Enclosure C AMS-Form-043.pdf
PDF 193 KB Posted
- Solicitation number
- 483336
- Issued by
-
Department of Energy Office of Science
About this file
This is a Quotation/Proposal Pricing Sheet template issued by Brookhaven National Laboratory (managed by Brookhaven Science Associates, LLC under contract to the U.S. Department of Energy). The document is a blank form (AMS-Form-043, Revision 2.0, effective 9/15/2026) for vendors to submit pricing in response to BSA Request for Quotation/Proposal No. 483336 for a MECA500-R-4 Robot, Power Supply, Training Package, and Calibration. The buyer/contract specialist contact is Joshua Winer.
Vendors must provide a total price in U.S. dollars inclusive of all taxes, fees, customs, duties, and other charges. The pricing shall remain firm for 30 days, with delivery on FOB Destination (Deliver at Place) terms and Net 30 payment terms. Vendors must identify the country of origin or place of manufacture; if located outside the U.S., they must provide the item HTS code and company export control point of contact information. Offerors must certify the item as a commercial item per FAR 2.101, confirm their SAM registration and current representations and certifications, and confirm their ability to meet the delivery timeline. By signature, vendors acknowledge agreement to BSA's requirements, delivery schedule, and terms and conditions. The form includes standard concurrence language regarding potential disclosure of proposals to U.S. Government personnel.
View the file
Other files
| File | Type | Posted |
|---|---|---|
| Enclosure A Draft PO 483336.pdf | ||
| RFQ 483336.pdf | ||
| RFQ 483336.pdf | ||
| Enclosure A Draft PO 483336.pdf | ||
| Enclosure C AMS-Form-043.pdf |
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Text version
Date Printed 9/23/2026 1 of 2
PROCUREMENT AND PROPERTY MANAGEMENT DIVISION
BROOKHAVEN NATIONAL LABORATORY
Managed by Brookhaven Science Associates, LLC under contract to the U.S. Department of Energy
ACQUISITION MANAGEMENT SYSTEM FORM
Form No. AMS-Form-043
Revision: 2.0
Effective Date: 9/15/2026
APPROVED BY:
Dedra Blood
Quotation/Proposal Pricing Sheet
Reference: BSA Request for Quotation/Proposal No. 483336
Description: MECA500-R-4 Robot, Power Supply, Training Package, and Calibration
Attention: Buyer/Contract Specialist: Joshua Winer
To whom it may concern: In compliance with your letter of solicitation dated [9/23/26], we submit our Quotation/Proposal
No. ___________________________
Total Price* $_____________
*Must be in U.S. Dollars and inclusive of all taxes, fees, customs, duties and other charges.
This price shall remain firm for 30 days.
Delivery is FOB Destination Deliver at Place (DAP).
Payment terms are Net 30
Country of Origin or Place of Manufacture: [insert place] *Item HTS CODE: [insert HTS code]
*Company’s Export Control Point of Contact (POC): [insert POC]
*Phone #: [insert phone #] *Email Address: [insert email address]
*Required if country of origin or manufacture is located outside of the U.S.
Date Printed 9/23/2026 2 of 2
Concurrence:
By signing this Quotation/Proposal Pricing Sheet, our firm hereby acknowledges and agrees to BSA's requirements and delivery schedule and agrees to provide the resources necessary to meet BSA's delivery schedule. We affirm we are registered in SAM and our representations and certifications as well as our small business size status (if applicable) are current and complete. Additionally, please certify the following:
Item commercial status. Check one of the following by clicking the ☐ next to the associated option:
☒ Commercial item as defined in FAR 2.101
☐ Non-commercial item
Can you meet delivery timeline? If yes, check this box: ☐
If not, please provide your forecasted delivery date: [insert delivery date]
Notice is hereby provided that BSA may disclose offeror proposals to U.S. Government personnel for review.
In such case, BSA will furnish the proposal to the Government with any confidentiality legends included by the
Offeror, but BSA is not responsible for any subsequent disclosure by the U.S. Government.
Certification: By signing this Quotation/Proposal Pricing Sheet, our firm hereby acknowledges and agrees to BSA's Terms and Conditions, as incorporated into the solicitation and attached documents.
Company ____________________ Signature __________________
Email Address ________________ Typed Name __________________
SAM UEI #___________________ Title _________________________
Telephone No.(___)____________ Date _________________________
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