Sole Source Procurement Approval Request

SOLE SOURCE PROCUREMENT APPROVAL REQUEST

All requests for sole source procurements in excess of $50,000 must be approved by the President or the President's designee, as well as meet the criteria established under the Code of Virginia, § 2.2-4303.E. This form must be signed by the department head. In addition, the department head must: (1) assign an identifying number to the request, (2) attach a brief description of the good or service, and (3) attach the justification for the sole source request.

Department:

Requisition Number Department

Signature and Date

Print Name of Department Head

Office of Procurement: Submitted by Buyer for approval: SS#:

Up to $10,000 – Approval by Buyer

Exceeds $10,000 and up to $50, 000 – Approval by Director of Procurement

Exceeds $50,000 - Recommend approval (Forward to Vice President for Administration)

Recommend rejection (Return to department)

More information needed (Specify and return to department)

Signature and date

Print Name Gregory W. Johnson, Director of Procurement

Vice President:

Approved

Rejected

Signature and date:

Revised 2/12 Anna B. Martin, Vice President for Administration

Revised 2/12 SOLE SOURCE JUSTIFICATION

1. EXPLAIN WHY THIS IS THE ONLY PRODUCT OR SERVICE THAT CAN MEET THE NEED OF THE DEPARTMENT.

2. EXPLAIN WHY THIS VENDOR IS THE ONLY PRACTICABLE AVAILABLE SOURCE FROM WHICH TO OBTAIN THIS SERVICE.

3. EXPLAIN WHY THE PRICE IS CONSIDERED REASONABLE.

4. DESCRIBE THE EFFORTS THAT WERE MADE TO CONDUCT A NON-COMPETITIVE NEGOTIATION TO GET THE BEST POSSIBLE PRICE FOR THE TAXPAYERS.

Revised 2/12