VCCS Technology Procurement or Project Request Form Revised 2010-11-22
Procurement/Project Title/Name:
Approvals Being Requested: TPPR: CONSULTANT: SOLE SOURCE:
Procurement Type: New: Renewal: Existing Contract: RFP IFB Quick Quote
Accompanying Documents: Quote: SON: SOW: Sole Source Letter:
. .
Vendor Name: / Contract #:
IssueTrak #: / COST / $
Procurement or Project Description:

. .

Requesting Institution/Activity: / Agency Code:
Contact Person: / Date:
Email: / Telephone #:
FAX #:

Project Management Office Action: The Procurement, Consultant and/or Sole Source Justification supplied on the attached pages has been reviewedand the following action has been taken:

ApprovedDisapproved More information is needed (see attached requirement)

This approval satisfies VCCS policy for review by Information Technology Services for sole source procurements or purchases and projectsexceeding $100,000. The above named Contact Person and/or procurement personnel at the Institution are responsible for following policies and procedures defined by the Agency Procurement and Surplus Property Manual (APSPM) and documenting approvals required by theInstitution and other applicable VCCS policies. A copy of this document will remain on file with the Project ManagementOffice. If you have questions regarding this procurement or project initiation request, please contact:

Approver’s Name & Title / Telephone:
Signature: / Date:

. .

Authorizing Procurement/Project Signature Date
James Davis, Vice Chancellor for Technology Services
. .
Authorizing Sole Source Signature Date
Keith Gagnon, Director of Procurement (Reviews all Sole Source Requests. Approves up to $50,000).
Donna Van Cleave, Vice Chancellor for Admin. Services (Approves all requests over $50,000).

INSTRUCTIONS for:

Procurement approval:complete this page and Procurement/Project Justification page.

Consultant approval:complete this page, Procurement/Project Justificationpage and Consultant Engagement Request page.

Sole Source approval:complete this page,Procurement/Project Justificationpage and Sole Source Justificationpage.
PROCUREMENT/PROJECT JUSTIFICATION (to be completed by requestor)

  1. Identify the business objectives or business issues addressed by this procurement or project.

  1. Describe the proposed solution. (Attach supporting documentation such as vendor proposal, project scope, license, or contracts. These documents may be submitted under separate cover to the Project Management Office.)

  1. Is this procurement or project defined in your Technology Plan? If so, please provide the title of the procurement or project as identified in your Technology Plan.

  1. What are the planned start and end dates for this procurement or project?

CONSULTANT ENGAGEMENT REQUEST (to be completed by requestor in compliance with APSPM Chapter 4.22.d (2))

Use of consultant services must be justified with regard to agency mission, programs, priorities, and funding.
  1. Is the work to be performed in support of a prioritized business objective which provides a return on investment and supports your agency/institution’s mission?
  1. If yes, please identify the planning process which was used to prioritize your business objectives (i.e., annual budget and/or strategic planning process) and the business objective being supported by this service.
  1. If no, please identify the return on investment anticipated by this work or project supported by this work.
  1. Select the justification for using external consulting services:
Internal expertise on staff, but not available during the required timeframe.
No staff with the required skill sets.

SOLE SOURCE PROCUREMENT JUSTIFICATION (to be completed by requestor)

  1. Explain why this is the only product or service that can meet your needs.

  1. Explain why this vendor is the only practicable source from which to obtain this product or service.

  1. Explain why the price is considered reasonable.

  1. Indicate method(s) used for determination/comparison pricing. Attach supporting documentation if necessary.
Method Used / Source / Comparison Price
Catalog or price list
Historical agency prices
Sales of same item to other purchasers
Prior competition
Independent estimate
Vendor is Sole Provider of Product
  1. Describe the efforts made to conduct a noncompetitive negotiation in an effort to get the best possible price for the taxpayers of the Commonwealth.

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