Download SOLE SOURCE CHECKLIST

VCCS Technology Procurement or Project Request Form
Procurement/Project Title/Name:
Approvals Being Requested: TPPR:
Procurement Type: New:
Accompanying Documents: Quote:
Revised 2010-11-22
CONSULTANT:
SOLE SOURCE:
Renewal:
Existing Contract:
RFP
SON:
SOW:
IFB
Quick Quote
Sole Source Letter:
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.
Vendor Name:
IssueTrak #:
Procurement or
Project Description:
Contract #:
COST $
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.
Requesting
Institution/Activity:
Contact Person:
Email:
Agency Code:
Date:
Telephone #:
FAX #:
Project Management Office Action: The Procurement, Consultant and/or Sole Source Justification supplied on the
attached pages has been reviewed and the following action has been taken:
Approved
Disapproved
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 projects exceeding
$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 the Institution and other
applicable VCCS policies. A copy of this document will remain on file with the Project Management Office. 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
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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 Justification page and Consultant Engagement Request
page.
Sole Source approval: complete this page, Procurement/Project Justification page and Sole Source Justification page.
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VCCS Technology Procurement or Project Request Form
Revised 2010-11-22
PROCUREMENT/PROJECT JUSTIFICATION (to be completed by requestor)
1. Identify the business objectives or business issues addressed by this procurement or project.
2. 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.)
3. 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.
4. What are the planned start and end dates for this procurement or project?
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VCCS Technology Procurement or Project Request Form
Revised 2010-11-22
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?
2. 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.
3. If no, please identify the return on investment anticipated by this work or project supported by this work.
4. 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.
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VCCS Technology Procurement or Project Request Form
Revised 2010-11-22
SOLE SOURCE PROCUREMENT JUSTIFICATION (to be completed by requestor)
1. Explain why this is the only product or service that can meet your needs.
2. Explain why this vendor is the only practicable source from which to obtain this product or service.
3. Explain why the price is considered reasonable.
4. Indicate method(s) used for determination/comparison pricing. Attach supporting documentation if necessary.
Method Used
Catalog or price list
Historical agency prices
Sales of same item to other purchasers
Prior competition
Independent estimate
Vendor is Sole Provider of Product
Source
Comparison Price
5. 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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