Exemption � Justification and Approval by 0QZF19


									                                    Exemption – Justification and Approval
Type                    Products           Products & services       Services     Construction work
For the period                                                   Global Value            $ CAN (excl. taxes)
Periodicity             One-time purchase         Recurrent                     Capital     Non-capital
Name                                                             Department
Title                                                            Cost center
Telephone                                                              Date

1. Authorized signatories as per DSA:
2. Type of exemption requested:
          Solicitation of offers by invitation (less than 500 000 $)
          Open Solicitation of offers (more than 500 000 $)
3. Scope of the requested exemption :
          one-time case
          for a defined time period : from :           to
          permanent (the justification must be reevaluated every five(5) years maximum)
4. Detailed justification of the exemption request:
   a) Specificity of the required products/services :

    b) Emergency of the situation :

    c) Financial impact (comparison of financial risks and demonstration of the financial advantage
       related to the derogation request) :

    d) Other arguments :

5. Proposed Alternative (method and suggested supplier(s):

6. Exemption approval:
      Without specific condition
      With specific condition(s) :

    Description of the specific condition(s) :


Requestor: __________________________________________ Date: ___________________________

Approved by :

 ___________________________________________________ Date : __________________________
Vice-president and chief financial officer

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