Attachment 2 Offerors Submission Package.pdf

SPE607-23-R-0204

OSP page 1 of 9

OFFER SUBMISSION PACKAGE (OSP)

INTO-PLANE / PURCHASE PROGRAM 1.2 W SOUTHCOM

(OVERSEAS) SOLICITATION SPE607-23-R-0204

PERIOD OF PERFORMANCE: 1 APR 2024 THROUGH 30 SEP 2026

CLOSING DATE AND TIME: December 20, 2023 @ 1:00 PM FORT BELVOIR, VA- EASTERN STANDARD TIME (EST). Late Offers: Any offers received after December 20, 2023 @ 1:00 PM will be considered “LATE” and may be excluded from the competition. Submit your offers well ahead of the closing date and time.

OSP CHECKLIST

1) STANDARD FORM 1449: Signature and date in ink or digitally in Blocks 30a, b and c. include your company name, address, telephone, and fax, “DUNS” and “CAGE code” number in Block 17a.

2) OFFEROR PRICE BREAKDOWN SHEET: For each item number/ICAO code. Sign and date in ink or digital signature.

3) CERTIFICATE OF ANALYSIS OR CERTIFICATE OF QUALITY: Fuel specification verification meets MIL STD 1548H with change 1 standards for all line items and locations. List line items and locations on the documents provided.

4) COMMITMENT LETTER (Reference template letter attached to solicitation)

5) SUPPLIER INVOICE: Include the price paid for fuel, per location with invoice dated: 1 November 2023 – 30 November 2023.

6) SAM ACCOUNT: Completed or updated by Solicitation closing date: http://beta.sam.gov/

Communication with Offerors for clarification shall be conducted before the competitive range is established by the solicitation close date, in accordance with FAR 15.306(b)(1)(ii)(2)(3)(i).

By submitting your OSP, you agree to the terms and conditions of the entire Solicitation, and any Amendments, unless clearly stated herein.

http://beta.sam.gov/

OSP 2 of 9

INSTRUCTIONS: CLOSING DATE AND TIME: December 20, 2023 @ 1:00 PM FORT BELVOIR, VA- EASTERN STANDARD TIME (EST). Late Offers: Any offers received after December 20, 2023 @ 1:00 PM will be considered “LATE” and may be excluded from the competition. Submit your offers well ahead of the closing date and time.

1. Offeror(s) with more than one CAGE code MUST complete one OSP per Offer Price Breakdown Sheet for all locations being offered.

2. The Offer Submission Package must be returned to this office as your proposal based on the OSP checklist.

NOTE:

X Standard Form 1449 (SF1449) - Sign and date in ink or digitally in Blocks 30a, b and c. Include your company name, address, telephone, and fax, DUNS and CAGE numbers in Block 17a.

_X Offer Price Breakdown Sheet must be expressed in U.S. Dollars per gallon and to the 6th decimal. Fuel in US Gallons and not Liters.

(Example: $0.000000) place for the Product being solicited. (Jet A w/o FSII, Jet A w/o FSII into Truck, Jet A w/ FSII, JP8)

3. Offeror(s) MUST update and complete registration in the System for Award Management (SAM) database by the solicitation closing date. The Web- Site to obtain details and instructions is: https://sam.gov/SAM/

4. Evaluation Criteria: Proposals will be evaluated based on a lowest price technically acceptable (LPTA) source selection process. The evaluation factors that establish the requirements of acceptability shall be technical acceptability and price.

5. Offerors must provide a Supplier Invoice with the Price Paid for fuel or government posting per location effective on the BASE REFERENCE DATE of 4 July 2023 (Invoice dated: 1 July 2023 – 31 July 2023.)

