Dept. Head/Chair/Dean’s Signature
Procurement Director’s Signature
VP for Finance and Administration’s Signature
$250,000.00+, Approval by VP for Finance and Administration
Date & Time Decision Posted:
Date & Time Decision Removed: Revised 08/02/2019
PURCHASES COSTING $75,000+ Failure to timely file a protest or failure to timely deliver the required bond or other security in accordance
with Board of Governors (BOG) Reg 18.002 and 18.003 shall constitute a waiver of protest proceedings
Is this product or service being purchased form the manufacturer?
Is this manufacturer the sole distributor?
Does the manufacturer have dealers or distributors that can also supply this product or service to the University?
In your expert opinion, is the price reasonable and competitive with other similar equipment and/or services?
Requisition #
Sole Source Affidavit
Under the requirement of The University of West Florida (UWF) Reg 6.0055 (2), the following is submitted in support of this
request for authority to purchase, without bidding, the items available from only one source.
Vendor Name
Vendor Address
Vendor FAX
Value of Order
or Contract
Vendor Phone
Describe briefly, in lay language, what
the Item/service is and how it is to be
used.
Why is this product required over any
other product? What does this product
provide that other products cannot?
Why is this product so unique that it is
considered a sole source?
If available from other dealers or
distributors, why are you requesting
this item to be considered a sole
source purchase and not biddable?
STATEMENT OF NO CONFLICT OF INTEREST
I/We, as a UWF employee(s) taking part in the development of this affidavit, attest that I/We am/are independent of, and have
no conflict of interest in, the entities to which this non-competitive award is made.
DEPARTMENT APPROVAL
I/We, the undersigned certify the above to be true and correct to the best of my/our knowledge and belief and the user and/or
undersigned does not have a financial interest in the above named vendor.
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