REQUEST FOR SOLE SOURCE AUTHORIZATION (SSA)
☐NEW REQUESTName of Agency: Name of Agency
☐REQUEST TO RENEW Agency Representative: Agency Representative
☐REQUEST TO AMENDE-mail: Email Address
For Requests to Renew or Amend: Current SSA#Enter SSA#Original Issue Date:
Name of Supplier: Enter Name of Supplier
Term (or desired delivery date): Cost Estimate: $
Do you anticipate the need for annual renewals?YES☐NO ☐
IDAPA 38.05.01.045 provides that:
“sole source purchase shall be used only if a requirement is reasonably available from a single supplier.”
For NEW requests:
Complete #1-5
The requesting agency must provide a written justification, documenting that the Sole Source purchase is required to meet a business need AND that the agency has thoroughly researched available alternative products or service providers (functional equivalents) as well as other suppliers for the same.
1Describe the Product or Service:
2Check each box that applies:
Sole source provider of a licensed or patented good or service (attach provider’s letter)Sole manufacturer AND distributor (attach manufacturer’s letter)
Sole provider of factory-authorized/warranty service (attach provider’s letter)
Sole provider of items that are compatible with existing equipment, systems, programs, etc.
Other (attach description and justification)
3Describe your Agency’s Business Need for the requestedProduct or Service:
4Describe what makes this Product or Service unique:
4Describe what makes this Product or Service unique:
5Provide a list of other suppliers contacted (name/contact information):
For Requests to RENEW:
Complete #6
6Confirm your Agency’s continuing Business Need for the Product or Service and describe the steps you took to confirm that the Product or Service continues to qualify as a sole source (e.g. contacted other vendors, Internet research, contact with other agencies with similar needs, etc.).
FOR RENEWALS: Each agency seeking authorization to renew a current SSA must conduct a business analysis every five years, at a minimum, documenting estimated costs (as well as other factors) related to maintaining the current provider versus switching/migrating to a new provider/alternative solution, if one is available.
For Requests to Amend:
Complete #7
7Describe (with specificity) the requested modifications to the scope of work, product requirements, cost or other proposed changes to your current SSA. The Amendment process is also utilized for extension requests for a term less than the renewal term.
My Agency’s recommendation for sole source is based upon a defined business need for the product/service; available suppliers; as well as an objective and thorough review of any functional equivalents.
By my signature below, I certify that I am aware that Idaho Code and IDAPA require procurements to be competitively bid unless specifically exempt; that the statements contained in this Request are complete and accurate, based on my professional judgment and independent investigation; that no personal advantage will accrue to me or any member of my immediate family as a result of this direct procurement; and that based on my analysis of my agency’s business need and research into available products or services, no other vendor can provide the same or similar product or service to meet my agency’s need.
Agency Requestor: ______Date: ______
Printed Name/Title: ______
Agency Purchasing Representative: ______Date: ______
Printed Name/Title: ______
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APPROVED REJECTED
DOP Administrator: ______Date: ______
Printed Name: ______
Additional Conditions which apply to this approval:
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INSTRUCTIONS:
1Complete this Request for Sole Source Authorization document (fill in the blanks and sign).
2Attach all supporting documentation (e.g. manufacturer’s letters attesting to single distributor; determination of business need for product/service; evaluation of other potential suppliers; etc.).
3Attach a copy of the supplier’s quote.
4Submit a requisition to DOP via IPRO and upload this form, the quote and the supporting documentation; or e-mail a manual DA-1 (signed) to .
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PROCESS:
1DOP initially reviews for completeness (all documents/signatures); and then reviews to determine if the commodity or service is available on a current contract or through a more appropriate avenue; followed by a review of the agency justification, to determine whether it meets IDAPA. DOP conducts an independent review; and may also request additional information or clarification from the agency to assist in its review.
2 If the request is approved, a legal notice is posted to DOP’s website for three calendar days. If no appeals are received, DOP issues an SSA to the agency after the five business day appeal period has passed (we begin counting after the three business day posting period is complete).
3The entire process can take (on average) anywhere from 10-21 days to complete.
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YOU HAVE AN SSA, NOW WHAT?
1Upon receipt of a DOP-issued SSA, the requesting agency may enter into a direct contract with the sole source supplier.
2The agency is responsible for negotiating the contract terms and conditions, administering the contract, and ensuring that the contract is in compliance with applicable laws and regulations.
3If your SSA is renewable, you will need to submit a Request to Renew, using this form (60-90 days prior to expiration); obtain the Contractor’s (sole source supplier) written agreement to renewal (conditioned on DOP approval); obtain a quote for the renewal term; and follow the renewal instructions on this form.
Request for Sole Source Authorization July 2013Page 1