Application for Determination of Sole Source Procurement
This form, with one or more categories completed, must accompany a purchase requisition for equipment, supplies
or services exceeding $20,000. Select the category or categories appropriate for this procurement. Attach all
documentation necessary to support the application. Procurements of $20,000 and greater shall be posted to the
NM Tech Purchasing website for the mandatory thirty (30) day period per NMSA 13-1-126.1
Requesting Department: End User’s Name:
Proposed Contractor: Estimated Cost:
Product Description: Date:
I am requesting a sole source procurement based on the following reasons:
Compatibility of existing equipment or supplies; provide details in Explanation. Include manufacturer,
model number and NMT PCN of existing equipment.
Item specifically required for use in conjunction with grant or contract. Attach applicable grant or
contract page and provide justification of why it is required for grant / contract and why other substitutes
are not acceptable.
Requirement is of a proprietary / copyright / licensing nature which is explained below.
The requested product has unique design / performance specifications or quality requirements which are
essential to my work, research protocol or teaching needs, and are not available in comparable products.
Please discuss this uniqueness / performance below.
NMT Staff has specialized training and / or extensive experience. Retraining would incur substantial cost
in money / time as explained below.
I have contacted other suppliers or service providers identified below and have considered their product,
however, their products / services are not acceptable because they are lacking one or more technical
capabilities as discussed below.
The requested product is essential in maintaining / continuing experiments. Other investigators have
used this product in similar research and for comparability of results, I require it.
Contractor is the sole manufacturer and sole distributor and has unique features / characteristics not
available from other sources (provide explanation and attach applicable documents).
Product is a prototype; contractor offers a trade-in allowance; availability of service, parts or maintenance
as discussed below.
Explanation:
By signing below, requestor certifies that the information provided is accurate to the best of their knowledge.
End User Signature (actual signature required) Printed Name Date
Date
Chief Procurement Officer (signature required)
For use by Purchasing:
Date application received in purchasing:
NMT Web Posting date:
Expiration date:
9/16
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