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VENDOR SELECTION FORM Subcontractor / Vendor Name This form must be used to document the selection of vendors for all purchases of 3 000 or more. Section I must always be completed in entirety. If choosing a pre-qualified vendor attach a quotation or explanation of pricing and complete Section I and signature sections only Procurements of 20 000 and over require a RFQ or RFP and written proposals which must be included with this form. Section I. Basic Information Complete for all procurements of 3 000 and over Grant Name Grant Contact Name Purpose of Procurement Service or Item Description Vendor Selected Price Was this vendor chosen from the XYZ Pre-qualified Vendor List Yes No Section II. Competitive Selection Same item or services priced by several vendors. Record oral or written quotations below and attach copies of any RFQs/RFPs and bids/quotations to this SSF as required by the Procurement Policies and Procedures. Section I must always be completed in entirety. If choosing a pre-qualified vendor attach a quotation or explanation of pricing and complete Section I and signature sections only Procurements of 20 000 and over require a RFQ or RFP and written proposals which must be included with this form* Section I. Basic Information Complete for all procurements of 3 000 and over Grant Name Grant Contact Name Purpose of Procurement Service or Item Description Vendor Selected Price Was this vendor chosen from the XYZ Pre-qualified Vendor List Yes No Section II. Competitive Selection Same item or services priced by several vendors. Record oral or written quotations below and attach copies of any RFQs/RFPs and bids/quotations to this SSF as required by the Procurement Policies and Procedures. a* Vendor A Price b. Vendor B Price Section III Sole Source Procurement Choose one or more reasons below and attach a written explanation supporting the reason s chosen* For additional information reference Section 4. 6 of the Procurement Policies and Procedures Manual* At least three quotations/proposals were requested and only one response was received Required by the terms of the sponsor s written solicitation or RFP attach copy Unique or prior experience expertise professional stature or key personnel Proprietary item with unique requirements or brand name only source capable of meeting EDC requirements Extreme Urgency insufficient time to conduct a competitive source selection due to the extreme urgency of the requirement nature of urgency must be fully documented in file. Section V Signatures Buyer is responsible for obtaining signatures. Program Director required Printed Name Signature Date Procurement Administrator required for 3 000 Executive Director required for 20 000. Section I must always be completed in entirety. If choosing a pre-qualified vendor attach a quotation or explanation of pricing and complete Section I and signature sections only Procurements of 20 000 and over require a RFQ or RFP and written proposals which must be included with this form* Section I. Basic Information Complete for all procurements of 3 000 and over Grant Name Grant Contact Name Purpose of Procurement Service or Item Description Vendor Selected Price Was this vendor chosen from the XYZ Pre-qualified Vendor List Yes No Section II.

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