New Sole Source Contract or Contract Modification or Extension (FAR 6.302 and DLMS 2-836). Complete Item 5.
New Sole Source Discretionary Grant or Cooperative Agreement (DLMS 2-836), or

Modification or Extension of a Discretionary Grant or Cooperative Agreement (DLMS 2-836). Complete Item 5.
Advisory and Assistance (A&A) Services (FAR 37.2). Complete Item 6.

Ratification of an unauthorized commitment (FAR 1.602-3). Complete Item 7.

Waiver to contract with a Current/Former Government Employee (individual or owner) (FAR 3.6 and DOLAR 2903.6).
Attach Narrative.

Application for use of Brand Name Specifications (FAR 6.302-1). Complete Item 5.

Potential financial conflicts (DLMS 2-836(b)(2) and FAR 3.104-7(b)). Attach Narrative.

B. Authority. If this request involves a grant or cooperative agreement, provide the specific legal authority, including citation (e.g. Section # of the XXXX Act, # U.S.C. ####):

If this is a request for sole source contract, grant, or cooperative agreement authority, review the instructions and identify below the bases for a sole source award. Please attach a succinct narrative supporting each of the bases chosen to support the sole source selection. If you are claiming that the proposed recipient is the only responsible source or has unique qualifications, you must provide supporting information such as market research or other available information indicating whether there are other potential recipients and, if so, explain why you do not consider them acceptable. In addition, outline any steps that will be taken in the future to eliminate the need for sole source authority.

6. Advisory And Assistance Services (A&A)

A. Check one of the following:

[Skip If Not Applicable]

Competitive A&A value over $50,000

Sole Source A&A

B. Subject to FAR 37.203, agencies may contract for advisory and assistance services, when essential to the agency's mission, to:

Π

(1) Obtain outside points of view to avoid too limited judgement on critical issues;

(2) Obtain advice regarding developments in industry, university, or foundation research;
(3) Obtain the opinions, special knowledge, or skills of noted experts;

(4) Enhance the understanding of, and develop alternative solutions to, complex issues;
(5) Support and improve the operation of organizations; or

(6) Ensure the more efficient or effective operation of managerial or hardware systems.

Ratifications of unauthorized commitments are authorized only under FAR 1.602-3 (c) which identifies seven limitations on use of the authority, and DOLAR 1.602-3, which outlines the DOL ratification procedures. Please review those requirements and attach to this form the required documents, including findings and a determination by the Agency Head that the statements are accurate, the Contracting Officer's determination that the price is fair and reasonable with a recommendation for payment, and legal counsel's (SOL/ETLS) determination that the ratification is legally supportable.

8. Conflict Of Interest Certification (Must Be Completed For Each Action):

I certify to the best of my knowledge and belief that statements provided herein are accurate and true, and I have no organizational, personal, financial or other conflicts of interest which could call into questions my objectivity in this matter or present a prohibited relationship under either 18 U.S.C. 208 or 5 C.F.R. § 2635.502.

Program Official (Contracting or Grant Officer's Technical Representative)

Note: Conflict of Interest statements apply to individuals and may be signed only by the individuals to whom they apply.

DL 1-490
(Rev. 10/03)

INSTRUCTIONS FOR COMPLETING THE DL 1-490

General Instructions: Agencies should consult DLMS 2-836, as well as the cited provisions of the Federal Acquisition Regulation (FAR) and Department of Labor Acquisition Regulation (DOLAR), as they prepare submissions to the PRB. Agencies also should ensure that their submissions are concise, but complete.

Item 1. Provide a one sentence title to describe the type of grant, contract, or cooperative agreement, and a short description of the purpose of the requested action. The total dollar threshold should include proposed optional periods of performance and additional services.

Item 2. FAR references may be found at http://www.arnet.gov/far/loadmainre.html; the Department of Labor Acquisition Regulation (DOLAR) may be found at http://www.dol.gov/dol/allcfr/Title_48/Chapter_29.htm; and all other references may be found at:http://www.labornet.dol.gov/DCS_FileSystem/DLMS2Administration/dlms2_0800.doc. If the proposed action is a grant or cooperative agreement, please provide the specific legal authority, including citation (e.g. Section of the Act, U.S.C. ), for the grant or cooperative agreement. You also may wish to consult the division of the Office of the Solicitor that serves your agency.

Item 3. The company or organization (including sub-organization) should be identified.

Item 4. The OASAM/Business Operations Center/Office of Acquisition and Management Services/Division of Acquisition Management Services may be able to assist you in this effort.

Item 5. Sole source justifications are summarized below. Please note, however, that authorizing program statutes or appropriation laws sometimes include specific provisions restricting non-competitive actions. In those cases, the statutory authority supercedes the authority outlined below and the statutory authority should be cited in your response to item 5.

Contract Authority:

FAR 6.302-1 Sole Source and no other supplies or services will satisfy agency requirements (i) unsolicited proposal

(ii) follow on to competed action for a major system.

(iii) rights in data, patent rights, copyrights or secret processes make supplies available from only one source.

FAR 6.302-2 Unusual and compelling urgency.

Item 6. Advisory and Assistance Services are defined in FAR 2.101 and the policy is detailed in FAR Part 37.2. Item 7. Ratification, as used in this subsection, means the act of approving an unauthorized commitment, by an official who has the authority to do so. The attached document should include: a brief description of what was acquired without authority; any mitigating statements; and a findings and determination by the Agency head that the statements are accurate, including a Contracting Officer's determination that the price is fair and reasonable, with a recommendation for payment and the concurrence of legal counsel (SOL/ETLS) with that determination.

Item 8. Conflict of Interest Certifications are necessary with each DL 1-490 submitted to the PRB. Approval may not be granted without proper signature. Conflict of Interest certifications are personal to the individual signing and may not be signed or delegated by one person on behalf of another.

NOTE: The Procurement Review Board reviews these requests and makes a recommendation to approve/disapprove to the Assistant Secretary for Administration and Management based on the merits of the case provided in the request.

2953.101 Simplified Acquisition Documentation Checklist DL 1-2216.

The following checklist must be used to document all simplified acquisitions

DL1-490 Instructions (Rev. 10/03)

at or below the simplified acquisition threshold.

Simplified Acquisition Documentation
Checklist

U.S. Department of Labor

PART I: CHECKLIST - Complete Section A for purchases less than $2,500, or Sections A and B for purchases between $2,500 and $100,000

SECTION A. Micro-purchases - Less than $2,500 (not set aside for small business only; no competition required if price is determined reasonable)

Sufficient funds are available to cover this purchase, and the price reflected on this order is considered fair and
reasonable.

All Quotation information is properly documented, and applicable/required clearances and/or approvals have
been obtained are included in this file

See www.jwod.com and www.unicor.gov. Required sources of supplies/services, including excess supplies,
were reviewed prior to the selection of this vendor (n/a for delivery orders against existing contracts)

The vendor does not appear on the List of Parties Excluded from Federal Procurement Programs. Reference
http://epls.arnet.gov/

This order does not represent an unauthorized commitment of funds requiring ratification under FAR 1.602-3
(otherwise attach documentation)

SECTION B. Purchase Between $2,501 and $100,000 (set aside for small business, competition is required for open
market orders, schedule comparison is required for GSA/FSS orders)

The order was best value among two or more solicited open market vendors. Use Form DL 1-2078, if not,
complete Parts II and III below.

The requirement was set aside for small business participation only. If not, complete Part IV below.

The procurement is for Information Technology products or software and has been reviewed for compliance with
Section 508 and SmartBuy licenses.

The item complies with http://www.eere.energy.gov/femp/procurement/ policies on recycling, and Energy star
compliance.

If this is a Delivery Order against a GSA/Federal Supply Schedule, at least 3 vendors schedules were reviewed prior
to issuing orders.

Written Solicitation between $10,000 - $25,000 was displayed in a public place, open market requirements over
$25,000 were synopsized.

Service Contract Act. This is an Open Market Purchase:
Davis-Bacon applicable, or SCA WD included

primarily a product,
(SF98 & 98a issued)

exempt per 29 CFR 541,

Other (i.e. contracting officer knowledge, comparison to independent government estimate)

PART III: SOLE SOURCE DOCUMENTATION - Only one source was solicited for the following reason(s)
all that apply)

The item is sole source in nature, i.e. copyright/patient, proprietary software/hardware, or original equipment
manufacturer, and not available from any other source.

Urgent and Compelling - state nature of emergency and reason no competition was obtained (lack of planning is not
sufficient reason)

PART IV: LARGE BUSINESS DOCUMENTATION - The requirement is not awarded to a small business because
all that apply)

No small businesses were located that can provide the required goods/services
No quotes were received from small businesses

Quotes received from small businesses were not the lowest prices or the best value (considering quality, delivery,
quantity, past performances, etc)