IRS_PRICE_QUOTATION_SHEET.doc

IRS PRICE QUOTATION SHEET

Please complete and submit. (Reference #: 5000076076) Quote Number: _________________ (if applicable)

Vendor’s Name: ___________________________________________________

Address: _________________________________________________________

City/State/Zip: ____________________________________________________ Point of Contact: ___________________________ Tel:_______________

Check All That Apply. Above Company is:

1. [ ] Corporation [ ] Partnership [ ] Sole Proprietorship [ ] Trust

[ ] Individual Estate

[ ] Joint Venture

2. [ ] US Owned Business

[ ] Other US Entity [ ] Foreign-Owned Business Incorporated in the US [ ] Foreign-Owned Business Incorporated in the US [ ] Other Foreign Entity (e.g. Foreign Gov’t)

3. [ ] Large Business [ ] Small Business

4. Small Business and [ ] Disadvantaged [ ] Women-Owned [ ] HUBZone

[ ] Service Disabled Veteran-Owned [ ] Veteran-Owned

[ ] 8(A)

5. Registered in SAM and qualified under NAICS code (see note below)

[ ] Yes [ ] No Additional Information Required:

1. DUNS #: ________________

2. Payment Terms: Net/10 ____________Net/20_____________Net/30 ______

3. Invoice Processing Platform (IPP) Point of Contact:

Name (First and Last): ____________________________________

Email: __________________________ Tel: _____________________

NOTE: Interested vendors shall be registered in the System for Award Management (SAM) database at www.sam.gov and have an active status (to include NAICS Code 336320, Motor Vehicle Electrical and Electronic Equipment Manufacturing and completed and updated Representations and Certifications) by submission date of quote. Failure to do so may disqualify vendor from receiving the award.

Buyer’s Information:

Name: Sheila Balkaran

Phone Number: 470-719-6503

Email: Sheila.Balkaran@irs.gov

FIRM-FIXED PRICE QUOTATION

TOTAL $______________________

NOTES:

1. Brand name only.

2. Inside delivery to: 1111 Constitution Avenue, W, 2nd Floor, Washington, DC 20224 by November 29, 2019. No partial delivery. (Driver’s clearance may be required prior to delivery.)

3. FOB: Destination.

4. Unit price shall include shipping.

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