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					                                       Departmental Justification
                                      Single/Sole Source Purchase
This form must be completed by the requesting department for all single and sole source purchases. Purchases
less than $25,000 can be approved by the Department. Purchases great than $25,000 must be submitted to UNL
Procurement Services for approval. Can send by mail: UNL Procurement, 1700 “Y” Street, Lincoln, NE 68588-
0645, by fax: (402) 472-2246 , or by email to the buyer.

   Requesting Department                                                Requestor’s Name
   Date Justification Submitted
   Item or Service To Be Purchased
   Estimated Cost of Item or Service
   Recommended Vendor: Name
                              Phone #                                       Fax #

Responses which require additional space should be continued on additional sheets and attached to this form with
reference to the specific question. Documents which explain or support your justification should also be attached
and returned with this form.

1. Is the item or service described above available only from the vendor identified above?
        Yes            No

   If your answer is yes, please explain: (List the most unique features or performance specifications and explain
   why this supplier is the only possible source).

2. If your answer is “no,” tell us what other vendor(s) (name and address) can supply this item or service.

3. Attach a price quote from your recommended vendor.

4. I have no conflict of interest in the selection of this sole source vendor. I will receive no personal or financial
   benefit from this purchase.

   Requestor's Signature                                Date

To Be Completed By UNL Procurement Services
Sole Source Purchase              Approved           Disapproved             Date:
By: Buyer                                                      Title:

   Director's Signature                                 Date

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