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 |  |  |  |  |  |  |  | STATE PROCUREMENT OFFICE
 |  |  |  |  |  |  |  | NOTICE & REQUEST FOR SOLE SOURCE
TO: |  |  |  | Chief Procurement Officer
FROM:
 |  |  |  | Name of Requesting Department
Pursuant to HRS §103D-306 and HAR chapter 3-122, [NAME], the Department requests sole source approval to purchase the following:
1.  Describe the goods, services, or construction to be procured.
2.  Vendor/Contractor/Service Provider Name: |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | 3. | Amount of Request:
4. Term of contract (shall not exceed 12 months), if applicable: |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | 5.  Prior SPO-001, [NAME] (SS) No.:
 | From: |  |  |  |  |  |  |  |  |  |  |  | To:
6.  Describe in detail the following:
a.  The unique features, characteristics, or capabilities of the goods, service or construction.
[NAME]How the unique features, characteristics or capabilities of the goods, service or construction are essential for the department       to accomplish its work.
7. Describe the efforts and results in determining that this is the only vendor/contractor/service provider who can provide      the goods, services or construction.
8.  Alternate source.  Describe the other possible sources for the goods, services, or construction that were investigated       but did not meet the department's needs.
9.  [NAME] the primary responsible staff person(s) conducting and managing this procurement.  (Appropriate delegated      procurement authority and completion of mandatory training required.)      *Point of contact (Place asterisk after name of person to contact for additional information).
Name |  |  |  |  |  |  |  |  |  | Division/Agency |  |  |  |  |  |  |  | Phone Number |  |  |  |  |  |  |  | E-mail Address
Department shall ensure adherence to applicable administrative and statutory requirements, including HAR chapter 3-122, Subchapter 15, Cost or Pricing Data if required.
All requirements/approvals and internal controls for this expenditure is the responsibility of the department.
I certify that the information provided is to the best of my knowledge, true and correct.
Department Head Signature |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | Date
For Chief Procurement Officer Use Only
 |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | Date Notice Posted:
Submit written objection to this notice to issue a sole source contract within seven calendar days or as otherwise allowed from date notice posted to:
 |  |  |  |  |  |  | [EMAIL]
Chief Procurement Officer (CPO) Comments:
 |  | Approved |  |  |  |  |  |  | Disapproved |  |  |  |  |  | No Action Required
 |  |  |  |  |  |  |  |  |  |  |  |  | Chief Procurement Officer Signature |  |  |  |  |  |  |  |  |  |  |  |  |  | Date