B1 Enclosure C AMS-Form-043B.docx
DOCX document 24 KB Posted
- Attached to
- Kinoform Beam Splitter
- Solicitation number
- BSA438002
- Issued by
-
Department of Energy Office of Science
About this file
This is a Quotation Pricing Sheet template (AMS-Form-043B) issued by Brookhaven National Laboratory for Request for Quotation No. 438002 concerning Tunable X-ray Kinoform Beam Splitters. The form is designed for vendors to submit pricing proposals in compliance with the solicitation requirements. Quotations must include the total payment amount for receipt and acceptance by BNL of the Tunable X-ray Kinoform Beam Splitters, specification of the manufacturer's location, and confirmation of delivery terms (Delivered at Place with Net 10 or 30 days payment terms). Vendors must also indicate the number of days their quoted price will remain firm. The form requires company information, authorized signature, and contact details from the submitting vendor.
By executing this pricing sheet, vendors acknowledge and agree to BSA's requirements, terms and conditions, and delivery schedule. The solicitation was managed by Brookhaven Science Associates, LLC (operating under contract to the U.S. Department of Energy) and directed toward Mark Brock, Subcontracts Supervisor at Brookhaven National Laboratory in Upton, New York. The referenced product is a nanostructured silicon grating kinoform beam splitter with specific technical parameters including 150nm pitch, 9600 eV design energy, approximately 500 micrometers by 4000 micrometers grating structure on a 15mm by 15mm silicon substrate frame with 5 micrometers structure height.
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Text version
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. 438002 |
| Tunable X-ray Kinoform Beam Splitters |
Brookhaven National Laboratory Brookhaven Science Associates, LLC P.O. Box 5000 – Bldg. 101 Upton, NY 11973
| Attention: | Mark Brock |
| Subcontracts Supervisor |
To whom it may concern:
In compliance with your letter of solicitation dated [insert date], we submit our Quotation No. ___________________________ dated _______________, for the referenced solicitation.
| Item |
| Payment |
| Amount |
| Cumulative Amount |
| 1 |
| Receipt and acceptance by BNL of the Tunable X-ray Kinoform Beam Splitters |
Total:
This price shall remain firm for [fill in # days] days.
List the Place of Manufacturer: ____________________
The terms of delivery and payment terms are Delivered at Place, Net [insert 30 or 10] Days.
Concurrence:
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 _________________________ |
Date Printed 1/14/2026 1 of 1 Date Approved 12/14/2020
File details come from the government source that posted it. Updated .