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-�----,. <br />• <br />• <br />SOLE SOURCE PURCHASE REQUEST <br />COLORADO DIVISIOIV OF PURCHASIN( <br />(FOR USE BY ALL AGENCIES & INSTITUTI� <br />Sole Source Procurement is an option if a purchase requirement is reasonably available onlv from a <br />single vendor or if it otherwise qualifies under Code of Colorado Regulations, 1CCR101-9. See <br />reverse side of this form for text of this rule. <br />ATTACH THIS COMPLETED FORM TO YOUR PURCHASE REQUISITION WHEN <br />SUBMITTING A REQUEST FOR SOLE SOURCE PURCHASE BY PURCHASE ORDER. <br />IF PURCHASE IS TO BE MADE BY AN AGENCY CONTRACT, SUBMIT THIS FORM FOR <br />PRIOR APPROVAL BEFORE CONTRACT NEGOTIATIOI�IS. <br />REQUESTING AGENCY: Colorado Water Conservation Board, Terry Moulton <br />DESCRIBE SUPPLY(S) / SERVICE(S) TO BE PURCHASED: Waterwise program kits, that include <br />water conservation devices and teacher curriculum guide to be distributed to 5`� graders throughout the <br />state. 400 kits will be purchased and delivered. National Energy Foundation is the only vendor [hat <br />produces and distributes these kits directly to the schools. This vendor has been used in past years as a <br />sole source vendor for purchase of these kits <br />APPROXIMATE COST: $ 14,000 <br />RECOMMENDED VENDOR / CONTRACTOR: (name & address) National Energy Foundation, <br />5160 Wiley Post Way, 1#200, alt Lake City, UT 84116 <br />FEIN �` - 132877240 <br />SOLE SOURCE STATUS IS DETERMINED AS FOLLOWS: (List all vendors / contractors contacted <br />and describe criteria used to determined sole source status of the one recommended - ATTACH <br />ADDITIONAL PAGES IF MORE SPACE IS NEEDED) This is the only vendor that produces and <br />delivers product directly to schools. <br />REQUESTED: <br />b � �� <br />G .r... ,s <br />Agency Signature Date <br />APPROVED: <br />by . \ _ �• y� <br />St te Purchasing Director Date <br />or Authorized Representative <br />