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REQUEST FOR A SOLE SOURCE
PROCUREMENT
NOTE: This form is to be used for items that are available from only one source and there are no alternates. Forward to
the Procurement Department sixty (60) days prior to actual need.
Commodity/Service Requested:
Describe Performance or Design:
Intended Source: (Vendor)
Vendor Contact Phone number:
Vendor Contract e-mail address:
Requesting Department Contact Initial below:
This purchase is clearly and legitimately limited to a Sole Source because the commodity or service is:
Item(s) are available from only one source and there are no alternates: ___________
Initials
Attach vendor documentation certifying that the vendor is the only source for the commodities or services in
question or holds the production, copyrights, trademark, and/or patent to the item.
Check the following statement(s) that apply:
□ The vendor holds the exclusive distribution rights for the item in question. Vendor documentation attached.
□ The item to be purchased is the only item compatible with existing equipment owned by the College (Single
Source).Vendor documentation attached.
□ The vendor is the sole provider of the goods or services which have unique characteristics essential to the
needs of the program to perform the intended function and no other goods or services will be suitable for
use by the College. Vendor documentation attached.
What steps were taken to verify that these features are not available elsewhere?
□ Other brands/manufacturers were examined (please list names, phone numbers, and explain why they are
not suitable for use by the College. Attach additional pages as necessary):
□ Other vendors were contacted (please list names, phone numbers and explain why those contacted would
not meet the needs of the College. Attach additional pages as necessary):
