ࡱ> npm_ bjbjjj 4^,b,b  @@8llVD$$$$-+-+-+CCCCCCC$JFIC-+*@-+-+-+C@@$$D+++-+^@R$$C+-+C++e@" B$PIi +( AC&D0VDAI+I, BI B-+-++-+-+-+-+-+CC+-+-+-+VD-+-+-+-+I-+-+-+-+-+-+-+-+-+ B : BEMIDJI STATE UNIVERSITY & NORTHWEST TECHNICAL COLLEGE GOODS AND SERVICES SOLE SOURCE JUSTIFICATION FORM Use this form to request and verify sole source status for the purchase of goods above $10,000.00 or services above $10,000.00. Do not proceed with purchase unless approval is received. If the request exceeds $100,000.00 contact the Director of Procurement to initiate the process to seek MnSCU approval to exceed $100,000.00. NOTE: The following are UNLIKELY to be sufficient sole source justifications: Personal or department preference for a product or vendor. Perception that the product is the best choice or the vendor is the best qualified (should be determined by a competitive process). Lack of planning resulting in limited time to conduct a competitive procurement. Past or existing relationship with the vendor. Special incentive or deal offered (can be assessed in open and competitive solicitation). Convenience. Requester: _______________________________ Phone: ___________________________________ Email: ___________________________________  Department:_______________________ College:__________________________  Specifications of Goods or Services Requested (attach additional page if needed):  Proposed Vendor: _________________________ _________________________________________ _________________________________________ Phone: ___________________________________ Email: ___________________________________ Website:___________________________________ Date of Firm Written Quote from Proposed Vendor: ____________________________ Amount of Firm Written Quote from Proposed Vendor: $__________________ Firm written quote must be attached. Search  SEQ CHAPTER \h \r 1Minnesota Statute 16C.02 subdivision 18 states: Single source means an acquisition where, after a search, only one supplier is determined to be reasonably available for the required product, service, or construction item. A search was conducted consisting of: (check all that apply) Market research Internet search or research Other vendors contacted Public notice given, list method : __________________________ OtherResults of Search ( no alternatives were identified ( no alternatives were deemed acceptable because (explain below):Describe the above search in detail:  Price  SEQ CHAPTER \h \r 1Minnesota Statute 16C.10 subdivision 1 states: The solicitation process described in this chapter is not required when there is clearly and legitimately only a single source for the goods and services and the commissioner has determined that the price has been fairly and reasonably established. Price has been fairly and reasonably established by: ( Comparison to previous comparable purchases ( Market survey ( Comparison to public sector contract pricing ( Independent estimate ( Discount off published catalog pricing ( Other, explain: Describe methodology and results related to price (attach any written supporting data, e.g., survey or market analysis):  Certifications by requester and approver (Dean / Director / Vice President) I certify: I recognize that state law requires the use of competitive solicitations unless exempted by law. I have reviewed the information and materials relevant to this procurement of goods and services, and I am requesting approval of an exception to the competitive process for the reasons described; The price to be paid to the proposed single source vendor is fair, reasonable, and provides the best value to MnSCU. This request for an exception to the competitive solicitation process is not the result of inadequate advance planning or for purposes of securing the products or services of a preferred vendor.  1. Person Requesting Sole Source Status (all information required) Signature: ____________________________________________ Date: _______________ Name: ______________________________________ Title: ______________________________________ Phone: _____________________________________ Email: _____________________________________  2. Approval by appropriate Dean/Director/Vice President (all information required) Signature: ____________________________________________ Date: _______________ Name: ______________________________________ Title: ______________________________________ Phone: _____________________________________ Email: _____________________________________  3. Procurement & Logistics Decision ( Approved. You are given one-time special permission for this Sole Source acquisition. ( Denied. Reason: ____________________________________________________________ Signature: ____________________________________________ Date: _______________ Director of Procurement & Logistics 218-755-2043      Has a sole source status been approved for this purchase and vender in the past? 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