454244 - ACH Authorization Form.pdf

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Attached to
GaAs Sensors
Solicitation number
454244
Issued by

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This document is a Request for Quotation (RFQ) issued by Brookhaven Science Associates, LLC (BSA), the operator of Brookhaven National Laboratory, under a Prime Contract with the U.S. Department of Energy (DOE) Office of Science. BSA is soliciting quotes for the fabrication of GaAs Sensors.

The key details are:

  • Solicitation Number: 454244
  • Quotes are due by Monday, December 02, 2024, at 4:00PM Eastern Standard Time
  • Pricing must remain firm for 60 days to allow for review and award
  • Offerors must be registered in the System for Award Management (SAM) and provide their Unique Entity ID number, except for foreign offerors who must complete the AMS-Form-050 (Annual Representations & Certifications)
  • The successful offeror will be required to complete additional forms such as the ACH Authorization Form, W-9 Form, and W-8 BEN or W-8 BEN-E Forms
  • The anticipated material delivery date is three (3) months after receipt of the signed award
  • Any questions must be submitted in writing by Friday, November 22, 2024, at 4:00PM Eastern Standard Time.

View the file

Other files

File Type Posted
454244 - Quotation Pricing Sheet.docx DOCX document
454244 - W-8 BEN-E Form (Foreign).pdf PDF
454244 - W-9 Form (REV 2024).pdf PDF
454244 - W-8 BEN Form (Foreign).pdf PDF
454244 - DRAFT Award.PDF PDF
454244 - Statement of Work_10-23-2024.pdf PDF
454244 - RFQ Document.pdf PDF

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Managed by Brookhaven Science Associates, LLC under contract with the

U.S. Department of Energy

Vendor ACH Authorization Form

VENDOR INFORMATION

Vendor/Company Name or DBA:

Vendor Number (if Applicable):

Tax ID Number (TIN):

DEPOSITORY INFORMATION

Financial Institution:

Routing/Transit/ABA Number:

Checking Account Number:

AUTHORIZATION

I (we) hereby authorize Brookhaven National Laboratory/Brookhaven Science Associates to make payments by initiating ACH (Automated Clearing House) credit entries or correcting entries to the account indicated above and associated with the financial institution named above. This authorization will remain in effect until BNL/BSA receives written notification to terminate or modify the same. It is my (our) understanding that credit authorizations may be revoked only by notification of the originator as described by NACHA (National Automated Clearing House Association) law.

Authorized Representative:

Email:

Phone:

Signature: Date:

VendorCompany Name or DBA:
Vendor Number if Applicable:
Tax ID Number TIN:
Financial Institution:
RoutingTransitABA Number:
Checking Account Number:
Authorized Representative:
Email:
Phone:
Date:

File details come from the government source that posted it. Updated .