6. Offeror(s) shall submit a Certificate of Analysis (COA) or Certificate of Quality (COQ) from each Supplier verifying that the fuel delivered meets MIL STD 1548H WITH CHANGE 1 standards. Offeror(s) must annotate each item number/ICAO code on the COAs. Offeror(s), who are not the Refueler or Fixed-Based Operator, are required to submit a Commitment Letter from the FBO with its initial proposal. COA and COQ must be in English. Reference sample Commitment Letter in the attachment(s). FAILURE to submit a COA or COQ and a Commitment Letter from FBO with its initial proposal may result in the proposal being excluded from the competition.

7. Faxed proposals are not authorized. Please e-mail your proposal(s) to: mail (DLA-Energy-PH.Requirements@dla.mil) & the contract administrator. Please ensure that your proposal(s) (SF1449) is signed per FAR 52.212-1. Late proposals will be processed in accordance with FAR 15.208 – Submission, Modification, Revision, and Withdrawal of Proposals. When submitting a proposal via e-mail, please ensure it is sent within enough time in order for it to be processed through the server.

The maximum file size per email is 10 MB (IAW L2.11-4).

8. Exceptions to the specifications, terms, and conditions of this solicitation may be considered pursuant to the Provision M0004

– M72 EVALUATION OF OFFERS (EXCEPTIONS/DEVIATIONS) (DLA ENERGY APR 1997). Indicate any exceptions and the extent to which your offer differs from the solicitation requirements on company letter signed by an authorized representative of the company attached with your offer.

9. Offeror(s) must agree to honor prices their proposal(s) for 180 calendar days from the date of RFP closing date. The successful Offeror’s proposal in response to the solicitation may be incorporated into the resultant contract in whole or in part at the time of award.

10. Primary Solicitation Point of Contact: For clarification, explanation, and additional information, please contact Jamika Forde at 571-767-6959; email: jamika.forde@dla.mil or Joseph Teye-Kofi; email:joseph.teye-kofi@dla.mil.

11. The Government has the right to evaluate all proposals in accordance with FAR Part 15.305(a) and establish the competitive range without discussions. Based on the ratings of each proposal against all evaluation criteria, the Contracting Officer will establish a competitive range comprised of all of the most highly rated proposals, unless the range is further reduced for purposes of efficiency. In the case where the Contracting Officer has determined that the number of most highly rated proposals will be too many to conduct an efficient competition, the Contracting Officer may limit the number of proposals in the competitive range to the greatest number that will permit an efficient competition among the most highly rated proposals.

The Contracting Officer will provide a written notice of competitive range decision to unsuccessful Offerors in accordance with FAR Part 15.503(a).

mailto:DLA-Energy-PH.Requirements@dla.mil mailto:jamika.forde@dla.mil mailto:jerome.heath@dla.mil.

OSP 3 of 9

Offerors, who submit an offer under Solicitation SPE607-23-R-0204 with any Amendments, for all locations, must complete all Certifications and Representations below. Full text for all Certifications and Representations are found in Solicitation clauses for SPE607-23-R-0204. Those Certifications and Representations available in SAM should be completed in SAM; those not available in SAM should be completed below.

FAR CLAUSES, DFAR CLAUSES AND DLA ENERGY CONTRACT TEXTS:

1. B-0001 - B15.01, SUPPLIES AND ESTIMATED QUANTITIES TO BE FURNISHED (INTO-PLANE) (DLA ENERGY

(DEC 2018)

2. G-0002 – G9.07-5 ELECTRONIC TRANSFER OF FUNDS PAYMENTS – RESERVE WIRE TRANSFER SYSTEM (DLA ENERGY JAN 2012) – Provide account details if Offeror is using a Non United States Bank

3. FAR 52.203-2 CERTIFICATE OF INDEPENDENT PRICE DETERMINATION (APR 1985)

4. FAR 52.203-11 CERTIFICATION AND DISCLOSURE REGARDING PAYMENTS TO INFLUENCE

CERTAIN FEDERAL TRANSACTIONS (SEP 2007)

