Bid Waiver Selection Form

Waiver of Advertising Request Form

This form is to be used to document the Board Action item proposed for the acquisition of Goods and Services greater than the public bid limit of $32,100, and must be used for State and General Service Administration Contracts over $500,000 in accordance with Procurement Policies and Procedure. Submit this form along with all documentation to Procurement Services, 855 Valley Road, Suite 112, Clifton, NJ 07013. Date: Requested by: Department: Background Range of Quoted Prices:

Purchasing Method Used: RFP Waiver of Advertisement. For list of Waiver Categories, please see Procurement Policies and Procedures Manual, Procurement Methodology section D, http://www.montclair.edu/media/ montclairedu/financetreasurer/forms/procurementforms/Procurement_Policies.pd f References Checked:

[Name]

[Name] Supplier Selected:

Amount:

Please attach sufficient information about each procurement including the price list for all bids and date the RFQ/RFP was received. Include names and titles of the Evaluation Committee members, if applicable. In addition, provide the reason for a bypass of the low bidder, if applicable. For Construction/ Information Technology project, provide a detailed description and the timeline of each project.

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Sufficient Funds have been budgeted and will be available for this Procurement from Account #:______The following must be attached: (1) Scope of Services sent to potential Bidders; (2) All proposals received; (3) A statement describing the reasons for selecting the proposed supplier; (4) The proposed supplier’s signed acceptance of the Standard Contract Terms and Conditions; (5) If applicable, a copy of the selected supplier’s MBE, WBE and/or SBE certification(s) (6) Supplier’s Affirmative Action Certificate or completed AA302/201 form. Both the Affirmative Action language and AA form must be obtained from suppliers who do not currently hold an AA certificate. Links to all forms can be found on the Procurement Service’s Website under Supplier: http://www.montclair.edu/finance-and-treasury/procurement/forms/

For additional details, please review Procurement Policy/Procedure# 1, page 5, section 11 15, http://www.montclair.edu/media/montclairedu/finance treasurer/forms/procurement forms/Procurement_Policies.pdf APPROVALS

SIGNATURE: ______Requester Date

SIGNATURE: ______Fiscal Agent (if different than above) Date

SIGNATURE: ______VP/ Dean Date

SIGNATURE: ______VP for University Facilities (if applicable) Date

SIGNATURE: ______VP for Information Technology (if applicable) Date To Be Completed by Procurement Services: Request/Explanation has been reviewed and complies with state and university policies for waiver of Yes No advertising: Applicable Waiver Category: ______

Procurement Approval: Date:

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