BEP-16-000195.docx

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Attached to
BRUSH (FOUR-ROW) Federal contract opportunity
Solicitation number
BEP-16-000195
Issued by
Department of the Treasury Office of the Comptroller of the Currency

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BRUSH (FOUR-ROW)

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TERMS_AND_CONDITIONS.pdf PDF

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REQUEST FOR QUOTATION

(THIS IS NOT AN ORDER)

THIS RFQ |X| IS |_| IS NOT A SMALL BUSINESS SET-ASIDE

PAGE

OF PAGES

1. Request No.

BEP-16-000195

1. R1EQUSET NO.

1. BEP-15-0001(A)

1. NO.

1. BEP-15-0001(A)

1. R REQUSET NO.

1. BEP-15-0001(A)

1. EQUSET NO.

1. BEP-15-0001(A)

2. DATE ISSUED

4/22/2016

3 REQUISITION/PURCHASE REQUEST NO.

2M021070

4. CERT. FOR NAT. DEF.
UNDER BDSA REG. 2
AND/OR DMS REG.1
RATING

5a. ISSUED BY Your Name

6. DELIVER BY (Date)

SEE SCHEDULE

5B. FOR INFORMATION CALL (NO COLLECT CALLS)
7. DELIVERYOTHER

NAME

Bureau of Engraving and Printing 14th and C St., S.W., Rm 705-A Washington, DC 20228

TELEPHONE NUMBER
|X| FOB DESTINATION
|_| (SEE SCHEDULE)
AREA CODE
NUMBER
9. DESTINATION
202
874-2392
a. NAME OF CONSIGNEE
Bureau of Engraving and Printing

8. TO BE COMPLETED BY QUOTER:

a. NAME

b. COMPANY

b. Street Address 14th & C Streets, SW

c. STREET ADDRESS

c. city Washington

d. CITY

e. STATE

f. ZIP CODE

d. State

e. ZIP CODE 20228

10. PLEASE FURNISH QUOTATIONS TO THE ISSUING OFFICE IN BLOCK 5A ON OR BEFORE CLOSE OF BUSINESS (Date) April 26, 2016 2:00 EST IMPORTANT: This is a request for information, and quotations furnished are not offers. If you are unable to quote, please so indicate on this form and return it to the address in Block 5A. This request does not commit the Government to pay any costs incurred in the preparation of the submission of this quotation or to contract for supplies or services. Supplies are of domestic origin unless otherwise indicated by quoter. Any representations and/or certifications attached to this Request for Quotations must be completed by the quoter.

11. SCHEDULE (Include applicable Federal, State and local taxes)

ITEM NO.
SUPPLIES/SERVICES
QTY
UNIT
UNIT PRICE
AMOUNT
(a)
(b)
(c)
(d)
(e)
(f)
BRUSH (FOUR-ROW) FOR THE I-10 WIPER TANK DRAWING NUMBER L546030 BLATT 108-06
500

EA

NUMBER

PERCENTAGE

NOTE: Additional provisions and representations |_| are |_| are not attached.

13. NAME AND ADDRESS OF QUOTER
14. SIGNATURE OF PERSON AUTHORIZED TO SIGN QUOTATION
15. DATE OF QUOTATION

a. NAME OF QUOTER:

b. STREET ADDRESS
16. SIGNER

a. NAME (Type or print)

b. TELEPHONE

c. COUNTY

d. CITY
e. STATE
f. ZIP CODE
c. TITLE (Type or print)
NUMBER

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