USVI Public Records

Document text

UNIVERSITY OF THE VIRGIN ISLANDS PURCHASING DEPARTMENT SOLE SOURCE JUSTIFICATION FORM Requester Name: ________________________ Department: _____________________________ Date: ____________________________________ Requisition - PO Number __________________ SOLE SOURCE CONSIDERATIONS - (mark the one that best applies) A. ! Replacement Equipment/Parts/Accessories - The purchase is for equipment, parts or accessories for existing equipment where compatibility with original equipment manufacturer is paramount. B. ! Technical Service - The purchase is for technical services associated with the assembly, installation or servicing of equipment of a highly technical or specialized nature. C. ! Exclusive Design - The item is manufactured or produced by a vendor, who holds exclusive rights to the item, and solely transacts (sells) direct to the customer. (There are no dealers or distributors). D. ! Other - Vendor offered sale price, or extended a discount or other financial incentive to the University. Please attach substantiating documentation. Vendor Name: ______________________________________ Contact: __________________________ Phone #:_______________________ Fax #: _______________________ E-mail: _______________ Needs Statement - Describe the product and/or service to be procured. Attach additional sheets if necessary. ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ The information provided herein is true and accurate to the best of my knowledge. I understand any false or misleading information may be considered a violation of the University of the Virgin Islands purchasing policies and procedures. Requestor Signature: ___________________________________________ Phone #: _________________________ Fax #: _____________________ For Purchasing Use Only ! Sole Source Justification is adequate. Purchase is authorized without competitive bidding. ! Sole Source Justification is inadequate. Requisition is returned to requestor. REASON: ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ! Sole Source Justification is inadequate. Proposals or bids will be solicited. __________________________________ _______________________ Purchasing Department Date Lack of planning does not create the need for a sole source vendor. Approved June 2003 This form does not apply to construction or construction related purchases.