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7 <br /> REQUEST FOR SOLE SOURCE <br /> To: Purchasing Office , <br /> From: /61%.—t <br /> fl? s��•, / �a i~ �`'l r1 <br /> Name of Department Head Dept./Division <br /> • <br /> Subject: Sole Source Request for the Purchase Of: aN1/4L-'2- {{�� 646 s`:,u-�. <br /> J3 a, �.rCIC, 5' .16.2.01-•••• <br /> REQUESTED SUPPLIER: :,- O �C <br /> REQUISITION NUMBER: - / 1' 7 COST ESTIMATE: r loenj 06 O ± <br /> • <br /> Sole source purchases are defined as clearly and legitimately limited to a single supplier. Sole source • <br /> purchases are normally not allowed except when based upon strong technological grounds such as <br /> operational compatibility with existing equipment and related parts or upon a clearly unique and cost <br /> effective feature requirement. The use of sole source purchases shall be limited only to those specific <br /> instances which are totally justified to satisfy compatibility or technical performance needs. <br /> STATEMENT OF NEED: <br /> My department's recommendation for sole source is based upon an objective review of the product/service <br /> required and appears to be in the best interest of the City. I know of no conflict of interest on my part or <br /> personal involvement in any way with this request. No gratuities,favors or compromising action have taken <br /> place. Neither has my personal familiarity with particular brands,types of equipment, materials or firms <br /> been a deciding influence on my request to sole source this purchase when there are other known suppliers to <br /> exist. <br /> Refer to the attached sole source justification as prepared by our department, to the attached review of <br /> available products/services and to my completed Purchase Requisition. <br /> Requestor Department He <br /> i <br /> Appro_ ed ❑Rejected <br /> BftefrepSi / .414 r tt3 / y-/6-r3_ <br /> SignofRequestor Date Signature ofDep He Date <br /> l/ ,dccas, -t►r-f��. <br /> • <br /> If Purchase is$10,000 or more: If Purchase is$50,000 or more: <br /> Purchasing Manager - Attorney <br /> • <br /> Approved ❑Rejected • ` I..••ved ■ ' ected <br /> / 4211 <br /> i . of Purchasing Manager Dare S' -of City Attorney a, <br /> • <br /> sJ#common/forms/sole <br /> 21 <br />