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A TRUE COPY - - -- -- - - _ LEDE CARQUON - 1SOL QCT-_cer_ G - - -- - FOR APPROVAL FORM Florida Department of Law Enforcement Edward Byrne Memorial Justice Assistance Grant Program OWNS Name of Subgrant Recipient : Indian River County Sheriff' s Office Authorized Official for Subgrant Recipient or Implementing Agency Typed Name of Authorized Official : Deryl Loar Typed Title : Sheriff d- Signature : jyt_ Telephone Number ( 772 ) 569-6700 x 6404 Date : June 29 , 2012 1 . Briefly describe the proposed contractual services and/or equipment and how it relates to your program . 2 . Explain your reasons for proposing to contract with , or purchase from , a non -competitive sole source . Address the expertise of the contractor , management, responsiveness , program knowledge and experience of contract personnel . Also provide the results of a market survey to determine competition availability or address why a market survey was not conducted . 3 . Indicate the contract period and explain the potential impact on contract deliverables if due dates are not met. Relate this information to the approval period for your grant award . Estimate the time and cost to hire a competent replacement should the current contractor default . 4. Describe what is unique about the project and the proposed sole source contractor that would warrant a sole source contract . 5 . Explain any other points you believe should be covered to support your request for a sole source contract . 6. Make a declaration that the action to be taken is in the " best interest " of the subgrant recipient and the implementing agency. T Address the Conflict of Interest Review ( i . e . proposed contractor is not excluded or debarred and was not involved in development of the procurement) NOTE: • If sole source procurement of contractual services and/or equipment is $ 100, 000 or more, justification for sole source procurement must be submitted to the Department of Law Enforcement for approval. IF • All the foregoing components must be addressed. Start on the next page and use continuation pages as necessary. • If the sole source procurement is less than $ 100, 000, the applicant should complete this form and maintain it in the program files available for monitoring and for audit. FDLE JAG Grant Application Package Sole Source Form Page 1 oft Rule Reference 11M,006 OCJG-011 (Rev. May 2012)