5. FAR 52.203-18 PROHIBITION ON CONTRACTING WITH ENTITIES THAT REQUIRE CERTAININTERNAL

CONFIDENTIALITY AGREEMENTS OR STATEMENTS—REPRESENTATION (JAN 2017)

6. FAR 52.204-16 COMMERCIAL AND GOVERNMENT ENTITY CODE REPORTING (JUL 2016)

7. FAR 52.204-17 OWNERSHIP OR CONTROL OF OFFEROR (JULY 2016)

8. FAR 52.204-20 PREDECESSOR OF OFFEROR (JULY 2016)

9. FAR 52.209-2 PROHIBITION ON CONTRACTING WITH INVERTED DOMESTIC CORPORATIONS-

REPRESENTATION (NOV 2015)

10. FAR 52.209-5 CERTIFICATION REGARDING RESPONSIBILITY MATTERS (OCT 2015)

11. FAR 52.209-7 INFORMATION REGARDING RESPONSIBILITY MATTERS (OCT 2018)

12. FAR 52.209-11 REPRESENTATION BY CPRPORATIONS REGARDING DELINQUENT TAX LIABILITY OR A

FELONY CONVICTION UNDER ANY FEDERAL LAW (FEB 2016)

13. FAR 52.212-3 OFFEROR REPRESENTATIONS AND CORPORATIONS COMMERCIAL ITEMS (OCT 2018)

14. FAR 52.222-25 AFFIRMATIVE ACTION COMPLIANCE (APR 1984)

15. FAR 52.222-56 CERTIFICATION REGARDING TRAFFICKING IN PERSONS COMPLIANCE PLAN (MAR 2015)

16. DFARS 252.209-7002 DISCLOSURE OF OWNERSHIP OR CONTROL BY A FOREIGN GOVERNMENT (JUN 2010)

17. DFARS 252.225-7020 TRADE AGREEMENTS CERTIFICATE—BASIC (NOV 2014)

18. DFARS 252.247-7022 REPRESENTATION OF EXTENT OF TRANSPORTATION BY SEA (AUG 1992)

19. K-0001 K15 RELEASE OF UNIT PRICES (DLA ENERGY MAR 2009)

20. K-0002 K33.01 AUTHORIZE NEGOTIATORS (DLA ENERGY APR 2007)

21. K-0004 K150 WIDE AREA WORKFLOW (DLA ENERGY MAY 2014)

The Offeror has completed the Certifications and Representations 1 through 21 above for the Solicitation SPE607-23-R-0204.

Print Name of Authorized Official:

Signature of Authorized Official: _ Date:

I. NOTES/EXCEPTIONS.

SECTION B: SUPPLIES OR SERVICES AND PRICE/COST

SPE607-23-R-0204

OSP 4 of 9

1. EMERGENCIES. In the event of an emergency during nonduty hours (nights, weekends, and holidays), please contact the Command Control Center at (571) 767-8420.

(a) All market prices must be stated in U.S. dollars per U.S. gallon in accordance with the CONVERSION FACTORS.

(b) TABLE.

Sub

Item No.

Reference Price &

Name of Publication Location Published and

Name of Product Method of Delivery Applicable Reference Price is Applicable

Market Price as of 4 July 2023 to Market

Price (Excluded All Taxes)

NOTE: Prices posted to the DLA Energy webpage, also known as Prices to Web, pursuant to paragraph (c) of clause B19.35 represent the Government’s calculation of the price adjustment under that clause. The Government does not warrant the accuracy of this calculation. The contractor has a duty to independently verify the calculation of the price adjustment prior to submitting an invoice. The contractor shall notify the contracting officer of any discrepancy in the calculation of the price adjustment for resolution prior to submitting an invoice. The contractor shall be liable to the Government for any administrative fee charged by the AIR Card® contractor to reprocess a transaction to correct any overpayment or underpayment resulting from the contractor’s failure to verify the calculation of the price adjustment prior to invoicing.

