CITY OF FONTANA
NON-COMPETITIVE SOURCE SELECTION JUSTIFICATION
Contract/Req. No.: Amendment No.: Requestor: Date:
Pre-Tax Amount: $ Tax: $ Freight: $ Total Amount: $
Vendor Name:
FUNDING SOURCE AND AUTHORIZATION (check as applicable)
City Resources Gov’t Grant Other
Certifications: Debarment4 Anti-Lobby5
Certificate(s)
Attached
Not
Applicable
Fund: Org Account:
Equipment Screening6: Yes Not Applicable Title Vests: - Purchase Description:
1. Source Selection - Competition is impracticable (Check appropriate box):
UNAVAILABLE FROM ANY OTHER SOURCE. No competitive advantage would be gained from competitive pricing, such as when equipment, goods, materials, supplies, personal property, or services are unique and are only available from one source. (Explain below. Include all contacts made to verify the sole source or single source situation.) COOPERATIVE PURCHASING AGREEMENT. This product or service required is being purchased under a cooperative purchasing agreement. (Explain below).
SAME PRICE PURCHASED BY ANOTHER PUBLIC AGENCY. The product or service required was awarded a bid by another public agency that has purchasing procedures substantially similar to those that the city would have been required to use, and the vendor offers the same price(s) to the city that it offered to the other agency.
EMERGENCY. This product or service required is due to an emergency, determined by the City Manager, which could not have been anticipated and critical need precludes any form of competition. (Purchases more than $100,000 must be presented at the next regular City Council Meeting for ratification by the City Council. Please attach supporting documentation and approval from City Manager).
OTHER REASON(S). (Explain below).
Detail information to support above justification(s):
4 Applies to purchases under a Federal Grant equal to or more than $25,000 5 Applies to purchases under a Federal Grant equal to or more than $100,000 6 Applies to
equipment purchases under a Federal Grant equal to or more than $10,000
2. Price/Cost Analysis (ONLY APPLICABLE TO PURCHASES/CONTRACTS THAT EXCEED $100,000):
The action taken in verifying price reasonableness is indicated below. Identify the method(s) listed below used to verify price reasonableness. Check one or more paragraphs below as applicable.
Current price schedule (verifiable catalogue, published price list, etc.) Schedule Name/No.: Unit Price: $
Supplier Contact: Date of Schedule:
Previous purchase.
Supplier: Unit Price:
PO No.: PO Date:
Similar item in related industry.
Price Source: Unit Price:
Supplier: Date:
Any other Reasonable basis:
3. Small Business’ Solicited (Federally Funded Procurements Only) Document whether Small Business, HUBZone Small Business, Small Disadvantaged Business, Women Owned Small Business or Service Disabled Veterans Owned Business or Veterans of Vietnam Era Owned Business concerns were solicited and, if not, why not.
Applicable Businesses’ referenced above were solicited.
No Applicable Businesses referenced above were solicited because ---------------------Attach additional sheets as needed----------------------