This form must accompany purchase requisitions for the sole source procurement of good and services when
the purchase will exceed $25,000. The purpose of this sole source justification is to show that a competitive
procurement is impractical because only one product or service can meet the specific need. It is not to be
utilized to circumvent normal purchasing procedure, nor for a price-based justification. Acceptance of this
request will be at the discretion of the CFO.
I am aware that the State of West Virginia Higher Education procurement regulations require procurements to
be done competitively whenever practicable. I am requesting a sole source procurement based on the following
criteria. The following statements are complete and accurate, based on my professional judgment and
investigations. I also certify that no personal advantage, gain or privilege has (or will) accrue to my immediate
family or myself through the purchase from this vendor.
Requesting Department:
Vendor Requested (name and address):
Briefly describe the product/service requested, its function and what it will be used for:
Please select the category (or categories) that best describes your sole source requirement. Answer any/all of
the questions pertaining to that category.
It is NOT required to complete all categories below. Complete only those that are applicable.
A. Compatibility to existing equipment, research, methodology, or training:
1. With what other material must this requirement be compatible?
2. What is the approximate dollar value of the existing material?
3. What are the unique properties that make this the only product compatible with existing material or
4. Provide any other supporting information, if applicable.
B. Only known manufacturer of the product:
1. What research/investigation has been done to support this claim (i.e., trade shoes, Internet
searches, professional journals, colleagues, etc?) Please list sources.
2. What other manufacturers did you solicit information from? Please list their names and summarize
your findings.
C. Only product that will met the requirements of the intended use although other like items
1. What other manufacturers did you evaluate? Please identify the manufacturer and the product
deficiencies that lead to their disqualification.
2. If this product is superior to all others, state the reason why. (Give very specific characteristics,
capabilities and properties.)
3. Provide other supporting research to document the need for this specific manufacturer, if
D. Regional Sales/Support/Service:
1. Is this the only know vendor to sell, support and/or service this type of product in this region?
2. If yes, give support of your need for immediate service as the primary requirement for vendor
NOTE: This alone will not qualify as a sole source justification if there are other manufacturers that sell
and service similar product within this region. Additional support would be requited above.
What are the consequences of not securing this specific item?
Provide any additional information not furnished above that supports your specific requirements necessitating
single/sole source purchase:
Requestors Signature: ___________________________________________________________
CFO Signature: ________________________________________________________________
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