Title:
E-mail:
VENDOR INFORMATION
PRODUCT / SERVICE REQUESTED
Estimated Price: $
Yes No
APPROVED BY
PURCHASING DIVISION ACTION
Approved Denied Date:
Reason:
By:
Manufacturer Name:
Manufacturer Part Number (if applicable):
Description of Services (if applicable):
Justification for Selection of Vendor:
SOLE SOURCE SINGLE SOURCE
Fully completed forms must be submitted to and approved by Purchasing before a PO or Contract may be issued.
The form needs to have been fully completed by requesting department and approved by Purchasing prior to seeking Council authorization for waiving competitive bidding on the grounds of sole/single sourcing.
Vendor Name:
Address:
Contact Name:
Phone Number:
Department Head Signature:
Requires Council Approval?
Approval Date:
____________________ _____________