UND Purchasing Office
Sole Source Subcontract Justification
This form must be completed by the
Principal Investigator (PI) or
Program Director (PD) and
submitted to Purchasing for sole
source determination prior to the
issuance of a subcontract using
sponsored project funds.
Dollar Amount of Subcontract to be issued: $_______________________
Fund _________ Dept # ________ Project number _________________
Vendor’s DUNS number ________________
Vendor is registered with SAM www.sam.gov
1.
Is this a continuation of a previous subcontract?
_____ Yes _____ No
If No, go to number 2.
If Yes, has the basis for selection changed from what was previously approved? _____ Yes _____ No
If Yes, go to numbers 5 and then to 7.
If No, fill in the prior purchase number: ________________________ and go to number 7.
2.
Has a teaming agreement been established?
If no, go to number 3.
If yes, attach a copy of the teaming agreement and go to number 7.
_____ Yes _____ No
3.
Is this for a subrecipient of grant or cooperative agreement funding?
If no, go to number 4.
If yes, go to number 7.
_____ Yes _____ No
4.
Is EPSCoR funding this subcontract?
_____ Yes _____ No
If Yes and the subcontract is going to North Dakota State University (NDSU), go to number 7.
If Yes and the subcontract is not going to North Dakota State University (NDSU) go to numbers 5, 6, and 7.
If No, go to numbers 5, 6, and 7.
5.
Description of subcontractor/services: Provide subcontractor name and generic description identifying the
service(s).
6.
Provide justification for the sole source award. Include facts such as: explanation why subcontractor is uniquely
qualified to perform the work; efforts to identify other subcontractors and reason why others do not meet your
requirements or would not qualify to submit a competitive offer.
7.
The undersigned Principal Investigator or Project Director certifies that the information provided to request a sole
source subcontract purchase is truthful and accurate and that no actual or potential conflict of interest exists in this
subcontract purchase.
PI or PD Name: (type or print): _____________________________
Date: ____________________________
PI or PD Signature: ________________________________________
PI or PD Title: ____________________
PI or PD Department Name: _____________________________________________________________________
SEND TO PURCHASING - Stop 8381
PURCHASING USE ONLY
Determination:
Sole Source approved-purchase as requested.
Sole Source not approved-issue bid/RFP using performance specifications. (Return to department.)
Authorized Purchasing Signature: __________________________________
Rev_11.29.2012
Date:____________________