Page | 1 Sole Source Form – Rev. May 12, 2016
City of Richmond
Sole Source Justification
THIS FORM MUST BE COMPLETED AND APPROVED PRIOR TO ANY PURCHASE _______________________________________________________________________________ Contact the Purchasing Division and discuss your rationale before completing this form. If Purchasing can help you make this a competitive purchase, then this form will not be required.
Attach this completed/approved form to requisitions when competitive quotes/bids/proposals are not solicited. (Required for requisitions > $3,000)
Requested Sole Source Supplier:
Company Name: ___________________________ Contact Name: ______________________ Address: _______________________________________________________________________ City: _________________________ State: _____________ Zip Code: ____________________ Phone Number (____) ___________ E-Mail _______________________________________ Duration of Contract: ____________________________________ Estimated Cost: $ _______________ Funding Source (Account String)_________________ Is the product/service IT related? Yes_____No _____ If Yes, please attach the approved IT Authorization Form For Product: Is the recommended company the manufacturer of the product? Yes_____ No _____ For Product: Does the manufacturer sell the item(s) through distributors? Yes_____ No _____ Description of Product or Service:
Describe the full scope of work or service contemplated including installation if required; items should include brand, model and part number if applicable; (if additional space is needed, include them in a separate page)
Sole Source Rationale: PLEASE ANSWER ALL THE FOLLOWING QUESTIONS: Explain why the recommended company is the only company that can meet the requirement. Address the following: Are there any other companies who can do this job? What condition (e.g. technological superiority, or performance risks, etc.) exists so that the recommended company has a significant advantage over any other company who can do this job? It is important to sufficiently address the key reason for awarding an order/contract without soliciting competitive bids. The rational must be clear and convincing, avoiding generalities and unsupported conclusions.
(if additional space is needed, include them in a separate page)
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Complete the following checklist
A specific contractor is the only source of the required item because (check all that apply):
The required items are proprietary to the Contractor, and contractor solely transacts (sells) direct to the customer. (There are no dealers or distributors for contractor).
The required items are proprietary to the Contractor, and contractor does not sell direct to the customer. Contractor solely distributes the item or service through only one dealer or distributor in the United States. (There are no dealers or distributors for contractor).
Note: If item or service is available from more than one source, the item or service may be treated as proprietary, but must be competitively solicited from multiple (two or more) sources.
A specific item is needed:
To be compatible or interchangeable with existing hardware As spare or replacement hardware For the repair or modification of existing hardware Federal or state grant names vendor as condition of funding. (Attach copy of grant that names vendor)
There is a substantial risk in contracting with any other contractor, (e.g., only one contractor has been successful to date in implementing a difficult manufacturing process or the services sought ). In a brief explanation, provide supporting evidence of why other contractors are considered to be unable to overcome the substantial risk.
Continuation of prior Work – Additional item, service or work required, but not known to have been needed when the original order was placed with vendor, and it is not feasible or practicable to contract separately for the additional need. Provide brief explanation and supporting evidence.
(if additional space is needed, include them in a separate page)
3 | Page
I acknowledge the City’s requirements for soliciting competitive quotes/bids for purchases over $3,000.00 and the criteria for justification for Sole Source purchases. I have gathered the required information, have made a concerted effort to review comparable/equal equipment/services (e.g., market research), and further affirm that there is no conflict of interest involved in the selection made.
D
epartment: _________________________________
Requester Name and Title: ____________________________________________________________ Note: Requester must be able to defend this justification.
Date:_____________ Phone: _______________
Department Director (Print) _____________________ (Sign) ________________ Date:__________ -
-------------------------------------------------------------------------------------------------------------------- Submit completed form to the Purchasing Division (Prior to submission to City Manager) Finance Director:
AP
PROVED: ____________________
NOT
APPROVED: ________________
_________
___________________
City Manager
(Under $10,000.00)
DATE: _11/_13/_24
COMMENTS:
______________________________
City Clerk Attesting to Council Approval
(Over $10,000.00) (Copy of Minutes may be substituted)
Note: Richmond Municipal Code Section 2.52.326 Sole Source Procurement requires final approval by the City Manager and/or City Council. Sole Source must be approved by Finance Director, PRIOR to Council Approval.
P
ROCEDURE
Sole Source purchase/service are exceptions to the normal bidding process and require a detailed justification. In processing Sole Source requests for supplies, services and/or equipment, the Purchasing Division adheres to and is governed by the principles set forth in City of Richmond Municipal Code Section 2.52.326 Sole Source Procurement.
If you are requesting a particular vendor, brand or product, you must make this fact clear on your Sole Source form.
Your request will then be restrictive and non-competitive, and will fall into a sole source category. If the sole source justification is approved, the requisition can be expedited without the normal bidding requirements.
Such a request should not be made unless you are confident that your request is reasonable and appropriately justified to meet the City’s requirements and withstand any possible audit. The City’s requirements and the format for submitting such requests are contained herein. Sole Source form must be signed by authorized department representative(s). The certification will remain on file for audit purposes.
The following factors DO NOT apply to sole source requests and should not be included in your sole source justification. They will not be considered and only tend to confuse the evaluation process.
1. Personal preference for product or vendor.
2. Cost, vendor performance, and local service (these are generally considered award factors in competitive bi
dding).
3. Features which exceed the minimum department requirements.
I.T. – RELATED PURCHASES AUTHORIZATION
Form must be fully completed and signed prior to information technology related purchases
Date ___________
Requested Vendor _______________________________________________ V# _____________ Vendor Address ________________________________________________________________ ________________________________________________________________ Contact Person ________________________________________________________________ Email Address ________________________________________________________________ Phone No ( ______ ) ____________________ Fax # __________________________ Quantity Item Unit Price Total _____ ___________________________________ $ ________ $ ________ _____ ___________________________________ $ ________ $ ________ _____ ___________________________________ $ ________ $ ________ Total $________
Purpose
This section must be completed with respective price quote(s) included with form:
_______________________________________________________________________________ _______________________________________________________________________________ _______________________________________________________________________________ Requested by
________________________ ________________________
Department Head IT Director
________________________ ________________________
Approval Date Approval Date
Information Technology Related – Purchase Form – Rev 5-2016
ADA (American with Disabilities Act) Compliance
Access and Accommodation
Compliance with the accessibility requirements of Section 508 of the Rehabilitation Act of 1973: In order to improve accessibility of existing technology and therefore increase the successful employment of individuals with disabilities, particularly blind and visually impaired, deaf and hard-of-hearing persons please answer the following questions:
Is this item ADA Compliant? Yes __________ No_________
If NO, please answer the following questions:
Will this item be used by the public? Yes ________ No _________ Can other vendors provide an ADA compliant product? Explain
Will this item be used by City employees? Yes ________ No _________
Categories for Information Technology (IT) Product
• Software applications and operating systems
• Web-based information and applications
• Telecommunications products
• Video and multimedia products
• Desktop and portable computers
• End user hardware
Examples of Information Technology (IT) Products
• World Wide Web
• Scanners
• Printers
• Copiers
• PDAs
• Computers
• Computer Software
• Computer Operating Systems
• Phones
• Apps
• Information Kiosks
• ATMs
• Multimedia
• Videos
• Fax Machines