Attachment 1: Request for Limited Sources Memo Format LIMITED SOURCES JUSTIFICATION ORDER >$3,000 FAR PART 8.405-6 2237 Transaction # or Vista Equipment Transaction #: 655-15-1-1359-0001 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: Lyn Wall
+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: 36 month lease, base plus two option year lease for Olympus Endoscopes and related equipment. (a) A DESCRIPTION OF THE SUPPLIES OR SERVICES REQUIRED TO MEET THE AGENCY'S NEED: Lease of Olympus Evis Exera III Endoscopes, Eletosurgical Generators, Workstations, Monitors and related equipement for the Saginaw VAMC, base year 10/1/2014 to 9/30/2015 with two (2) option years. (b) ESTIMATED DOLLAR VALUE: $225,960.85 contract total, (c) REQUIRED DELIVERY DATE: 10/1/2014 (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. The goal of the VISN 11 Endoscopy Subcommittee is to standardize all scopes within a medical center, to compy with the VHA Endoscope IPT Guidance (11/16/2010), Standardization of Endoscopy Equipment reduces errors, improves patient safety and reduces set up and reprocessing of medical equipment. The Saginaw VAMC currently uses Olympus endoscopes, gastroscopes, cystoscopes and related Olympus Equipment. Staff, both nurses and doctors are currently trained and validated on Olympus Equipment that is in use throught VISN 11 and the Saginaw VAMC, Endoscopes, Cystoscopes, and Gastroscopes, purchasing another brand would result in additional training and possibly compromise patient care. Olympus Endoscope Equipment is only available from one source on FSS, V797P-2065D, Olympus America. 0 A patent, copyright or proprietary data limits competition. The proprietary data is: 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. 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 contract pricing for the NAC contract, V797P-2065D. This pricing is also similar to other Olympus Endoscope scopes leases within VISN 11, VA251-P-1107. By procuring new Olympus scopes the trade in value for the existing Olympus scopes is $32,000. (6) DESCRIBE THE MARKET RESEARCH CONDUCTED AMONG SCHEDULE HOLDERS AND THE RESULTS OR A STATEMENT OF THE REASON MARKET RESEARCH WAS NOT CONDUCTED: GSA Schedule 65II A, A-9 Medical scopes were searched, there are two other vendors who offer scopes on FSS Schedules, Pentax, V797D-30172, Karl Storz V797D-30255, Olympus is the only vendor that offers endoscope leases which are preferable due to the heavy use this equipment incurs during patient care at the Endoscopy clincs within VISN 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
