Justification for Sole Source/Proprietary Purchase | Form Vendor Information: Name Address, City, ST, Pin Phone # E-Mail I |Short Description of Product or Service and land price [Type of Justification: 1D Sole Source: Proprietary: REQUIRED: =| Oe ___ For the purpose of this form, the particular item or service is available from only one supplier (usually the manufacturer) is unique and no other product will be suitable or acceptable to meet the need ‘Attach a signed lellerhead quotation and declaration of sole source from the Supplier [a proprietary purchase is considered competitive and the solicitation shall include language indicating the purchase has been approved as proprietary and not invite bids for equal products. (Attach proprietary certificate) a Known Distributors 1D Standardization 1D Maintainabitty 3 Other [Additional Informatior O __Altach Price Justification [Please attach at least two Purchase Order of the |material supplied by the supplier at similar lower price| lelsewhere in suppor of the prices offered in the |certicate Explain briefly how ONLY the product or service above can meet your needs (TIP: of the rationale(s) selected above): identify what other products or services have been investigated to meet this need (include mfg. and model Ihumber where appropriate): Briefly explain why and how other products investigated are ting your needs: Ipc Chairman - PCD Registrar Vice Chancellor SS ee