Attachment 3 - Quote Submission Form.pdf

United States Department of Agriculture

Research, Education, and Economics Agricultural Research Service

Office of the Director Contracting Operations Branch ● Acquisition and Property Division

5601 Sunnyside Avenue ● Beltsville, MD 20705 USDA is an Equal Opportunity Provider and Employer

QUOTE SUBMISSION FORM

Solicitation Title: _____________________________________________________________________

Solicitation Number: ______________________

Company Information:

Currently Registered and Active in the System for Award Management (SAM): ( ) Yes ( ) No

SAM Unique Entity Identifier (UEI) Number:

Company Legal Name: _____________________________________________

Doing Business As (if applicable): ____________________________________

Company Address as registered in the System for Award Management (SAM):

CAGE Code(s):

Socio-economic status for the NAICS code: __________ (with a small business threshold of under ______________) – please check ALL that apply:

( ) Small Business Concern [ ] Disadvantaged

[ ] SBA-certified 8(a) Program Participant [ ] SBA-certified HUB Zone Business

[ ] Veteran Owned [ ] Service-Disabled Veteran Owned

[ ] Woman-Owned [ ] Economically Disadvantaged Woman Owned

( ) Other Than Small Business Concern

( ) I confirm that my company is registered in the System for Award Management (SAM) with the socio-economic status identified above and the NAICS code specified or that my firm qualifies for the selected the socio-economic status under the applicable NAICS code.

Agricultural Research Service

Office of the Director Contracting Operations Branch ● Acquisition and Property Division

5601 Sunnyside Avenue ● Beltsville, MD 20705 USDA is an Equal Opportunity Provider and Employer

Quote Information:

Quote Number: _________________

Quote Date:

Quote Expiration Date:

Quoted Prices:

Vendors shall insert pricing/data in the cells below. All line items must be priced.

The Line-Item Total Amount is the Quantity multiplied by the Unit Price.

The Total Quoted Price is the sum of all Line-Item Total Amounts.

Line Item

Item Description Quantity Unit Unit Price

Total Amount

0001 Epoxy Resin Countertop, Long Peninsula (Approx 83 Sq Ft)

Each

0002 Epoxy Resin Countertop, Short Peninsula (Approx 24 Sq Ft)

Each

0003 Epoxy Resin Countertop, West Wall Bench 1 (Approx 65 Sq Ft)

Each

0004 Epoxy Resin Countertop, East Wall Bench (Approx 54 Sq Ft)

Each

0005 Epoxy Resin Countertop, North Wall Bench (Approx 46 Sq Ft)

Each

0006 Epoxy Resin Countertop, Stair Wall Bench (Approx 15 Sq Ft)

Each

0007 Epoxy Resin Backsplash (Approx Length 72 Ft)

Each

0008 Epoxy Resin Sink Each 0009 Cabinet, 1.5-Ft One-Door Each 0010 Cabinet, 2-Ft Four-Drawer Each 0011 Cabinet, 2.5-Ft Two-Door Each 0012 Cabinet, 2.5-Ft Six-Drawer Each 0013 Cabinet, 2.5-Ft Eight-Drawer Each 0014 Cabinet, 3-Ft Sink Each 0015 Cabinet, 3-Ft Two-Door Each 0016 Cabinet, 3-Ft Six-Drawer Each

Agricultural Research Service

Office of the Director Contracting Operations Branch ● Acquisition and Property Division

5601 Sunnyside Avenue ● Beltsville, MD 20705 USDA is an Equal Opportunity Provider and Employer

0017 Cabinet, 3-Ft Eight-Drawer Each 0018 Cabinet, 4-Ft Wide Open Each 0019 Acid Storage Cabinet Each 0020 Flammables Storage Cabinet Each 0021 Table Legs Each 0022 Filler Panels Each 0023 Scribe Panels Each 0024 Stainless Steel Scullery Sink Each 0025 Deck-Mounted Hot/Cold Faucet Each

Total Quoted Price:

Time to Delivery: ( ) days ( ) weeks ( ) months

Country of Manufacture Information:

Product Name(s) and Part Number(s):

Manufacturer’s Legal Name:

Product is Manufactured in the United States of America (is a domestic product): ( )Yes ( )No

Manufacturing Address (for domestic products):

Country of Origin (for nondomestic products):

( ) I confirm that a written certification of the above information was obtained from the product’s manufacturer and is included in the support documents submitted with this quote.

Certification:

I understand that incomplete sections, failure to provide all required documentation, and/or failure to sign this certification may remove my company’s quote from being put into consideration by the Government for award.

Signature:

Agricultural Research Service

Office of the Director Contracting Operations Branch ● Acquisition and Property Division

5601 Sunnyside Avenue ● Beltsville, MD 20705 USDA is an Equal Opportunity Provider and Employer

Name:

Title:

Contact Information:

Date: