Fillable Form 9: The City of Edgewater (City of Edgewater Florida)

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Form 9: The City of Edgewater (City of Edgewater Florida)

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  • 6 check-boxes
  • 15 other fields

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8
The City of Edgewater
Finance Department
104 Riverside Drive
Edgewater, FL 32132
SOLE SOURCE JUSTIFICATION
Form 9
TO: Finance Department
FROM:
REQUISITION #:
Subject - Purchase of:
Requested Supplier – Contact:
Company:
Address:
City, State, Zip:
Phone:
Estimated Cost: $
Statement of Need: My recommendation for sole source is based upon an objective review of the product/service
being required and appears to be in the best interest of the City. I know of no conflict of interest on my part or
involved in any way with this request. No gratuities, favors or compromising actions have taken place. Neither
has my personal familiarity with particular brands, types of equipment, materials or firms been a deciding
influence on my request to sole source this purchase when there are other known suppliers to exist.
Sole Source Justification: Mark those that apply.
1. Sole source request is for the original manufacturer or provider; there are no regional distributors. (Attach the
manufacturers written certification that no regional distributors exist. Item 4 must also be checked).
2. Sole source request is for the only area distributor of the original manufacturer or provider. (Attach the
manufacturers -not the distributors - written certification that identifies all regional distributors. Item 4 also must be
checked).
3. The parts/equipment are not interchangeable with similar parts of another manufacturer. (Explain in separate
memorandum and attach).
4. This is the only known item or service that will meet the specialized needs of this department or perform the
intended function. (Attach memorandum with details of specialized function or application).
5. The parts/equipment are required from this source to permit standardization. (Attach memorandum describing the
basis for the standardization request).
6. None of the above applies. A detailed explanation and justification for this sole source request is contained in the
attached memorandum.
Division Head Signature: __________________________ Date: _________________
Department Head Signature: __________________________ Date: _________________
Comments:
Finance Approval:_____________________________________ Date: _________________
Becca Beaman
8672
POW-R MOLE MODEL PD-4 BORING MACHINE
LANCASTER, NY 14086
POW-R MOLE SALES, LLC
1400 COMMERCE PARKWAY
32,374.06
12/17/2020
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Form 9: The City of Edgewater (City of Edgewater Florida)

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Completed 16 February 2021

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