UNIVERSITY OF THE VIRGIN ISLANDS 
PURCHASING DEPARTMENT 
SOLE SOURCE JUSTIFICATION FORM 
 
 
Requester Name:  ________________________ 
Department: _____________________________ 
 
Date: ____________________________________ 
Requisition - PO Number __________________ 
 
SOLE SOURCE CONSIDERATIONS - (mark the one that best applies) 
A.        !  Replacement Equipment/Parts/Accessories - The purchase is for equipment, parts or 
accessories for existing equipment where compatibility with original equipment 
manufacturer is paramount.  
B. 
!  Technical Service - The purchase is for technical services associated with the assembly, 
installation or servicing of equipment of a highly technical or specialized nature.    
C. 
!  Exclusive Design - The item is manufactured or produced by a vendor, who holds 
exclusive rights to the item, and solely transacts (sells) direct to the customer.  (There are 
no dealers or distributors). 
 
D. 
!  Other - Vendor offered sale price, or extended a discount or other financial incentive to 
the University.  Please attach substantiating documentation. 
 
Vendor Name:  ______________________________________   Contact: __________________________ 
                                    
Phone #:_______________________   Fax #: _______________________   E-mail:  _______________ 
Needs Statement - Describe the product and/or service to be procured.   Attach additional sheets if necessary. 
 
____________________________________________________________________________ 
____________________________________________________________________________ 
____________________________________________________________________________ 
The information provided herein is true and accurate to the best of my knowledge.  I understand any false or 
misleading information may be considered a violation of the University of the Virgin Islands purchasing policies 
and procedures.   
 
Requestor Signature: ___________________________________________  
  
Phone #: _________________________  Fax #: _____________________ 
 
 
For Purchasing Use Only 
 
!   Sole Source Justification is adequate.  Purchase is authorized without competitive bidding. 
!   Sole Source Justification is inadequate.  Requisition is returned to requestor. 
      REASON:  
____________________________________________________________________________ 
____________________________________________________________________________ 
____________________________________________________________________________ 
!   Sole Source Justification is inadequate.  Proposals or bids will be solicited. 
   
__________________________________                     _______________________ 
               Purchasing Department 
 
 
 
Date 
 
 
Lack of planning does not create the need for a sole source vendor. 
 
     Approved June 2003 
 
This form does not apply to construction or construction related purchases.