Single/sole Source Justification (Ssj) Form printable pdf download

Single/sole Source Justification (Ssj) Form

Single/Sole Source Justification (SSJ)

This form must be used as justification for a purchase from a single or sole source

without open competition when the purchase is $10,000.00 or above. S.S.J.s are not to be

utilized to circumvent normal purchasing procedure. They are to be used only as an

exception when all attempts to pursue competitive purchasing practices have failed.

Acceptance of this request will be at the discretion of Purchasing Services. Pricing is not

a justification for a single or sole source purchase; competitive pricing should be obtained

through Purchasing Services.

The following statements, in my professional judgment, are correct. I have

researched/investigated my requirements to support these findings. I also certify that no

personal advantage, gain or privilege has (or will) accrued to me through the purchase

from this vendor. I have reviewed the vendor’s proposed costs and find those costs fair

and reasonable for the technical effort proposed.

Investigator’s name/signature: _______________________________________________

Title: ___________________________________________________________________

Date: _________________________

Phone: _____________________________

Electronic Document #: _________________________

Briefly describe the product/service you are requesting and its function.

Please select the category (or categories) that best describe your single/sole source

requirement. Answer and/all of the questions pertaining to that category.

Note: It is not required to complete all categories below. Complete only those that are

applicable.

‫ ڤ‬A. Compatibility to existing equipment, research, methodology, or training:

With what other material must this requirement be compatible?

What is the approximate dollar value of the existing material?

What are the unique properties that make this the only product compatible

with existing material or research?

Provide any other supporting information, if applicable.

8/2/04

Single/sole Source Justification (Ssj) Form