FAR 52.209-2 – PROHIBITION ON CONTRACTING WITH INVERTED DOMESTIC CORPORATIONS-REPRESENTATION (NOV 2015)

(a) Representation. The Offeror represents that—

(1) It [ ] is, [ ] is not an inverted domestic corporation; and

(2) It [ ] is, [ ] is not a subsidiary of an inverted domestic corporation.

(End of provision)

FAR 52.209-5 – CERTIFICATION REGARDING RESPONSIBILITY MATTERS (OCT 2015)

(a)

(1) The Offeror certifies, to the best of its knowledge and belief, that --

(i) The Offeror and/or any of its Principals --

(A) Are [_] are not [_] presently debarred, suspended, proposed for debarment, or declared ineligible for the award of contracts by any Federal agency;

(B) Have [_] have not [_], within a three-year period preceding this offer, been convicted of or had a civil judgment rendered against them for: commission of fraud or a criminal offense in connection with obtaining, attempting to obtain, or performing a public (Federal, State, or local) contract or subcontract; violation of Federal or State antitrust statutes relating to the submission of offers; or commission of embezzlement, theft, forgery, bribery, falsification or destruction of records, making false statements, tax evasion, violating Federal criminal tax laws, or receiving stolen property (if Offeror checks “have”, the Offeror shall also see 52.209-7, if included in this solicitation); and

(C) Are [_] are not [_] presently indicted for, or otherwise criminally or civilly charged by a governmental entity with, commission of any of the offenses enumerated in paragraph (a)(1)(i)(B) of this provision; and

(D) Have [_], have not [_], within a three-year period preceding this offer, been notified of any delinquent Federal taxes in an amount that exceeds $3,500 for which the liability remains unsatisfied.

(1) Federal taxes are considered delinquent if both of the following criteria apply:

(ii) The Offeror has [_] has not [_], within a three-year period preceding this offer, had one or more contracts terminated for default by any Federal agency.

(End of Provision)

FAR 52.209-7 – INFORMATION REGARDING RESPONSIBILITY MATTERS (OCT 2018)

(b) The Offeror [_] has [_] does not have current active Federal contracts and grants with total value greater than $10,000,000.

(End of provision)

DFARS 252.225-7020 TRADE AGREEMENTS CERTIFICATE—BASIC (NOV 2014)

(c) Certification and identification of country of origin.

(1) For all line items subject to the Trade Agreements—Basic clause of this solicitation, the Offeror certifies that each end product to be delivered under this contract, except those listed in paragraph (c)(2) of this provision, is a U.S.-made, qualifying country, or designated country end product.

(2)

The following supplies are other nondesignated country end products:

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FAR 52.209-11 – REPRESENTATION BY CORPORATIONS REGARDING DELINQUENT TAX LIABILITY OR A FELONY CONVICTION

UNDER ANY FEDERAL LAW (FEB 2016)

(b) The Offeror represents that—

(1) It is [ ] is not [ ] a corporation that has any unpaid Federal tax liability that has been assessed, for which all judicial and administrative remedies have been exhausted or have lapsed, and that is not being paid in a timely manner pursuant to an agreement with the authority responsible for collecting the tax liability; and

(2) It is [ ] is not [ ] a corporation that was convicted of a felony criminal violation under a Federal law within the preceding 24 months.

(End of provision)

DFARS 252.209-7002 DISCLOSURE OF OWNERSHIP OR CONTROL BY A FOREIGN GOVERNMENT (JUN 2010)

Offeror’s Point of Contact for Questions about Disclosure (Name and Phone Number with Country Code, City Code and Area Code, as applicable)

Name and Address of Offeror

Name and Address of Entity Controlled by a Foreign Government

Description of Interest, Ownership Percentage, and Identification of Foreign Government

(End of provision)

G-0002 G9.07-5 ELECTRONIC TRANSFER OF FUNDS PAYMENTS – FEDERAL RESERVE WIRE TRANSFER SYSTEM

(DLA ENERGY JAN 2012)

(a) The Contractor shall supply the following information to the Contracting Officer no later than 5 days after contract award and before submission of the first request for payment. The bank designated as the receiving bank must be capable of receiving Federal wire transactions via either a SWIFT Code or an IBAN.

(b) Any change by the Contractor in the designation of the bank account to receive electronic transfer of funds in accordance with this contract text must be received by the Contracting Officer no later than 30 days prior to the date the change is to become effective.

(c) The electronic transfer of funds does not constitute an assignment of such funds in any form or fashion.

COMPLETE THE FOLLOWING INFORMATION (TYPE WRITTEN OR CLEAR PRINTING) (DO NOT EXCEED 25 CHARACTERS)

RECIPIENT’S NAME: | | | | | | | | | | | | | | | | | | | | | | | | | |

ORIGINATOR ABA: 044036205 (DLA ENERGY fill-in) RECIPIENT’S CAGE CODE:

CONTRACT NUMBER: (DLA ENERGY fill-in) [ ] CHECKING TYPE 22 [ ] SAVINGS TYPE 32

RECIPIENT’S DUNS NUMBER:

BENEFICIARY’S BANK SORT CODE: | | | | | | | (FOR BANKS IN THE UNITED KINGDOM ONLY)

(6 CHARACTERS ONLY)

(d) CONTRACTOR’S DESIGNATED OFFICIAL SUBMITTING ELECTRONIC FUNDS TRANSFER INFORMATION.

NAME | | | | | | | | | | | | | | | | | | | | | | | | | |

TITLE | | | | | | | | | | | | | | | | | | | | | | | | | |

TELEPHONE NUMBER | | | | | | | | | | | | | | | | | | | | | | | | | |

SIGNATURE

(e) Notwithstanding any other provision of the contract, the requirements of this contract text shall control.

(Line Item Number) (Country of Origin)

BENEFICIARY’S BANK NAME: | | | | | | | | | | | | | | | | | | | | | | | | | | |

BENEFICIARY’S BANK ADDRESS: | | | | | | | | | | | | | | | | | | | | | | | | | |

BENEFICIARY’S BANK ACC. No: BENEFICIARY’S BANK SWIFT No. | | | | | | | |

(EITHER 8 OR 11 CHARACTERS ONLY)

IBAN NUMBER:

SOLICITATION/CONTRACT/ORDER FOR COMMERCIAL ITEMS

OFFEROR TO COMPLETE BLOCKS 12, 17, 23, 24, & 30

1. REQUISITION NUMBER

7002047767

2. CONTRACT NO.

7. FOR SOLICITATION

INFORMATION CALL:

3. AWARD/EFFECTIVE

DATE

a. NAME

Jamika Forde

4. ORDER NUMBER 5. SOLICITATION NUMBER

SPE607-23-R-0204

b. TELEPHONE NUMBER (No Collect calls)

Phone: DSN392-767-6959

6. SOLICITATION ISSUE

DATE

2023 NOV 16

8. OFFER DUE DATE/

LOCAL TIME

2023 Dec 20

01:00 PM

9. ISSUED BY CODE SPE607 10. THIS ACQUISITION IS UNRESTRICTED OR SET ASIDE: % FOR:

DLA ENERGY

INTOPLANE

8725 JOHN J. KINGMAN ROAD

SMALL BUSINESS

HUBZONE SMALL

BUSINESS

WOMEN-OWNED SMALL BUSINESS

(WOSB) ELIGIBLE UNDER THE WOMEN-OWNED

SMALL BUSINESS PROGRAM

FORT BELVOIR VA 22060

USA SERVICE-DISABLED

VETERAN-OWNED

SMALL BUSINESS

EDWOSB

8 (A)

NAICS: 324110

SIZE STANDARD:

11. DELIVERYFOR FOB DESTINA-

TION UNLESS BLOCK IS

MARKED

15. DELIVER TO

12. DISCOUNT TERMS

CODE

13a. THIS CONTRACT IS A

RATED ORDER UNDER

DPAS (15 CFR 700)

16. ADMINISTERED BY

13b. RATING

14. METHOD OF SOLICITATION

RFQ IFB RFP

CODE 17a. CONTRACTOR/ Full Company Name & Address & Email & Phone

OFFEROR

18a. PAYMENT WILL BE MADE BY CODE

TELEPHONE NO.

