BG270670PS.pdf

Date Printed 5/6/2014 1 of 1 Date Approved 24 March 2010

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

APPROVED BY:

Don Rawlings/ 3/24/10

PPM Manager/Date

Quotation Pricing Sheet

Reference: BSA Request for Quotation No. BG270670

Newport Corp Optic PN#'s or Equivalents

Brookhaven National Laboratory

Brookhaven Science Associates, LLC

P.O. Box 5000 – Bldg. OSL-44

Upton, L.I., NY 11973

Attention: Beth Gilman

Buyer Gentlemen:

In compliance with your letter of solicitation dated May 6, 2014, we submit our Quotation No.

___________________________ dated _______________, for [Newport Corp Optic PN#'s or Equivalents (see Draft PO attached)].

Total Price $_____________ Lead Time ___________

This price shall remain firm for [30] days.

The terms of delivery and payment terms are FOB Destination, Net 30 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 agree to provide the resources necessary to meet BSA's delivery schedule.

Company _____________________ Signature _____________________

Address ______________________ Typed Name __________________

______________________________ Title _________________________

Telephone No.___(___)__________ Date _________________________