Date:	Agency Code:	411
Agency Name:	Virginia Department of Forestry
Contact Person:	Telephone No.:
Total Amount of Sole Source:	Fax No.:
Commodity Code:
Description:
The Nature of the Emergency was:
I certify that I am the agency head or designee and I am authorized to approve this request.
AGENCY HEAD OR DESIGNEE NAME (print)	AGENCY HEAD OR DESIGNEE SIGNATURE	DATE
SOLE SOURCE PROCUREMENT JUSTIFICATION
It is the policy of the Commonwealth of Virginia that contracts be awarded on a competitive basis and that the use of a sole source procurement must be limited to those instances where only one source is practicably available. Sole source requests must contain a memorandum from the purchasing agency that addresses in a direct and concise manner the following four points:
1)	Explain why this is the only product or service that can meet the needs of the purchasing agency.
2)	Explain why this vendor is the only practicably available source from which to obtain this product or service.
3)	Explain why the price is considered reasonable.
4)	Describe the efforts that were made to conduct a noncompetitive negotiation to get the best possible price for the taxpayers.
DIVISION OF PURCHASES AND SUPPLY
Approved	Disapproved	More information needed (specify and return to agency)
NAME (print)	SIGNATURE	DATE
Note: This form must be filed with the contract/purchase order. Agencies and institutions area delegated authority to make contract award after appropriate approval. (Purchase using noncompetitive negotiation).