B.1. ENCLOSURE C AMS FORM_043.pdf

ENCLOSURE C

Date Printed 3/20/2026 1 of 2 Date Approved 12/14/2020

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 No. 0.1

APPROVED BY:

L. McKnight / 12/14/2020

PPM Manager/Date

Quotation Pricing Sheet Reference: BSA Request for Quotation No. BG475931 Psylotest xTS – 4.5kN X xTS Test System w/On-Site Installation, Alignment & Training or its equivalent

Brookhaven National Laboratory Brookhaven Science Associates, LLC P.O. Box 5000 – Bldg. 101 Upton, NY 11973

Attention: Beth Gilman Sr. Buyer

To whom it may concern:

In compliance with your letter of solicitation dated [insert date], we submit our Quotation No.

___________________________ dated _______________, for a Psylotest xTS – 4.5kN X xTS Test System w/On-Site Installation, Alignment & Training or its equivalent

Line Item Description Qty UOM Unit Price

Merchandise Amount

1 xTS – 4.5kN X xTS Test System 1.0000 EA

2 Analog output card (2 channels: displacement and load) 1.0000 EA

3 Psylotest software automation module 1.0000 EA 4 Two (2) additional replacement encoders 1.0000 EA 5 Support posts 1.0000 EA 6 Installation and Training 1.0000 EA

Total “All Inclusive” Firm Fixed Price $_____________

Lead Time _______________

Country of Origin __________

Shipping From _____________

This price shall remain firm for [60] days.

The terms of delivery and payment are FOB Destination, Net 30 Days.

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ENCLOSURE C

Date Printed 3/20/2026 2 of 2 Date Approved 12/14/2020

0BConcurrence:

By signing this Quotation Pricing Sheet, our firm hereby acknowledges and agrees to BSA's requirements, terms and conditions, and delivery schedule, and agrees to provide the resources necessary to meet BSA's delivery schedule.

Company _____________________ Signature _____________________

Address ______________________ Typed Name __________________

______________________________ Title _________________________

Telephone No.___(___)__________ Date _________________________

Concurrence: