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<br />22 <br />216348v2 <br />Appendix E <br /> <br />PROFESSIONAL/TECHNICAL CONTRACT SINGLE SOURCE REQUEST FORM <br /> <br />Submit form to: City of North St. Paul Finance Department <br /> <br />Submit with: Detailed Quote/Scope of Work <br /> <br /> DEPARTMENT <br /> PROPOSED CONTRACTOR <br /> <br /> Name of company: <br /> Address: <br /> <br /> Telephone: <br /> <br /> <br /> Web Address (if available): <br /> <br /> CONTRACT PERIOD <br /> <br /> _to _ <br /> <br />*The term of the contract must not exceed two years <br />unless the Council determines that a longer duration is <br />in the best interest of the City. If you are requesting that <br />the original contract length be longer than two years, <br />please attach a written justification. <br /> CONTRACT PRICE <br /> <br />$ <br />DESCRIPTION OF SERVICE REQUIRED: <br /> <br /> <br />SINGLE SOURCE CATEGORY <br />(Check applicable box, attach documentation or provide explanation below) <br /> Legislation or appropriation mandates use of <br />contractor (Legislation attached) <br /> <br /> Expert witness required by AGO (attach documentation) <br /> Mailing lists, subscriptions or media advertising <br /> Warranty voided if service provided by other contractor <br /> Software license renewals, additions or upgrades <br />available from only one source <br /> <br /> Brand compatibility available from only one source <br /> Other proprietary situation <br /> Other <br /> THIS PROCUREMENT IS A SINGLE SOURCE BECAUSE (attach additional page if needed): <br /> <br /> NOTE: The following are unlikely to be sufficient single source justifications: <br />♦ Personal or agency preference for a contractor <br />♦ Agency perception that the vendor is the best qualified (this should be determined through a competitive process) <br />♦ Lack of agency planning resulting in limited time to conduct a competitive procurement <br />♦ Past or existing relationship with the vendor <br />♦ Special incentive or deal offered (can be assessed in open and competitive solicitation) <br />♦ Agency convenience