Fillable Formu501b01 (Louisiana State University)

Fill Online, Printable, Fillable, Blank Formu501b01 (Louisiana State University) Form

Use Fill to complete blank online LOUISIANA STATE UNIVERSITY pdf forms for free. Once completed you can sign your fillable form or send for signing. All forms are printable and downloadable.

Formu501b01 (Louisiana State University)

On average this form takes 8 minutes to complete

The Formu501b01 (Louisiana State University) form is 2 pages long and contains:

  • 0 signatures
  • 7 check-boxes
  • 28 other fields

Country of origin: US
File type: PDF

U.S.A. forms for Louisiana State University

BROWSE LOUISIANA STATE UNIVERSITY FORMS

Related forms
Fill has a huge library of thousands of forms all set up to be filled in easily and signed.
Fill in your chosen form
Sign the form using our drawing tool
Send to someone else to fill in and sign.
find another form
 
Louisiana State University
Finance & Administration
Office of Procurement Services
FRM-U501.B.01 v2/2018 Page 1 of 2
SOLE SOURCE JUSTIFICATION FORM
Department:
Date:
Department Head:
Requisition Number:
1. State relevance of purchase to your mission, purpose, research or study:
2. Identify item(s) or service(s) to be approved for sole source treatment:
3. Name of manufacturer of item(s) or service (s) provider (if applicable):
4. Name of single source supplier:
Supplier ID#:
Mailing Address:
Phone Number:
Fax Number:
Web Site Address (if available):
Yes
No
6. Select Sole Source Type:
a.
Patented Technology
Explain how patent is related to research being conducted.
Explain how research and patented technology are related.
b.
Continuity of Research
Describe the specific good/service needed due to prior/ongoing research.
Provide LSU property tag information (if applicable).
Specify LSU Property location.
LSU Building Name:
Room Number:
Louisiana State University
Finance & Administration
Office of Procurement Services
FRM-U501.B.01 v2/2018 Page 2 of 2
c.
Compatibility with Existing Goods/Services
Describe how the specific good/service is compatible with existing good/service.
Provide LSU property tag information (if applicable).
Specify LSU Property location.
LSU Building Name:
Room Number:
d.
Proprietary Technology
e.
Grant/State Requirement
7. Requisition Attachments Checklist
• LSU Quote Form
• Sole Source Justification Form
• Firm Price Quotation from sole source
supplier. Quoted prices shall be firm for 30 days and inclusive of all
costs including transportation. Quoted shipping terms must be FOB: LSU
• Signed letter or email from the manufacturer, producer, service provider or rights holder confirming sole
source
• If patented technology type, supplier must provide US or Foreign Patent number and supporting
information
• If compatibility with existing goods/services type, supplier must confirm only their items (no other similar
items from another supplier) will provide for compatibility with existing LSU property
• If proprietary technology type, supplier must describe how they obtained rights in order
to be deemed as
the
sole manufacturer and the sole supplier
• If grant/state requirement type, department must provide grant/state document indicating the item or
services must be purchased from sole source supplier. Note a supplier quote used as an in the grant/state
documentation for quoting purposes is not sufficient to support sole source approval.
I hereby declare the information provided herein to be true and accurate to the best of my knowledge. I understand any false or
misleading information may be considered a violation and can subject me to prosecution and penalty under Louisiana Revised
Statutes.
Name: Date:
(Type or print)
Title or Rank:
Telephone Number:
Email Address:
ATTACH TO A REQUISITION AND ROUTE FOR COST CENTER MANAGER OR DESIGNEE FOR APPROVAL(S). NOTE: THE DEPARTMENT
AUTHORITY’S REVIEW AND CONCURRENCE WITH THIS JUSTIFICATION, AND DECLARATION ATTESSTED TO ABOVE, IS SERVED BY
APPROVING THE REQUISITION.
Download
Save PDF to desktop
Email
Email completed PDF
Send for Signing
Email for others to sign
Print
Print document
Choose a Field
Click on a field and
select the person that should complete it
Want to add a signature?
You can add a signature field
and assign it to someone else
to sign
Choose a Field
Click on a field and
select the person that should complete it

Formu501b01 (Louisiana State University)

This document is locked as it has been sent for signing.

You have successfully completed this document.

Other parties need to complete fields in the document. You will recieve an email notification when the document has been completed by all parties.

This document has been signed by all parties.

Completed 20 July 2020

Message

View Audit Log
Print With Audit Log
Duplicate Document