Single/Sole Source Request Form
To help make things easier, we would like to implement the form below using gmail for single/sole source requests and alleviate the paper form process. The form is designed to meet state purchasing regulations. The form includes links to other web pages for additional guidance.
INSTRUCTIONS: Copy and past the form below into an e-mail, complete the form, and send the e-mail to the Superintendent or Business Administrator for approval. This should take the place of using a paper form and hopefully help speed up the process. Please be aware your sole source purchase request must include one of the justifications that state purchasing code allows for (see below). Any request that does not include a justification allowed by law (see below) cannot be granted.
Thanks
SINGLE/SOLE SOURCE PURCHASING REQUEST
Beaver County School District
INSTRUCTIONS: Prior to obligating the District or your school for any single/sole source purchase of $1,000 or more (waiver of competitive purchasing process), personnel must first complete this form and submit it to the Superintendent or Business Administrator for approval along with applicable documentation. A single/sole source request is appropriate only if a purchase requirement is reasonably available from a single or sole source provider or if it otherwise is justified under state compliance regulations.
Estimated Cost:
Recommended Supplier:
Supplier Contact Information (Name, Address, Phone, Fax, E-mail, etc.):
SINGLE/SOLE SOURCE JUSTIFICATION: Single/Sole source request is based upon the following as allowed by state regulations. Please identify in your e-mail request which of the following apply and provide supporting explanations and information.
Compatibility of equipment/service: Please provide manufacturer name, make, model #, etc. of existing equipment this purchase must be compatible with. What is the remaining life expectancy of the existing equipment? What is unique about the product/service to justify sole source purchase? Could the product/service be reasonably modified to allow for competition? Please explain why the transitional or compatibility costs are prohibitive to change to a different product/service. Provide the names and contact information of the suppliers contacted to see what competitive options are available.
Trial or Testing: Why is the trial or testing necessary? What is the anticipated end result of the trial or test? Do any other suppliers provide this product or service? What criteria were used to choose this supplier? What are the scope/size, duration, and location of the test or trial? The trial/test may not exceed 18 months; please explain the details regarding the trial/test period.
Equipment /service is only available from a single/sole source supplier in U.S.: What is unique about the product/service to justify sole source purchase? Could the product/service be reasonably modified to allow for competition? Provide the names and contact information of the suppliers contacted to explore the competitive options available.
Condition of Donation or Fundraiser: The purchase is related to a condition of a donation that will fund the full cost of the supply, service, or item. Please explain the details.
Ethics Disclosure: Are there any employee conflicts of interest you are aware of in relation to this request? If "yes", please explain.
REFERENCES: