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Okaloosa County BOCC — April 15, 2014 — sole source form_Post Office Lift Station — reading text
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SOLE SOURCE PURCHASE DATA SHEET
Date: 4/9/2014 PR No.: Requestor: Jeff Littrell Phone No.:_651-7172
Department/Division: _Water & Sewer/Director
ltem Description:_12” Portable By-Pass Pump (Thompson 12JSVG-DJDS-90H-MC or latest model)
Requesting Department's Suggested Vendor: Thompson Pump
Vendor's Address: 3310 McLemore Dr., Pensacola, FL 32514
Woters
Vendor's Telephone No.: (850) 478-2833 Point of Contact: Rick-Wetters— ——
Sole Source Justification: time constraint/emergency — pump failure at Post Office Lift
Station: see BCC Agenda Request for 4/15/2014 meeting
Sot Eka) 4/4) 201
Requesting Department Director Signature Date
REVIEW BY PURCHASING DEPARTMENT
VERIFY IF OTHER SOURCES OF SUPPLY MEETS THIS NEED
Vendor #1 Contact: Phone No.:
Vendor #2 Contact: Phone No.:
Vendor #3 Contact: Phone No.:
Buyer Comments:
Signature of Buyer Who Reviewed Date
Purchasing Services Coordinator Comments:
Purchasing Services Coordinator Signature Date
PURCHASING MANUAL - SOLE SOURCE DETERMINATION
Comments:
Approve: Disapprove:
Amount of Purchase: Date:
Purchasing Director Signature Date