SSA number: ______________
Department
Of
Finance.
Single Source Authorisation request for the supply of goods and
services
Where a purchaser is unable to comply with the Financial Regulations and seek competition
through quotation or formal tendering routes, then it is necessary to record the reasons for
use of a single source of supply and obtain the necessary approvals before any further action
is taken. In exceptional circumstances the requirement to conduct quotations or formal
tendering may be waived and approval given for a sole supply situation.
Please ensure that all sections on this form are completed in full, attach any supporting
documentation in respect of your proposal and forward it for approval to:
a) If your request for SSA is between £5,000 and £50,000, the form must be signed by the
proposer and authorised by the Departmental Authoriser (not below Department
Manager level or Faculty Finance Manager).
b) If your request for SSA exceeds £50,000, the form must be signed by the proposer, the
Departmental Authoriser and also forwarded to Procurement for authorisation.
If in any doubt about the Single Source Authorisation process, please speak to Procurement
for advice.
*********************************************************************************
PART A
Please tick  the appropriate single source reasons from the list below and provide
further detail in Part B.
Tick
Reason
Description
Single
The goods or services are only available from one source for
source/sole
technical or artistic reasons or for reasons connected with the
here
supply
protection of exclusive rights.
Compatibility
The goods required are a partial replacement for or are an
addition to existing goods. If the goods were purchased from
an alternative supplier, the University would acquire goods
with different technical characteristics that would result in
a) incompatibility with the existing goods
b) disproportionate technical difficulty in the operation of the
existing goods
Emergency
An emergency justification may exist if the goods or services
are required to
a)correct or prevent an emergency health, environmental or
safety hazard
b) enable the emergency repair or replacement of existing
equipment essential for daily operations
No quotes
If a request for 3 quotations has been issued and no suppliers
submitted a quotation or the quotations submitted are not
acceptable, e.g. do not meet time constraints, do not meet
specifications.
If you select this option as the reason for single source, please
complete PART D.
Other
If you believe you had another valid reason not to obtain 3
quotes please contact Procurement for advice
***************************************************************************************
PART B
Please enter the following mandatory information
i)
Department Name
ii)
Budget/Research Grant
iii)
Name of Research
Organisation (if
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applicable)

Please check the grant funding conditions regarding quotation
and tendering requirements.

If the purchase is being funded by RCUK, the RCUK threshold
relating to procurement processes will apply, and any SSA
request over £25,000 should also be forwarded to Procurement
for authorisation.

Please note that if the purchase is being funded by ERDF, the 3
quotes exemption cannot be given.
iv)
v)
Proposed Supplier Name
Estimated value of
goods/services (exc. VAT)
Tick to confirm maintenance costs (if applicable) for future years have been included in
the above costs
(left click twice in box and choose Checked)
Please be aware that the quotes threshold of £5k applies to the aggregate (total) value of all
requirements for the purchase, lease, rental or hire of goods and services of a similar type. This
applies to your requirement both now and over either 4 years or the grant period.
More information on aggregation can be found here.
Please continue on the next page.
vi)
Description of goods/services for which sole supply authorisation is sought
including period of contract if applicable.
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vii) Give reasons why the sole supply is the only appropriate course of action and what
value for money considerations you have made.
PART C
Please scan in or attach supplier quotation.
Tick to confirm attached
(left click twice in box and choose Checked)
PART D
Please scan in or attach copies of quotation requests including specifications sent to other
suppliers and any responses received.
This only needs to be completed if you selected ‘No Quotes’ as the reason for single source in
PART A.
PART E
Department Authorisation
Proposer name (must have delegated budget authority)
Name:
Email address:
Telephone:
Group/team/Section:
Signature:
Date:
Departmental Authoriser Name (not below Departmental Manager level, and/or Faculty
Finance Manager) for orders between £5k and £50k excluding VAT.
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Name:
Position:
Department:
Signature:
Date:
The form should be retained for audit purposes for a period of 7 years.
A copy of this authorised form should be attached to the purchase order.
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Procurement Authorisation (if over £50k exc. VAT)
Category Manager Name:
Signature:
Date:
Head of Procurement
Name:
Signature
Date:
Document control – Procurement or Departmental use
Date Received
Reference Number
Request Decision
Granted/Refused
Previous SSA reference, if applicable
Legal Approval ( If required)
Financial Approval Needed?
Yes / No
Financial Approval if externally grant funded, agreed by
Name:
Department to underwrite cost if needed.
Signature:
Conditions applicable on approval
Deadline for Conditions where applicable
Summary of Action to be taken
-
To ensure Financial Regulations will be followed in
future
Date granted
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