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 Email: E_Mail_Address@u.washington.edu
OPTION 1: Complete Both Questions:
UNIT PRICE ALONE IS NOT A REASON FOR SOLE SOUCE
OPTION 2: Check all boxes that apply: (Provide Explanation
on attachments) Collaborative agreement/research with (Explain) __________________________________________________ Continuity of research (Prior PO# __________________) Service/Maintenance (Prior PO# __________________) New Coverage Match existing equipment: UW Tag # ________________________ Serial # ________________________ Original Equipment Manufacturer (OEM) As a replacement part Component to be interfaced with equipment For interchangeability Consumable used with equipment Repair/Service (sole OEM authorized) Equipment upgrade Government Other (Explain) Explain: ___________________________________________________ ___________________________________________________ ___________________________________________________ ___________________________________________________ ___________________________________________________
Unique requirement or specific problem (Requirements/functions/features): We need a submersible which must have the following: - Depth: 1 mile - Glass Bottom - Robotic arms that will be able to pick up items as small as a needle. This is to allow search for deep sea shipwrecks off the coast of Washington and Oregon, which is a funded commitment to the Department of Navy. XYZ Company is the only company that makes a submersible with the above specifications. List companies contacted/brands investigated during vendor search (Minimum of 3 vendors preferred) (Required-Must Complete): _______________________________________________ Aquafish Co: Maximum depth capacity is 0.5 mile, if submersed deeper than that, it may lose pressurization. Whalewatch Co: Does not have the necessary level of 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 Justin Example Name (Printed)
Phone: 206/555-0000
Please email or fax completed form to: purentry@u.washington.edu or fax: 206-543-3854 (please include requisition number and the word “Attachment” in 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:
UNIT PRICE ALONE IS NOT A REASON FOR SOLE SOUCE
OPTION 2: Check all boxes that apply: (Provide Explanation
on attachments) Collaborative agreement/research with (Explain) __________________________________________________ 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 For interchangeability of shelves & boxes Consumable used with equipment 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.
Unique requirement or specific problem (Requirements/functions/features): ___________________________________________________ ___________________________________________________ ___________________________________________________ ___________________________________________________ ___________________________________________________
List companies contacted/brands investigated during vendor search (Minimum of 3 vendors preferred) (Required-Must Complete): ___________________________________________________ ___________________________________________________ ___________________________________________________ ___________________________________________________ ___________________________________________________ ___________________________________________________
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 Justin Example Name (Printed)
Please email or fax completed form to: purentry@u.washington.edu or fax: 206-543-3854 (please include requisition number and the word “Attachment” in the subject line).
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/