Single source request form

Step 1: Work/Services information

Description/Title of work/Services

Step 2: Department information

Department

Division

Contract administrator name

Email (Only @winnipeg.ca addresses will receive a confirmation email when the request is submitted.)

Contract administrator phone number 000-000-0000

Step 3: Proposed contractor

Contractor name

Contact name

Phone number 000-000-0000

Step 4: Other information

Estimated contract value
(excluding any extensions)

Reason as per Materials Management Policy Review and select a reason under B4.1

Details for reason selected above

IS Expenditure Approval Required? If applicable (include approval email with request) Contact the IT rep in your Dept. for assistance.

Yes

Note:

IF OVER $75K (Administrative Standard FM-002, Appendix 13)

The Trade Agreements apply to a procurement when the value (including all options such as additional purchases or mutually agreed extensions) of the procurement meets or exceeds:

$75,000 for goods or services, including consultants or
$200,000.00 for construction.

Attach supporting documents

Please limit each file to 10 MB, ending in .pdf, .doc, .docx, .txt, .jpg, .jpeg, .png, .gif, .tiff, .tif, .msg, or .bmp.

File one (optional)

File two (optional)

File three (optional)

Note: If the contract value is over $100K, a report is required and this form is not applicable.

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Privacy statement

This collection of your personal information is authorized by section 36(1)(b) of The Freedom of Information and Protection of Privacy Act. Your information will be used to respond to you and to assure service quality. It is protected by the Act’s privacy provisions and will not be used or disclosed for any other purpose, except as authorized by law. Contact the Corporate Access and Privacy Officer by mail (City Clerk’s Department, 510 Main Street, Winnipeg MB, R3B 1B9) or by telephone (311), if you have questions about the collection or use or your personal information.