Emergency Procurement or Sole Source Form

Emergency Procurement or Sole Source Form

Emergency Procurement or Sole Source

Contracting Entities (CEs) should use this form under the following circumstances: Emergency Procurement A public emergency or unexpected emergency situation forces a need for immediate purchases that cannot be delayed by the time required for a full competitive solicitation for products and/or services. Sole Source Procurement The required product and/or service is available only from a single (sole) source distributor, supplier, or manufacturer, and this specific product and/or service is the only suitable solution to fill this need (preference for a particular brand or vendor when a suitable alternative exists should not be the basis for a sole source request.)

Approval Time Frames

Note that while TDA may approve the request, it may stipulate a shorter timeframe that will allow the CE to establish a competitive process for future purchases of these products/services.

Directions

The following information is required. TDA will evaluate the request and provide approval or denial via e-mail within 3 business days of submittal of a complete form. TDA cannot process incomplete requests and may reach out concerning missing information and if there are any questions. Note that the CEs are required to maintain documentation that supports statements made in this submission. If approved, CEs must also maintain documentation related to the emergency or sole source procurement.

Affected CACFP sub-Program

Select

Type of Request*

Select

Provide a description to support your request.*

In the space below provide a written detailed description of the circumstances that support the CEs request. TDA requires the CE to explain the circumstances that require the CE to request approval for the purchase. The description MUST include what the CE is needing to purchase and the cost or estimated cost of the service or goods. If applicable the CE must include the length of time they will use this approved purchase.

Requested Amount*

CE must include a cost or estimation of cost.

File Upload

Upload any documentation to support your purchase request. This includes copies of quotes, invoices, contracts, or any other documents the CE believes supports the request.

Drag and drop files here or

Attestation Statement*

Note: Only CE staff may submit this form. A food service management company (FSMC) staff member cannot submit this form on behalf of the CE or attest to its accuracy. Today's Date

Contracting Entity (CE) ID Number*

CE Name*

Check each of the following statements as true*

I am an Authorized Representative (AR) of the Contracting Entity (CE) listed on the "FND-101, CERTIFICATE of AUTHORITY for EXTERNAL USERS" or "FND-135, USER ACCESS MANAGER FORM" that has been approved by TDA prior to submission of this request.

I certify that the CE has retained documentation related to the information submitted in this request.

I am not a Food Service Management Company employee.

Each party acknowledges and agrees that the information in this form is attested by the name entered in the above field and shall be considered as an original signature for all purposes and shall have the same force and effect as an original signature.

Person attesting to the information on this form:*

Enter First and Last Name

Position/Title*

Email address for the CE Contact*

Phone Number for the CE Contact*

Phone

Please include the information below if the CE conact for Procurement is different from the person attesting to the form.

Name of the CE Contact for Emergency Procurement

Enter First and Last Name

Position

TDA may contact you with additional questions. By submitting this application, the Contracting Entity is confirming that this form is true and correct.

Send me a copy of my responses

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