17b. CHECK IF REMITTANCE IS DIFFERENT AND PUT SUCH ADDRESS IN 18b. SUBMIT INVOICES TO ADDRESS SHOWN IN BLOCK 18a UNLESS BLOCK

OFFER BELOW IS CHECKED SEE ADDENDUM

19.

ITEM NO.

20.

SCHEDULE OF SUPPLIES/SERVICES

21.

QUANTITY

22.

UNIT

23.

UNIT PRICE

24.

AMOUNT

See Schedule (Use Reverse and/or Attach Additional Sheets as Necessary)

25. ACCOUNTING AND APPROPRIATION DATA

26. TOTAL AWARD AMOUNT (For Govt. Use Only)

27a. SOLICITATION INCORPORATES BY REFERENCE FAR 52.212-1, 52.212-4. FAR 52.212-3 AND 52.212-5 ARE ATTACHED. ADDENDA ARE

27b. CONTRACT/PURCHASE ORDER INCORPORATES BY REFERENCE FAR 52.212-4. FAR 52.212-5 IS ATTACHED. ADDENDA ARE

ARE NOT ATTACHED

ARE NOT ATTACHED

AUTHORIZED FOR LOCAL REPRODUCTION PREVIOUS EDITION IS NOT USABLE STANDARD FORM 1449 (REV. 2/2012)

28. CONTRACTOR IS REQUIRED TO SIGN THIS DOCUMENT AND RETURN

COPIES TO ISSUING OFFICE. CONTRACTOR AGREES TO FURNISH AND

DELIVER ALL ITEMS SET FORTH OR OTHERWISE IDENTIFIED ABOVE AND ON ANY

ADDITIONAL SHEETS SUBJECT TO THE TERMS AND CONDITIONS SPECIFIED

29. AWARD OF CONTRACT: REF. OFFER

DATED . YOUR OFFER ON SOLICITATION

(BLOCK 5), INCLUDING ANY ADDITIONS OR CHANGES WHICH ARE

SET FORTH HEREIN, IS ACCEPTED AS TO ITEMS:

30a. SIGNATURE OF OFFEROR/CONTRACTOR 31a. UNITED STATES OF AMERICA (SIGNATURE OF CONTRACTING OFFICER)

30b. NAME AND TITLE OF SIGNER (Type or Print) 30c. DATE SIGNED 31b. NAME OF CONTRACTING OFFICER (Type or Print) 31c. DATE SIGNED

OSP 7 of 9

19.

ITEM NO.

20.

SCHEDULE OF SUPPLIES/SERVICES

21.

QUANTITY

22.

UNIT

23.

UNIT PRICE

24.

AMOUNT

32a. QUANTITY IN COLUMN 21 HAS BEEN

RECEIVED INSPECTED ACCEPTED, AND CONFORMS TO THE CONTRACT, EXCEPT AS NOTED:

32b. SIGNATURE OF AUTHORIZED GOVERNMENT

REPRESENTATIVE

32c. DATE 32d. PRINTED NAME AND TITLE OF AUTHORIZED GOVERNMENT

REPRESENTATIVE

32e. MAILING ADDRESS OF AUTHORIZED GOVERNMENT REPRESENTATIVE 32f. TELEPHONE NUMBER OF AUTHORIZED GOVERNMENT REPRESENTATIVE

