Whenever Jenks Public Schools issues a requisition estimated to cost $10,000.00 or more, which by reasonable
specifications indicated restricts the bidders to one (1) person or business entity, the administrator of the requesting
department and the purchasing department shall prepare an affidavit and recite the reasons for such restricting
specifications or other facts justifying the requested purchase. To be acceptable, the affidavit must also include the
statement “We will not accept nor pay for any other item for the reasons stated on this affidavit.” (Title 74, Sect. 89,
Oklahoma Statutes)
SOLE SOURCE AFFIDAVIT (to be completed by requisitioner)
Jenks Requisition No. :
DATE:
SERVICE PROVIDER/VENDOR:
ADDRESS:
CITY:
CONTACT:
ZIP:
PHONE:
I hereby affirm that the services or products to be purchased pursuant to the provisions of the attached contract
are very specialized or for which great acquired expertise is needed and to the best of my knowledge:
is the only person or business entity which is singularly and peculiarly qualified to provide such services or
products, and if a product is the only brand name which is singularly and peculiarly unique, for the following
reason(s):
I understand that the signing of this affidavit knowing such information to be false may subject me to
punishment for perjury.
We will not accept nor pay for any other item for the reasons stated on this affidavit.
SIGNED____________________________
Date:
/
/
Date:
/
/
SIGNED____________________________
(Chief Financial Officer)
Date:
/
/
SIGNED____________________________
Date:
/
/
(Head of Requisitioning Department)
SIGNED____________________________
(Director of Purchasing)
(Superintendent)
JPS PUR-126