<p> SOLE SOURCE PROCUREMENT APPROVAL REQUEST</p><p>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.</p><p>Department:</p><p>Requisition Number Department </p><p>Signature and Date </p><p>Print Name of Department Head </p><p>Office of Procurement: Submitted by Buyer for approval: SS#: </p><p>Up to $10,000 – Approval by Buyer</p><p>Exceeds $10,000 and up to $50, 000 – Approval by Director of Procurement</p><p>Exceeds $50,000 - Recommend approval (Forward to Vice President for Administration)</p><p>Recommend rejection (Return to department)</p><p>More information needed (Specify and return to department)</p><p>Signature and date </p><p>Print Name Gregory W. Johnson, Director of Procurement </p><p>Vice President:</p><p>Approved </p><p>Rejected </p><p>Signature and date: </p><p>Revised 2/12 Anna B. Martin, Vice President for Administration</p><p>Revised 2/12 SOLE SOURCE JUSTIFICATION</p><p>1. EXPLAIN WHY THIS IS THE ONLY PRODUCT OR SERVICE THAT CAN MEET THE NEED OF THE DEPARTMENT.</p><p>2. EXPLAIN WHY THIS VENDOR IS THE ONLY PRACTICABLE AVAILABLE SOURCE FROM WHICH TO OBTAIN THIS SERVICE. </p><p>3. EXPLAIN WHY THE PRICE IS CONSIDERED REASONABLE.</p><p>4. DESCRIBE THE EFFORTS THAT WERE MADE TO CONDUCT A NON-COMPETITIVE NEGOTIATION TO GET THE BEST POSSIBLE PRICE FOR THE TAXPAYERS.</p><p>Revised 2/12</p>