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ISU-Sole-Source-Request-Form - ISU_Sole_Source_Request

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PURCHASING SERVICES

RequestforSoleSource

(PurchasingRequestEstimateis$10,000.00orGreater)

1|Page

Rev 2, August 16, 2019

To:IdahoStateUniversity–DirectorofPurchasing–Rick Dutson

From:Department:

SoleSourceRequestforthepurchaseof:

RequestedSupplier:

RequisitionNumber: CostEstimate:$ (Attachquotealso)

Solesourcepurchasesaredefinedasclearlyandlegitimatelylimitedtoasinglesupplier.Solesourcepurchasesareonly

allowedwhenbaseduponstrongtechnologicalgroundssuchasoperationalcompatibilitywithexistingequipmentand

relatedparts,oruponaclearlyuniqueandcosteffectivefeaturerequirements.Theuseofsolesourcepurchasesshallbe

limitedtoonlythosespecificinstancesthatarecompletelyjustifiedtosatisfycompatibility,technicalperformanceneeds,or

otherun

iquecircumstances.

StatementofNeed

Mydepartment’srecommendationforsolesourceisbaseduponanobjectivereviewoftheproduct/servicerequiredand

appearstobeinthebestinterestoftheUniversity.Iknowofnoconflictofinterestonmypartorpersonalinvolvementin

anywaywiththisrequest.Nogratuities,favorsorcompromisingactio

nshavetakenplace.Neitherhasmypersonal

familiaritywithparticularbr

ands,typesofequipment,materials,orfirmsbeenadecidinginfluenceonmyrequesttosole

sourcethispurchasewhenthereareotherknownsuppliersthatexist.

RequesterAffirmation

IamawareISUPurchasingPolicyrequiresprocurementsexceeding$10,000.00tobecompetitivelybidwhennecessary.The

followingstatementsarecompleteandaccurate,basedonmyprofessionaljudgmentandinvestigations.Ialsocertifythatno

personaladvantagewillaccruetomeoranymemberofmyimmediatefamilyasaresultofth

isprocurement.

RequesterSignature: Date:



RequesterPrintedName:

*****************************************************************************************************

ISUPurchasingDepartmentBuy

er: Approved Rejected

Signature: Date:

*****************************************************************************************************

ISUDirectorofPurchasing: Approved Rejected

Signature:

Rick Dutson

Date:

PURCHASING SERVICES

RequestforSoleSource

(PurchasingRequestEstimateis$10,000.00orGreater)

2|Page

Rev.2,

August 16, 2019

RequisitionItem

/Service:

Isthisare

newal? Yes ☐ IfYes,answerquestions 1–4

No ☐ IfNo,answerquestions 4‐11

1. PriorPurchaseOrderNumber:

2. Pleaseconfirmyourdepartm

entscontinuingbusinessneeds,andattachcurrentquote.

3. Describethestepstake

ntoconfirmthattheproduct/servicecontinuestoqualifyasasolesource;includesuppliers

contacted,websearches,etc.

4. Justificationthatthisisasolesource*,ch

eckallthatapply:

Soleproviderofalicensedorpatentedgoodorservice

Soleproviderofitemsthat

iscompatiblewithexistingequipment,inventory,systems,programsorservices

Soleproviderofgood

sand/orservicesforwhichmydepartmenthasestablishedastandard**

Soleprovideroffactory‐aut

horizedwarrantyservice

Soleproviderofgood

sand/orservicesthatwillmeetthespecializedneedsofmydepartmentorperformthe

intendedfunction(pleasedetailbeloworinanattachment)

Solemanufactureranddistributor(attachManufacturer’slettertothiseffect)

Thisrenewalrequesthasalr

eadybeenadvertised

PURCHASING SERVICES

RequestforSoleSource

(PurchasingR

equestEstimateis$10,000.00orGreater)

3|Page

Rev.2,

August 16,2019

5. Whatnecessaryfeat

uresdoesthisvendorprovidewhicharenotavailablefromothervendors?Pleasebespecific.

6. Whatstepsweretakentoverifythatth

esefeaturesarenotavailableelsewhere?

Otherbrands/manufacturerswereexamined(pleaselistphonenumbersandnames,andexplainwhytherewere

notsuitable).Youmayuseanattachmentifnecessary.

Othervendorsthatwerecontacted.Pleaselistnamesandphonenumbersandexplainwhythesewerenot

suitable.Youmayuseanattachmentifnecessary.

*SoleSource:onlyonevendorpossessestheuniqueandsingularlyavailablecapabilitytomeettherequirementofthe

solicitation.

**Procurementsofitems/servicesforwhichyourdepartmenthasestablishedastandardbydesignatingabrandor

manufacturerorbypre‐approvingviaatest

ingshallbecompetitivelybidifthereismorethan

onevendorthatcanprovidethe

commodity/service.

Pleaseanswereachofthefollowingindetail.Youmayattachaseparatesheetifnecessary,referencingeachquestionby

number:

7. Whatmakesthiscommodity/serviceunique?(Patents/copyrights,needcompatibilitywithexistinge

quipment–why?

Spaceconstraints,mustmatcheq

uipmentwithanotheragencyordepartment,consequencesifthiswereputoutforbid,

etc.)

PURCHASING SERVICES

RequestforSoleSource

(PurchasingRequestEstimateis$10,000.00orGreater)

4|Page

Rev.2,

August 16,2019

8. Whatstepsha

veyoutakentodeterminethatthisistheonlyproductorservicethatwillmeetyourparticularneeds?

(Professionalopinions/correspondence,tradepublications,tradeshows,visitsto,orcorrespondencewith,other

institutionsthathaveinstalledthesameproduct,sitevisitations,etc.)

9. Willthispurchasetie

ustoaparticularvendorforfuturepurchases?(Eitherintermsofmaintenancethatonlythisvendor

willbeabletoperformand/orifwepurchasethisitem,willwethenneedmore“like”itemsinthefuturetomatchthis

one?)

10. Willthisvendortieustoa

particularvendorforsoftwareand/orsoftwaremaintenance?(Doyouneedittoberenewable

andforhowlong?)

11. Pleaseaffirmativelystate,“Nootherve

ndorcanprovidethesameorasimilarproduct/service,”andencloseanyother

informationwhichwillhelpmakethedeterminationthatthisisasole/singlesourceprocurement.

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Completed 10 February 2020

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