B1 Enclosure C AMS-Form-043B.docx

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Attached to
Kinoform Beam Splitter
Solicitation number
BSA438002
Issued by

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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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 .