LARAMIE COUNTY COMMUNITY COLLEGE
Sole Source Justication
Sole source is dened as such that only one supplier or manufacturer can provide the product or service. When and
where possible, every eort shall be made to research alternative products and sources of supply for all purchases.
All sole source justications are to be reviewed and approved by Director of Contracting and Procurement.
Instructions: Equipment, goods, materials, retention of personnel, property, services and/or
supplies which perform a certain function for which no other source is known to exist is classied
as a “sole source” as dened per the LCCC Procurement Procedure Manual. Completion of
this Form in its entirety is required for all such requests, complete with all necessary supporting
documentation as dened below. Completed Form shall be forwarded to the Purchasing Oce.
Requested By
Name Department/
Division
Date of
Request
Phone Ext.
Is the recommended company the manufacturer?
Yes
No
Does the manufacturer sell the item(s) through distributors?
Yes
No
Sole Source Justication:
Schedule:
Identify the date you need delivery
Estimated
Cost
Budget
Code
Sole Source Rationale
Justify why the recommended good/product/material/service and subsequent company/vendor/supplier is the
only source that can meet your request requirements, understanding that said recommendation will result in
a noncompetitive procurement process. In Sole Source Justication above, address the justication for your
request and recommendation. e rational must be clear and convincing, avoiding generalities and unsupported
conclusions. Use one or more of the following as applicable. Check all that apply:
Available only from source because of patents, copyrights, secret processes, territorial rights per manufacturer,
or natural monopolies; or,
Films, manuscripts, papers, library materials, or books published and/or distributed from only source; or,
Electricity, gas, water or other utility services; or,
Captive replacement parts or components for existing equipment, goods, materials and supplies; or,
Sole brand purchase of equipment, goods, materials and supplies which has been selected to standardize
inventory, maintain repair and/or replacement parts, and/or comply with existing systems; or,
Service required to maintain warranty coverage of existing equipment or facilities: or,
Equipment specically engineered and/or manufactured or designed to perform a proprietary function: or,
Used equipment – competitive pricing process waived: or,
Advertising – sole entity for specied audience (radio, TV, or print).
Emergency – goods or services purchased without competition for situations that aect the safety and welfare
of employees, students and the public.
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Purchases using federal funds
Check box, if any portion of this purchase is being paid through a federal award or state award with
federalow-through funds. Attach completed LCCC Federally-Funded Award Sole Source Procurement
Justication form.
Acknowledgement
I am aware of and hereby acknowledge LCCCs requirements for competitive quoting and/or bidding and
the criteria for justication for Single Source/Sole Source Purchasing. I have gathered the required technical
information and have made a concerted eort to review comparable/equal equipment (e.g., market research).
I have attached the pertinent documentation showing what market research was conducted to preclude other
items from consideration.
______________________________________________ ______________________________________________
Requestor Signature Dean/Director Signature
______________________________________________ ______________________________________________
Printed Name Printed Name
__________________________________ __________________________________
Date Date
All expenditures exceeding $5,000 require approval by a member of President’s Cabinet.
______________________________________________ ______________________________________________
Signature of President’s Cabinet Member Date
______________________________________________
Printed Name
THIS SECTION TO BE COMPLETED BY THE PURCHASING OFFICE
Request does constitute a sole source purchase
Request does not constitute a sole source purchase
Request is insucient to form an opinion or make a decision
______________________________________________________________ ______________________
Director, Contracting & Procurement Date
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PRS 13025 1/19
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