SOLE SOURCE JUSTIFICATION - GOODS AND SERVICES
A Sole Source Justification may be made when there is clearly and legitimately a single source of supply
COMPLETE OPTION 1 OR OPTION 2
Purchase Requisition#: W012345 Department: Department of Research
OPTION 1: Complete Both Questions: Email: E_Mail_Address@u.washington.edu
UNIT PRICE ALONE IS NOT A REASON FOR SOLE SOUCE OPTION 2: Check all boxes that apply: (Provide Explanation
on attachments)
Unique requirement or specific problem Collaborative agreement/research with (Explain)
(Requirements/functions/features): __________________________________________________
We need a submersible which must have the following:
- Depth: 1 mile Continuity of research (Prior PO# __________________)
- Glass Bottom Service/Maintenance (Prior PO# __________________)
- Robotic arms that will be able to pick up items as small as a New Coverage
needle. Match existing equipment:
UW Tag # ________________________
This is to allow search for deep sea shipwrecks off the coast of Serial # ________________________
Washington and Oregon, which is a funded commitment to the Original Equipment Manufacturer (OEM)
Department of Navy. XYZ Company is the only company that As a replacement part
makes a submersible with the above specifications. Component to be interfaced with equipment
List companies contacted/brands investigated during vendor For interchangeability
search (Minimum of 3 vendors preferred) (Required-Must Consumable used with equipment
Complete): Repair/Service (sole OEM authorized)
_______________________________________________ Equipment upgrade
Aquafish Co: Maximum depth capacity is 0.5 mile, if submersed Government
deeper than that, it may lose pressurization. Other (Explain)
Whalewatch Co: Does not have the necessary level of Explain:
precision with its robotic arms, and only a window on the ___________________________________________________
bottom, not a true glass bottom. ___________________________________________________
Seagull: Does not produce submersibles with robotic arms. ___________________________________________________
___________________________________________________
___________________________________________________
Must complete for either option
Information provided is true and accurate for this decision and may be used for
audit documentation.
Date: 02/25/2009 Please email or fax completed form to:
purentry@u.washington.edu or fax: 206-543-3854 (please
Justin Example
Name (Printed)
include requisition number and the word “Attachment” in
Phone: 206/555-0000 the subject line).
Attach any additional documentation to this form
For additional information visit our web site: http://www.washington/edu/admin/purchstores/
SOLE SOURCE JUSTIFICATION - GOODS AND SERVICES
A Sole Source Justification may be made when there is clearly and legitimately a single source of supply
COMPLETE OPTION 1 OR OPTION 2
Purchase Requisition#: W12345 Department: Department of Research
OPTION 1: Complete Both Questions: OPTION 2: Check all boxes that apply: (Provide Explanation
UNIT PRICE ALONE IS NOT A REASON FOR SOLE SOUCE on attachments)
Collaborative agreement/research with (Explain)
Unique requirement or specific problem __________________________________________________
(Requirements/functions/features):
___________________________________________________ Continuity of research (Prior PO# __________________)
___________________________________________________ Service/Maintenance (Prior PO# __________________)
___________________________________________________ New Coverage
___________________________________________________ Match existing equipment:
___________________________________________________ UW Tag # # AC-123
Serial # #X-5123JS
Original Equipment Manufacturer (OEM)
As a replacement part
Component to be interfaced with equipment
List companies contacted/brands investigated during vendor For interchangeability of shelves & boxes
search (Minimum of 3 vendors preferred) (Required-Must Consumable used with equipment
Complete): Repair/Service (sole OEM authorized)
___________________________________________________ Equipment upgrade
___________________________________________________ Government
___________________________________________________ Other (Explain)
___________________________________________________ Explain: Must have Revco freezer model XYZ with built in alarm
___________________________________________________ to match 4 others in our Freezer Room. Only this brand can be
___________________________________________________ linked to the existing freezers and integrated with the Buildings
24hr monitoring alarm system to ensure no loss of research
samples.
Must complete for either option Please email or fax completed form to:
Information provided is true and accurate for this decision and may be used for
audit documentation. purentry@u.washington.edu or fax: 206-543-3854 (please
Date: 02/25/2009 include requisition number and the word “Attachment” in
Justin Example the subject line).
Name (Printed)
Phone: 206/555-0000
Email: E_Mail_Address@u.washington.edu
Attach any additional documentation to this form
For additional information visit our web site: http://www.washington/edu/admin/purchstores/
Attach any additional documentation to this form
For additional information visit our web site: http://www.washington/edu/admin/purchstores/