CSU LONG BEACH SOLE SOURCE / BRAND APPROVAL REQUISITION NUMBER: ________________________________________ DATE: ________________________ Please fill in the following information. See reverse side for instructions. (Attach a separate page if room is not sufficient.) DEFINITIONS SOLE SOURCE: Item is available from only one vendor. Item is one-of-a-kind and is not sold through distributors. Manufacturer is sole distributor. SOLE BRAND: Various vendors can supply the specified model and brand and competitive bids will be solicited for the request brand only. This is a request for (please check one only): SOLE SOURCE SOLE BRAND 1. What are the unique performance features of the product or brand requested that are not available in any other product or brand? (For services: What are the unique qualifications this vendor possesses?) Identify specific, measurable factors/qualifications. 2. Why are the unique features/qualifications required? 3. What other brands/services were evaluated, rejected and why? Provide brand name, model, vendor name and contact, date contacted and prices quoted. A minimum of three suppliers must be surveyed and the results noted below. 4. To match or "intermember" is not normally an acceptable justification for sole brand. If you determine this is a factor which should be considered, the quantity, manufacturer, brand, model, State property ID number of the existing equipment, and necessity for "interfacing" must be provided below. CERTIFICATION: I am aware of the State requirements for competitive bidding and the established criteria for justification for sole source/sole brand purchasing. As an approved department representative, I have gathered the required technical information and have made a concerted effort to review comparable/equal equipment. This effort is documented in this justification. I hereby certify as to the validity of the information and feel confident that this justification for sole source/sole brand procurement meets the States criteria and withstand an audit by the State Auditor General, or a vendor protest. The following procedures have been followed to justify this purchase: 1. Unique performance factors have been specified 2. Statement as to why they were required 3. Other products have been evaluated against the unique performance factors identified in line one (1) , if applicable, and reasons for rejection stated Please complete #1 and #2 below and forward to Purchasing with your requisition. 1. REQUESTOR:______________________________________ DEPARTMENT: ____________________________________________ 2. _____________________________________ ______________________________________ _________________________ 3. _____________________________________ ______________________________________ _________________________ Print Name Date ______________________________________ _________________________ Print Name Date ______________________________________ ________________________ Signature (Division Executive or Designee - Level 4*) Print Name Signature (Director of Purchasing) 4. _____________________________________ Signature (Assoc. Vice President, Financial Management) 5.______________________________________ Signature (Vice President, Division of Administration and Finance) Print Name Date Date Reset Form INSTRUCTIONS FOR COMPLETING A SOLE SOURCE/BRAND DOCUMENT This form must be completed when a request is made for a non-competitive purchase and the specifications limit the bidding to one source and/or one brand or trade name, the ordering department must include a written justification containing the following information: a. The unique performance factors of the product specified. b. Why these factors are required. c. What other products have been evaluated, rejected, and why (Attach market survey: list of vendors contacted including their names, addresses and phone numbers and price quotes, a minimum of three vendors must be contacted; reference: Government Code 14781, 14807 and PCC 10301.) If the justification submitted is not sufficient, the requisition will be returned to the ordering department requesting additional information. Submission of this justification form does not indicate automatic approval. It is not approved until all appropriate signatures are obtained. *Please see the Signature Authority Guidelines for more information. Should the campus Purchasing Department and the ordering department fail to agree that the non-competitive purchase request is justified, a meeting will be held between the Procurement and Support Services Offices, and Department Head/Division Manager or the Dean. Should the matter still be unresolved, the final decision will be made by the Associate Vice President for Financial Management. You should be aware that in the event of a protest, the individuals signing the certification on the justification form may be required to provide further proof of the validity of the justification and, if necessary, appear personally at the State Board of Control hearing. If the State should determine that California State University, Long Beach, has not adhered to appropriate State policies, all purchasing authority delegated to the campus could be revoked and appropriate disciplinary action taken.