ࡱ> O krbjbj4)4) 4~VCeVCe"%|d d 8DRL&!)K+K+K+K+K+K+K$xN.QZOK###OKH L(((#F)K(#)K((RF<HP " 2$4?GK"L0RL]GRf$R<HHnRQI!h!J(E"<"k!!!OKOK\&>!!!RL####R!!!!!!!!!d o: Purpose of this form: To communicate and document the reason for recommending a supplier where (a) competitive bidding was not used or (b) competitive bidding was used and a supplier other than the lowest bidder is recommended. Description of Product and/or Service:  FORMTEXT       Name of Supplier:  FORMTEXT       Date:  FORMTEXT       Please select the reason for recommending the above named supplier:  FORMCHECKBOX  The requested product is an integral part or accessory to existing equipment.  FORMCHECKBOX  The service requested is for existing equipment, which can only be completed by the original manufacturer, or a manufacturers designated service provider.  FORMCHECKBOX  The requested product or service has unique design, performance, and/or quality specifications that are essential to a particular research protocol or teaching needs and are not available in comparable products.  FORMCHECKBOX  The requested product or service is essential in maintaining research continuity in the following manners (check all that apply).  FORMCHECKBOX  Requested product is being used in continuing research experiments  FORMCHECKBOX  For comparability of research results, I require the same product  FORMCHECKBOX  This good/service has been identified and approved in this research grant contract Grant Source: FORMTEXT       Grant Number: FORMTEXT        FORMCHECKBOX  The requested service requires a supplier that can demonstrate unique skills or experience.  FORMCHECKBOX  The selected hotel, event location, or conference space is either the best available choice for the dates selected or the most convenient location.  FORMCHECKBOX  The selected caterer is either the best value available or one of the exclusive caterers for an event location.  FORMCHECKBOX  Only one supplier is capable of providing supplies or services.  FORMCHECKBOX  A federal agency has expressly authorized a sole source supplier based upon a written request from the University. (Attach copy of written authorization.)  FORMCHECKBOX  Emergency The goods or services are needed to correct or prevent an emergency health, environmental or safety hazard; special or time sensitive events; and/or emergency repair or replacement of existing equipment essential for daily operations. Please note - in accordance with the federal governments Uniform Guidance, all requests using federal grant funds for over $250,000 to purchase through a directed or sole source will require a detailed cost breakdown from the supplier including the requested profit. Additional Information (Required Irrespective of Reason Selected): Please explain why other suppliers were excluded from the evaluation. Attach additional sheets if necessary.  FORMTEXT       If compatibility with existing equipment is your reason for recommending the supplier, provide the following information about the existing equipment. Description: FORMTEXT       Manufacturer & Model No.:  FORMTEXT       Other Suppliers Contacted: Note all other suppliers considered for this product or service. Include the reason why the product or service was not acceptable. Attach additional sheets if necessary. Supplier: FORMTEXT       Contact Name & Phone #: FORMTEXT       Product/Service Description: FORMTEXT       Technical Deficiency: FORMTEXT       Supplier: FORMTEXT       Contact Name & Phone #: FORMTEXT       Product/Service Description: FORMTEXT       Technical Deficiency: FORMTEXT       Authorization  FORMTEXT       Printed or Typed Name, Title, and Department of Dean, *Department Chairperson, or Department Director x Signature of Dean, *Department Chairperson, or Department Director *Division Chiefs from the Departments of Medicine and Pediatrics may also sign as approvers.  FORMTEXT       Printed or Typed Name of Requester x Signature of Requester I certify that I am in compliance with the Universitys conflict of interest policies 07-05-02, 07-05-03 and 11-01-03. I have no potential conflicts to disclose and understand and accept my obligation to disclose in a timely fashion any interest a Related Person or I may have in a proposed University transaction. The above information is an accurate and current statement of all my reportable outside interests and activities, to the best of my knowledge. For Purchasing Services Department Use Only Reviewed by:  FORMTEXT      ________________________ Date of Review: FORMTEXT       Approved:  FORMCHECKBOX Yes  FORMCHECKBOX  No Reason for denial: FORMTEXT        FORMCHECKBOX  Need additional information before a decision can be made. Information needed: FORMTEXT        University Policies: University of Pittsburgh Policy 05-02-17 permits, under certain conditions, purchases of goods or services from a directed or sole source without soliciting bids from multiple sources. The University recognizes that special circumstances may not support the use of competitive bidding. In these situations, directed or sole source purchases may be an acceptable alternative. Directed or sole source purchases are an exception to the ձһƬ Competitive Bidding Policy, and must always be in writing. The Purchasing Services Department will approve a directed or sole source purchase on a case-by-case basis. Definitions: Directed source is a term used to designate that a product or service must, for specific and justifiable reasons, be purchased from one specified supplier. Directed source procurement may be used when one of the following conditions exists: The requested product is an integral part or accessory to existing equipment. The service requested is for existing equipment which can only be completed by the original manufacturer or manufacturers designated service provider. The requested product or service has unique design, performance, and/or quality specifications that are essential to a particular research protocol or teaching needs and are not available in comparable products. The requested product or service is essential in maintaining research continuity. The requested service or system requires a supplier with unique skills or experience. Sole source is a term used to designate that only one supplier exists that is capable of providing a particular product or service. Process: The Directed or Sole Source Justification Form shall accompany any request for a purchase from a Directed or Sole Source where: the purchase exceeds $10,000, and the purchase is not covered by an existing contract or price agreement. Furnish the necessary explanation and documentation as noted on the form. 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Forward the form and supporting documentation to the Purchasing Services Department for review and approval. Evaluation: For directed and sole source purchases, University departments are responsible for evaluating alternative sources of supply and documenting the reasons that the purchase will be directed to a particular supplier or service provider when alternative sources are available. University departments also are responsible for verifying that prices paid for directed and sole source purchases are fair and reasonable. Under no circumstances shall a supplier be advised that a contract will be awarded on a directed or sole source basis before approval by the Purchasing Services Department. Purchasing Services determines whether a directed or sole source justification is reasonable based on one or more of these criteria: The requestor has investigated and documented his/her evaluation of potential alternate sources of supply for the requested product and/or service. The requestors documentation explains how similar products and/or services cannot meet the required specifications. The requestor has documented that a good faith effort has been made to identify other sources. If the purchase meets the criteria for Directed or Sole Source, a representative from the Purchasing Services Department will authorize the purchase. If the purchase does not meet the criteria or the Purchasing Services Departments representative needs additional information, the Purchasing Services Department will note that on the Directed or Sole Source Justification Form and return the form to the requesting department Exclusions: Guest speakers, honoraria, subscriptions, dues, memberships and other similar items will be treated as sole source, and do not require sole source justification documentation. Requirements for Federal Research Grants and Contracts Research grants and contracts from the Federal government have additional contractual requirements related to purchasing. Research Administrators and Principal Investigators are responsible for identifying and complying with any additional purchasing provisions, such as the Uniform Guidance (2 CFR 200) and Federal Acquisition Regulations, that may be included in the terms of their research grants and contracts. 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