LIMITED SOURCES JUSTIFICATION ORDER >$3,000 FAR PART 8.405-6 2237 Transaction # or Vista Equipment Transaction #: 655-14-4-059-0264 This acquisition is conducted under the authority of the Multiple Award Schedule Program. The material or service listed in par. 3 below is sole source, therefore, consideration of the number of contractors required by FAR Subpart 8.4 - Federal Supply Schedules, is precluded for the reasons indicated below. Restricted to the following source: Provide original manufacturer's name for material or contractor's name for service. (If a sole source manufacturer distributes via dealers, ALSO provide dealer information.) Manufacturer/Contractor: OLYPMUS AMERICA INC. Contract #V797P-2065D Manufacturer/Contractor POC & phone number: MAUREEN ALLEN
+1 (555) 000-0000 Mfgr/Contractor Address: 3500 CORPATE PARKWAY, CENTER VALLEY, PA 18034-0610 Dealer/Rep address/phone number: MAUREEN ALLEN
+1 (555) 000-0000 1 The requested material or service represents the minimum requirements of the Government. (1) AGENCY AND CONTRACTING ACTIVITY: Department of Veterans Affairs Saginaw VA Medical Center VISN: 11 (2) NATURE AND/OR DESCRIPTION OF ACTION BEING APPROVED: Purchase of Olympus Cystoscopes and Visera video and related equipment for the Saginaw VA Medical Center. (3) (a) A DESCRIPTION OF THE SUPPLIES OR SERVICES REQUIRED TO MEET THE AGENCY'S NEED: 6 ea Olympus CystonephroVS Cystoscopes, model CYF VH, 2 ea Visera Elite Video Systems, model OTV S190 and related equipment. (b) ESTIMATED DOLLAR VALUE: $227,586.05 (c) REQUIRED DELIVERY DATE: 9/1/2014 (4) IDENTIFICATION OF THE JUSTIFICATION RATIONALE (SEE FAR 8.405-6), AND IF APPLICABLE, A DEMONSTRATION OF THE PROPOSED CONTRACTOR'S UNIQUE QUALIFICATIONS TO PROVIDE THE REQUIRED SUPPLY OR SERVICE. 1 Specific characteristics of the material or service that limit the availability to a sole source (unique features, function of the item, etc.). Describe in detail why only this suggested source can furnish the requirements to the exclusion of other sources. VISN11 is standardizing imaging equipment to include Urology Cystoscopes. By using the same High Definition Olympus Cystoscopes Scopes and Visera video at each station this reduces reexams, increases standard of care, simplifies training and provides a better service model for in on station and outside vendor support. Currently , The VA Healthcare Centers at Ann Arbor, Battle Creek and Detroit. 0 A patent, copyright or proprietary data limits competition. The proprietary data is: If FAR 8.405-6(a) (2)iii before posting. Do not include specific proprietary data. Only mention the type of equipment, procedure, etc. to show that proprietary supplies or services are being procured.) These are "direct replacements "parts/components for existing equipment 0 These are "direct replacements" parts/components for existing equipment. 0 The material/service must be compatible in all aspects (form, fit and function) with existing systems presently installed/performing. Describe the equipment/function you have now and how the new item/service must coordinate, connect, or interface with the existing system. The new cystoscopes use the existing Olympus Power Supply already in place in the OR. 0 The new work is a logical follow-on to an original Federal Supply Schedule order provided that the original order was placed in accordance with the applicable Federal Supply Schedule ordering procedures. The original order must not have been previously issued under sole source or limited source procedures. 0 An urgent and compelling need exists, and following the ordering procedures would result in unacceptable delays. (5) DESCRIBE WHY YOU BELIEVE THE ORDER REPRESENTS THE BEST VALUE CONSISTENT WITH FAR 8.4 TO AID THE CONTRACTING OFFICER IN MAKING THIS BEST VALUE DETERMINATION: $227,586.05 This price is fair and reasonable based on historical pricing for similar items. Purchase orders 553-A30249, 506-A40148, 515-G30006 all show prices for Olympus Cystoscopes And Visera Video Systems. (6) DESCRIBE THE MARKET RESEARCH CONDUCTED AMONG SCHEDULE HOLDERS AND THE RESULTS OR A STATEMENT OF THE REASON MARKET RESEARCH WAS NOT CONDUCTED: A market study conducted, there are two other digital videoscopes offered by FSS Schedule 65 Vendors, The KARLA Storz 11272VN is only approved for Vetinary use and the Richard Wolf eyemax does not offer the HD video capability that the Olypmus cystoscopes provides. Olympus America , V797P 2065D, is the only source of Cystoscopes VS Cystoscopes and Viersa Systems on Schedule 65 11. (7) ANY OTHER FACTS SUPPORTING THE JUSTIFICATION: None (8) A STATEMENT OF THE ACTIONS, IF ANY, THE AGENCY MAY TAKE TO REMOVE OR OVERCOME ANY BARRIERS THAT LED TO THE RESTRICTED CONSIDERATION BEFORE ANY SUBSEQUENT ACQUISITION FOR THE SUPPLIES OR SERVICES IS MADE: Should another requisition of this nature reoccur ,we would undertake a new market survey. (9) REQUIREMENTS CERTIFICATION: I certify that the requirement outlined in this justification is a Bona Fide Need of the Department of Veterans Affairs and that the supporting data under my cognizance, which are included in the justification, are accurate and complete to the best of my knowledge. I understand that processing of this limited sources justification restricts consideration of Federal Supply Schedule contractors to fewer than the number required by FAR Subpart 8.4. (This signature is the requestor's supervisor, fund control point official, chief of service or someone with responsibility and accountability.) SIGNATURE DATE NAME TITLE SERVICE LINE/SECTION FACILITY (10) APPROVALS IN ACCORDANCE WITH FAR 8.405-6(d): a. CONTRACTING OFFICER'S CERTIFICATION (required): I certify that the foregoing justification is accurate and complete to the best of my knowledge and belief. CONTRACTING OFFICER'S SIGNATURE DATE ______________________________ NAME AND TITLE FACILITY HIGHER LEVEL APPROVAL: (REQUIRED $3K and above) b. NCM/PCM/DESIGNEE: I certify that the foregoing justification is accurate and complete to the best of my knowledge and belief. (Instructions: IAW NCO 11 delegation authority, all procurements estimated to exceed $500K must be approved by the NCM. Procurements between $3K and $650K are to be approved by the Supervisory Contract Specialist of the applicable Team (as the "Designee"). SIGNATURE DATE Name NCO 11 NCM/PCM/Designee HIGHER LEVEL APPROVAL: (Required For orders over $650,000):