JUSTIFICATION FOR NON-COMPETITIVE
PURCHASES AND/OR CONTRACTS
CERTIFICATION FORM
Date _______________
Department Requesting Non-Competitive Purchases and/or Contracts _________________________________
Vendor/Contractor providing good(s)/services(s) __________________________________________________
Description of the good(s)/service(s) to be acquired ________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
I, ______________________, certify that, to the best of my knowledge, the justication for non-competitive
purchases and/or contracts submitted to the Purchasing and Auxiliary Services department for the purchase of
the above Good(s)/Service(s) is justiable. Research has been done to ensure the Good(s)/Services(s) is unique
and only possess specic characteristics that can be lled by only the above source.* Or that the purchase is
a proprietary product that is manufactured and marketed by a person or persons having exclusive rights to
manufacture and sell the product.
____________
Date
____________
Date
____________
Date
____________
_____________________________________
Requestor Signature
_____________________________________
Director/Chair Signature
_____________________________________
Executive Director/Dean Signature
_____________________________________
Vice President/Provost Signature
Date
The vendor/contractor must furnish a letter on company letterhead indicating that it is the sole source, and
the letter must be signed by an authorized company representative.
0111454 NEW 15229
Southwest Tennessee Community College is an AA/EEO employer and does not discriminate on the basis of race, color, national origin, sex, disability or age in its program and activities.The following person has been
designated to handle inquiries regarding the non-discrimination policies: Executive Director of Human Resources and Afrmative Action, 737 Union Avenue, Memphis, TN 38103, (901) 333-5760.
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