Maryland Military Department

Sole Source/No Substitute/Emergency Procurement Determination

(To be completed by the Requestor and submitted to the Chief Procurement Officer)

Date:

Item(s)/Service Requested:

Vendor:

Vendor Phone number:

Address:

Vendor Federal ID #:	DVET#:	MBE#:	SB#:

Requesting:	Sole Source	No Substitute	Emergency

Justification:

Requestor must complete the following:

Explain why no other product or service shall be suitable or acceptable to meet the Agency’s need or if an emergency what the emergency is and when it first became known.

Explain what the results would be if the product or service is not obtained or becomes unavailable:

Are sufficient funds available?	YES	NO

PCA	FUND	AOBJ	FEDERAL %	STATE%

Is the price fair and reasonable?	YES	NO

If yes how is this known?

What is the relationship of the State’s price to the published list price? Are we getting a good discount?

Is there another product or service available which is comparable but costs more or less?

If purchased previously, how does the current price compare with the previous price?

If this is an emergency, describe what steps are you going to do to prevent this from happening again.

Signature:

Requestor

It is determined that this procurement is in compliance with COMAR 21.05.05-.06

Approval Granted:

Chief Procurement Officer

Approval Granted:

Agency Head or Designee