SOLE SOURCE / SOLE BRAND - DOC by 3Y4MP8

VIEWS: 0 PAGES: 1

									                           SOLE SOURCE / SOLE BRAND JUSTIFICATION

REQUISITION #                                         DATE

                                          SOLE SOURCE                               SOLE BRAND

    This product DOES contain                                This product DOES contain Class 3b or 4 lasers.
    radioactive material and IS capable
    of producing X-Rays.

    This product DOES contain any                            If required, written approval has been received
    explosives, pyrophorics or highly                        from EH&S for this purchase.
    toxic gases.


1. Proposed Source:
    Contact Name:

   Telephone No.:                          Fax No.:

   Email:

2. Scope of Work: (Describe what the item/service is and how it is to be used)

If the requested product is an integral part or accessory compatible with existing equipment please provide-
Existing equipment
Manufacturer
Model/Serial #       GIT #          Dollar Value_____

3. Exclusive Capability: (Describe proposed source’s unique capabilities and/or personnel to perform this work, and why
    this is the only source available.) Sole Source Only Request

    State any extenuating circumstances or considerations


4. Sole Brand Justification:


5. Price Analysis:
    o    Comparable item/service         Vendor        Cost
    o    Comparable item/service         Vendor        Cost
    o    Current price list attached (highlight items)      GSA contract price




Date _________Sole Source/Brand Approved _____________________ Contract Officer




D:\Docstoc\Working\pdf\becad5cf-811e-45b8-b8b8-1ca79e1e34bb.doc

								
To top