32g. E-MAIL OF AUTHORIZED GOVERNMENT REPRESENTATIVE

33. SHIP NUMBER 34. VOUCHER NUMBER 35. AMOUNT VERIFIED

CORRECT FOR

36. PAYMENT

COMPLETE PARTIAL FINAL

37. CHECK NUMBER

PARTIAL FINAL

38. S/R ACCOUNT NO. 39. S/R VOUCHER NUMBER 40. PAID BY

41a. I CERTIFY THIS ACCOUNT IS CORRECT AND PROPER FOR PAYMENT 42a. RECEIVED BY (Print) 41b. SIGNATURE AND TITLE OF CERTIFYING OFFICER 41c. DATE

42b. RECEIVED AT (Location)

42c. DATE REC'D (YY/MM/DD) 42d. TOTAL CONTAINERS

STANDARD FORM 1449 (REV. 2/2012) BACK

OSP 8 of 9

OFFER PRICE BREAKDOWN SHEET (OVERSEAS version)

AIRPORT NAME AND ICAO CODE:

(Identify the airport and its ICAO code found in the solicitation schedule)

VENDOR CAGE CODE: LARGE OR SMALL BUSINESS:

CLIN NUMBER: STATE/ COUNTRY:

EST QUANTITY GALLONS:

IF THE INCUMBENT, STATE YOUR CONTRACT NUMBER #

REFERENCE DATE: 4 JULY 2023

($ USD Currency)

PUBLICATION PRICE (OPIS/PLATTS) FOR THE ABOVE REFERENCE DATE: $

PRICE YOU PAID FOR YOUR FUEL ON ABOVE REFERENCE DATE: $ A.

FREIGHT (state if “INCLUDED” in price or if “NONE”) $ B.

AIRPORT FLOWAGE FEE (if applicable): $ C.

STATE/LOCAL TAXES & FEES - Specify tax/fee types and the amount per Contract Provisions I28.02-2 and M57:

$ c.1

$ c.2

$ c.3

$ c.4

TOTAL STATE/LOCAL TAXES & FEES (Must equal d.1 through D.4): $ D.

INTO-PLANE FEE (required): $ E.

TOTAL UNIT PRICE OFFERED W/O FSII

Jet A w/o FSII, Jet A-1 w/o FSII (Into Truck), TS1: (sum of A thru E) $ F.

FSII PRICE: (If none, state “None.”) $ G.

TOTAL UNIT PRICE OFFERED W/FSII Jet A w/ FSII, Jet A-1 w/FSII, TS1, JP8 (sum of F & G) $ H.

ADDITIONAL FEES

INTO-TRUCK FEE (if required) $ _ I.

RAPID REFUELING FEE (if applicable) $ J.

OTHER FEES (if applicable) $_________________K

PUBLICATION SELECTED FOR REFERENCE PRICE ADJUSTMENT

OPIS:

PLATTS:

OTHER:

Prices will change on [ ] Monday [ ] Tuesday [ ] Weekly [ ] Monthly[ ] Other

Refinery/

OSP 9 of 9

** NOTE Call Out Fees and hours are not evaluated items; however, in the event that 24-hour service is not available and the Government is unable to provide advance notification of after-hour delivery requirements, into-plane fuel may be procured from another source.

Per Hour or Per Occurrence (Included)

Hours of Operations [ ] 24 hours per day, 7 days per week (preferred) OR [ ] Other (Specify hours/call-out, and phone number for call-outs):

Circle One

Call-Out/Overtime Fee and Advance Notice: Holidays Included: YES or NO

Are you the REFUELER for this offer under this location? (Please check one)

**** (Commitment letter must match the name and Address of the Refueler/FBO information below. COA or COQ must be in English)

Refueler (FBO) Point of Contact Name:

Full Physical Address (Country & State)

Person at Facility Phone Number:

Source Name:

Physical Address:

Phone Number:

K-0002 - K33.01 Authorized Negotiators (Reference: DLA Energy APR 2007)

Name & Title: Email &Phone:

Name & Title: Email & Phone:

YES NO

OFFER PRICE BREAKDOWN SHEET (OVERSEAS version)