PROC|DAS Sole Source Procurement Justification Form | Iowa Department of Administrative Services

1) Has this item(s) already been purchased? *

No

Yes

2) Has the vendor ever been an employee of the State of Iowa? *

No

Yes

2) Has the vendor ever been an employee of the State of Iowa? Yes

If yes, please explain the nature of the employment and period of service.

3) What is the item, and what function does it serve? *

4) Explain why the recommended vendor is the only one qualified to provide the requested item(s) at the exclusion of all others, i.e. what makes this vendor uniquely qualified? *

5) Describe the research that has been completed to insure that no other competition exists. Provide names of vendors contacted who are unable to provide the item(s) or perform the service. *

6) Have you requested a contract with the vendor at any time during the past twelve months? *

No

Yes

6) Have you requested a contract with the vendor at any time during the past twelve months? Yes

If yes, please describe the item(s) provided and the amount agreed to be paid.

7) How did you determine that the vendor's price was reasonable? *

8) Which of the following best describes this sole source procurement? You may select more than one. *

One vendor is the only one qualified or eligible or is quite obviously the most qualified or eligible to provide the good. (Must state how determined.)

The procurement is of such a specialized nature or related to a specific geographic location that only a single source, by virtue of experience, expertise, proximity, or ownership of intellectual property rights, could most satisfactorily provide the good. (Must state how.)

Applicable law requires, provides for, or permits use of a sole source procurement. (Must state restriction.)

The federal government or other provider of funds for the goods being purchased (other than the state of Iowa) has imposed clear and specific restrictions on the use of the funds in a way that restricts the procurement to only one vendor. (Must state restriction.)

The procurement is an information technology device that is systems software or an upgrade, or compatibility is the overriding consideration, or the procurement would prevent voidance or termination of a warranty, or the procurement would prevent default under a contract or other obligation. (Must state how)

If an information technology device, system, or software, has approval been received from the TCC (Technology Coordination Committee) and/or State CIO?

If procurement is over $25,000, and not a renewal of an IT software agreement or license, and is not a construction project, has IDOM approval been received?

9) Explain how this procurement fits the sole source situation(s) selected above. *

10) Please define financial impact of Approval *

11) Please define financial impact of Denial *

Your information will be sent to:
Dept of Administrative Services
Central Procurement Bureau
Hoover State Office Bldg, 3rd Floor
Des Moines, IA 50319-0105

You are here

Sole Source Procurement Justification Form

Posting Requirement for Sole Source contracts

To be completed by Requesting Agency

Search form

You are here

Sole Source Procurement Justification Form

Posting Requirement for Sole Source contracts

To be completed by Requesting Agency