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al <br /> REQUEST FOR SOLE SOURCE <br /> To: Purchasing Office <br /> From: Dave Davis /Public`Works/ Utilities <br /> Name of Department Head Dept./Division <br /> Subject: Sole Source Request for the Purchase Of: <br /> Bioxide GL 7830002 <br /> REQUESTED SUPPLIER: Siemens Water Technologies <br /> REQUISITION NUMBER: 1-Zpi 06-7 q S COST ESTIMATE: 250,000.00 <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 Head <br /> ,I Approved ❑Reject d <br /> _Ricky O ••• e�j / _/ 3-29-2011_ i/,.,,I l /41 / , (� <br /> Sign.- e o� r r / Da "gna'.i4- of D :'!Head Date <br /> �� - /AT 3/ i <br /> If Purchase is$10,000 or more: If Purchase is$50,000 or more: <br /> Purchasing Manager City Attorney <br /> 0 Approved <br /> Rejected pproved [1:1Rejected <br /> 1�JI r�� l 1 . 2LO l / _ <br /> m rrh-d o-mr hasing Manager Date Signature of City Attorney ate <br /> S:\ROsbome\Purchace items\Bioxide Sole Source 3-2011.docx <br />