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` CO) 9 . p G SOLE SOURCE JUSTIFICATION FOR SERVICES AND EQUIPMENT REQUEST ^ ^' FOR APPROVAL FORM �+ 0 Florida Department of Law Enforcement �, z Edward Byrne Memorial Justice Assistance Grant Program r CO -v Name of Subgrant Recipient: an River County Sheriffs Office m Authorized Official for Subgrant Recipient or Implementing Agency Typed Name of Authorized Official : Deryl Loar Typed Title : Sheriff 4%2"=- Signature : Telephone Number ( 772 ) 669 =6700 x 6404 Date : June 28 , 2013 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 ore 'j�ass 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. 7 . . 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. • 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 Foran Pagel oft Rule Reference 1113-9M6 OCJG411 (Rev. May 2012)