CITY OF FONTANANON-COMPETITIVE SOURCE SELECTION JUSTIFICATIONContract/Req. No.: Amendment No.: Requestor: Date:Pre-Tax Amount:$Tax:$Freight:$Total Amount:$Vendor Name:FUNDING SOURCE AND AUTHORIZATION (check as applicable)City ResourcesGrant OtherCertifications: Debarment4Anti-Lobby5Certificate(s)AttachedNotApplicableFund::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, suchas 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 cooperativepurchasing agreement. (Explain below).SAME PRICE PURCHASED BY ANOTHER PUBLIC AGENCY. The product or service required was awarded a bid byanother 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 havebeen anticipated and critical need precludes any form of competition. (Purchases more than $100,000 must be presented at the nextregular City Council Meeting for ratification by the City Council. Please attach supporting documentation and approval from CityManager).OTHER REASON(S). (Explain below).Detail information to support above justification(s):4Applies to purchases under a Federal Grant equal to or more than $25,000 5Applies to purchases under a Federal Grant equal to or more than $100,000 6Applies to equipment purchases under a Federal Grant equal to or more than $,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 pricereasonableness. 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.SmallSolicited (Federally Funded Procurements Only)Document whether Small Business, HUBZone Small Business, Small Disadvantaged Business, Women Owned Small Businessor Service Disabled Veterans Owned Business or Veterans of Vietnam Era Owned Business concerns were solicited and, if not,why not.Applicablereferenced above were solicited.No Applicable Businesses referenced above were solicited because---------------------Attach additional sheets as needed----------------------