION FOR OTHER THAN FULL AND OPEN COMPETITION for

SIMPLIFIED ACQUISITIONS VALUED BELOW $250K

☐ FAR 13.106-1(b)(1)(i) Soliciting from a single source ☐ FAR 13.106-1(b)(1)(ii) Brand name specification

PURCHASE REQUEST NUMBER: DESCRIPTION OF ACTION:

☐ New Requirement

☐ Modification

ESTIMATED VALUE (inclusive of options):

FUND TYPE: YEAR:

1. NAME OF PROPOSED SOLE SOURCE CONTRACTOR / BRAND NAME MANUFACTURER:

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

3. UNIQUE SALIENT CHARACTERISTICS THAT LIMIT AVAILABILITY TO ONLY ONE SOURCE, WITH THE

REASON NO OTHER SUPPLIES OR SERVICES CAN BE USED:

4. REASON WHY CONTRACTOR IS THE ONLY SOURCE CAPABLE OF MEETING MISSION REQUIREMENTS;

SPECIFICALLY, THE REASON NO OTHER SOURCE CAN MEET THE UNIQUE CAPABILITIES IN SECTION 3:

Is this a follow-on contract? yes☐ no☐ If yes, provide contract number: _____________________________

5. MARKET RESEARCH:

6. TECHNICAL CERTIFICATION:

I certify that the supporting data under my cognizance, which is included in the sections above, is accurate and complete to the best of my knowledge and belief.

NAME AND TITLE OF CUSTOMER DIGITAL SIGNATURE EMAIL ADDRESS DATE

7. ACTIONS TO INCREASE COMPETITION (For Contracting Personnel Use):

8. CONTRACT SPECIALIST/PURCHASING AGENT REVIEW:

I have done my due diligence in verifying the information presented above by the requiring activity and have attempted to obtain competition to the maximum extent practicable.

NAME OF REVIEWER DIGITAL SIGNATURE EMAIL ADDRESS DATE

9. ENDORSEMENT OF THE ACC-APG TENANT DIVISION CONTRACTING OFFICER

I hereby ☐approve / ☐disapprove this justification in accordance with the authority cited on this document.

Approval is based on the availability of funds and provided that the services and property herein described have been otherwise authorized for procurement.

NAME OF CONTRACTING OFFICER DIGITAL SIGNATURE EMAIL ADDRESS DATE

chanel.d.williams Highlight

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