Approval #
Sole Source Justification Form
It is the policy of Rowan University to procure all materials, equipment, supplies, and services through competitive
means. However, there exists a category of expenditure whereby such open bidding is not possible due to the product
or service being available from only one source. In those instances, the Procurement Department upon appropriate
justification, will act with all due diligence to obtain the product or service at the best possible price to the University.
This form must be completed with one or more categories completed in order to be forwarded to the Procurement
Department to have a sole source justification decision rendered.
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All answers must be typed or printed on this form.
All categories that apply must be completed for consideration.
Please provide full explanations, complete descriptions, and/or list all relevant reasons where space has been
provided. Forms lacking detail will be returned to the sender for further explanation before consideration.
Forms must be signed and dated.
Section 1:
Requesting Department:
Requester:
Title:
Proposed Item/Service & Description: (include any prior approvals: IT; State Certification; etc.)
Vendor/Contractor:
Total Price:
I am aware that University Procurement Guidelines require that we procure all products and services via competitive
bidding whenever feasible, practical and within the best interest of the public. I therefore request sole source
justification with this understanding.
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Section 2:
The requested product is an integral repair part or accessory compatible with existing equipment:
☐ Yes ☐ No ☐ N/A
1. Existing Equipment:
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Manufacturer/Model Number:
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Age/Current Value of Equipment:
2. Requested Equipment/Accessory/Part:
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Manufacturer/Model Number:
Explain Relationship between current equipment and requested equipment:
Section 3:
The requested product has unique design/performance specifications which are essential to my research protocol or
clinical, investigative, or other needs and are not available in comparable products:
☐ Yes ☐ No ☐ N/A
1. These capabilities are:
2. In addition to the product requested, I have contacted other suppliers identified below and
considered their product of similar capabilities. These products are not acceptable because they are
lacking one or more of the technical specifications described in above:
☐ Yes ☐ No ☐ N/A
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Vendor:
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Product Description:
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Vendor Contact / Phone Number:
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Technical Deficiency:
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Vendor:
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Product Description:
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Vendor Contact / Phone Number:
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Technical Deficiency:
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Vendor:
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Product Description:
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Vendor Contact / Phone Number:
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Technical Deficiency:
The requested product is essential in maintaining experimental or administrative continuity. Provide a
thorough explanation.
☐ Requested Product is being used in continuing experiments
☐ Other investigators have used this product in similar research and for comparability of results, I
require it
☐ I have standardized the requested product; the use of another would require considerable time
and money to evaluate
Explain in detail:
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Section 4:
The requested product is one with which I (or my staff) have specialized training and/or extensive experience.
Retraining would incur substantial cost in money and/or time:
☐ Yes ☐ No ☐ N/A
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Manufacturer/Model of existing equipment:
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Age/Current Value:
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Estimated hours/per person required to train:
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Other factors:
Section 5:
Please consider sole source approval for this reason(s) (e.g., trade-in allowance; availability of service, parts and
maintenance; product is a prototype; responsibility for integrated system performance will be voided if other vendors are
introduced, etc.): Attach any and all documentation supporting this request. Summarize this information below:
Section 6:
Emergency Requirements-Additional Documentation Summary (Please check the explanation which applies):
☐ Immediate compliance with building codes and permits
☐ Needed immediately for ongoing experimentation
☐ Replacement parts or equipment necessary for continuing research, construction or operations
☐ Other, please explain:
Section 7:
Please list any other factors that may help the Procurement Department make a determination in this matter:
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Authorization
Requestor Name:
Requestor Signature ________________________________________________________________________________
Date: Click here to enter a date.
Full name of supervisor of requestor:
Supervisor Signature _______________________________________________________________________________
Date: Click here to enter a date.
Department Head / Administrator:
Department Head / Administrator Signature:___________________________________________________________
Date: Click here to enter a date.
Senior Director, Contracting & Procurement:
Christine Brasteter
Department Head / Administrator Signature:___________________________________________________________
Date: Click here to enter a date.
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