B1 Enclosure C AMS Form 043 Quotation Pricing Sheet.docx
DOCX document 28 KB Posted
- Attached to
- Confocal Super Resolution Microscope
- Solicitation number
- BSA477108
- Issued by
-
Department of Energy Office of Science
About this file
This is a Quotation/Proposal Pricing Sheet template for Brookhaven Science Associates (BSA) Request for Quotation/Proposal No. 477108, issued by the Procurement and Property Management Division at Brookhaven National Laboratory under the Department of Energy. The solicitation concerns the procurement of a Super Resolution/Confocal Optical Microscope, with the buyer identified as Mark Brock. The pricing sheet requires vendors to submit milestone-based pricing across six key deliverables: Preliminary Technical Design, Final Technical Design, Factory Acceptance Test Report, Delivery to BNL, Commissioning of the instrument, Training on the instrument, and Delivery of End Item Documentation Package. All pricing must be submitted in U.S. dollars and be inclusive of taxes, fees, customs, duties, and other charges, with a firm price validity period of 90 days and FOB Destination delivery with freight prepaid.
The form requires vendors to specify payment terms (Net 30 for large or foreign businesses, Net 10 for small businesses), country of origin/place of manufacture, HTS code, and export control point of contact information for items manufactured outside the U.S. Offerors must confirm their commercial status (standard catalog item, modified catalog item, or non-commercial item), certify their ability to meet the delivery timeline, maintain current SAM registration, and ensure their representations and certifications are complete. The form includes a notice that BSA may disclose proposals to U.S. Government personnel for review while respecting any confidentiality legends submitted by the offeror, though BSA assumes no responsibility for subsequent government disclosure.
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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:
PPM Manager/Date
Quotation/Proposal Pricing Sheet
| Reference: | Brookhaven Science Associates (BSA) Request for Quotation/Proposal No. 477108 |
| Description: Super Resolution/Confocal Optical Microscope |
Attention: Buyer/Contract Specialist: Mark Brock
To whom it may concern: In compliance with your letter of solicitation dated [insert date], we submit our Quotation/Proposal No. ___________________________
| Milestone |
| Amount |
BSA receipt and acceptance of Preliminary Technical Design Submitted
BSA receipt and acceptance of Final Technical Design Approved
BSA receipt and acceptance of Factory Acceptance Test Report
BSA receipt and acceptance of Delivery to BNL
BSA receipt and acceptance of Commissioning of instrument
BSA receipt and acceptance of Training on instrument
BSA receipt and acceptance of Delivery of End Item Documentation Package
Total Price* $_____________ *Must be in U.S. Dollars and inclusive of all taxes, fees, customs, duties and other charges.
This price shall remain firm for [90] days.
Delivery is FOB Destination, Freight Prepaid.
Payment terms are Net 30 (Large or Foreign Businesses), Net 10 (Small Businesses) Days.
Country of Origin or Place of Manufacture: [insert place] *Item HTS CODE: [insert HTS code]
*Company’s Export Control Point of Contact (POC): [insert POC] *Phone #: [insert phone #] *Email Address: [insert email address] *Required if country of origin or manufacture is located outside of the U.S.
Company Address: [insert address]
Concurrence:
By signing this Quotation/Proposal 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. We affirm we are registered in SAM and our representations and certifications as well as our small business size status (if applicable) are current and complete. Additionally, please certify the following:
Item commercial status. Check one of the following by clicking the ☐ next to the associated option:
☐ Standard catalog item ☐ Modified catalog item ☐ Non-commercial item
Can you meet delivery timeline listed in the draft contract ? If yes, check this box: ☐ If not, please provide your forecasted delivery date(s): [insert delivery date or delivery table]
Notice is hereby provided that BSA may disclose offeror proposals to U.S. Government personnel for review. In such case, BSA will furnish the proposal to the Government with any confidentiality legends included by the Offeror, but BSA is not responsible for any subsequent disclosure by the U.S. Government.
| Company ____________________ |
| Signature __________________ |
| Email Address ________________ |
| Typed Name __________________ |
| SAM UEI #___________________ |
| Title _________________________ |
| Telephone No.(___)____________ |
| Date _________________________ |
Date Printed 4/29/2026 1 of 1 Date Approved 12/14/2020
File details come from the government source that posted it. Updated .