Single/SoleSourceJustificationForm
Use for all purchases of $5000 or more when low bidder has not been selected
Refertothebidsandquotationspolicyat:
http://www.case.edu/bizpolicies/procure
Brief Description of %ULHI'HVFULSWLRQRIPurchase:
SelectedVendor:_________________________________________
Checkboxesasappropriate:
(SECTION I) SOURCE JUSTIFICATION
PART A
Award to SINGLE SOURCE (Check one)
Reorderbasedonpreviousbidoranalysis(withinoneyear).Sendcopyofprevious
quote.Supplypreviouspurchaseordernumber_____________PODate_________.
Repairservicesorpartsunavailablefromanyothersourceexceptoriginalequipment
manufacturerortheirdesignatedservicingdealer.
Compatibilityofequipmentorsuppliesrequired.Listequipmentwithwhichpurchase
willbeused:Model#___________SerialNumber___________.
Upgradetoexistingsoftware.Availableonlyfromtheproducerofthissoftwarewho
sellsondirectbasisonly.
Usedordemonstrationequipmentavailableatalower-than-newcost.(Providecopyof
quoteshowingusedvs.newpricing.)
Other. (Explain in Section III)
PART B
Award to SOLE SOURCE (Check box below)
Onlyknownsourceintheworld.(Explain technical or other reasons why similar or like items
are not available for cost/price analysis in Section III.)
(SECTION II) ESTABLISHMENT OF PRICE REASONABLENESS
Analysisofofferand/oroffershasdeterminedthatthepriceproposedisdeterminedto
befair,reasonableandinthebestinterestsoftheUniversitybasedonthefollowing:
 Priceobtainedwasfromacatalogorstandardpricelistregularlymaintainedbythe
vendorcoveringstandardcommercialproductssold.(Attach copy of vendors price list.)
Priceobtainedincludesadiscountfromcurrentlistprices.(Attach copy of quote showing
list price and net price paid.)
Other.(Explain Below.)
(SECTION III) EXPLANATION
(Use additional sheet if needed)
SECTION IV AUTHORIZATION/APPROVALS
Department_______________________________Requisition/OrderNumber________________________
AuthorizedSignature___________________________ContactPhoneNumber_______________________
PrintedName______________________________ContactE-mailAddress__________________________
PurchasingAuthorization:Signature_______________________________________Date______________
Single/Sole Source Justication Form Page 2
Procurement Office Use Only
PO NUMBER _____________________________ DATE _____________________
Indicate any savings made available from the sole or single source vendor.
List Price
Net Price
Savings
Buyer Comment:
Buyer Date
Manager Date
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