IRS_PRICE_QUOTATION_SHEET.pdf

IRS PRICE QUOTATION SHEET

Please complete and submit. (Reference #: D-7-D9-36-MA-I07)

Quote Number: _________________ (if applicable)

Vendor’s Name: ___________________________________________________

Address: _________________________________________________________

City/State/Zip: ____________________________________________________

Point of Contact: ___________________________ Tel:_______________

Check All That Apply. Above Company is:

1. [ ] Corporation [ ] Partnership [ ] Sole Proprietorship [ ] Trust [ ] Individual Estate [ ] Joint Venture

2. [ ] US Owned Business [ ] Other US Entity [ ] Foreign-Owned Business Incorporated in the US [ ] Foreign-Owned Business Incorporated in the US [ ] Other Foreign Entity (e.g. Foreign Gov’t)

3. [ ] Large Business [ ] Small Business

4. Small Business and [ ] Disadvantaged [ ] Women-Owned [ ] HUBZone [ ] Service Disabled Veteran-Owned [ ] Veteran-Owned [ ] 8(A)

5. Registered in SAM and qualified under NAICS code (see note below) [ ] Yes [ ] No

Additional Information Required:

1. Federal Tax ID# (TIN): _______________DUNS #: ________________

2. Payment Terms: Net/10 ____________Net/20_____________Net/30 ______

3. Invoice Processing Platform (IPP) Point of Contact:

Name (First and Last): ____________________________________

Email: __________________________ Tel: _____________________

NOTE:

To qualify for a “small business set-aside”, interested vendors shall be a for-profit business concern and meet the small business size standard for the NAICS code that the contracting officer assigns to the procurement. Additionally, interested vendors shall, by submission date of quote, (1) be registered in the System for Award Management (SAM) database at www.sam.gov (to include NAICS Code 492110, Couriers and Express Delivery Services, (2) Be in an active status in SAM, (3) not be in the excluded parties list system (EPLS), and (4) have a completed and updated Representations and Certifications. Failure to do so may disqualify vendor from receiving the award.

http://www.sam.gov/

FIRM-FIXED PRICE QUOTATION

ITEM

NO.

SCHEDULE OF

SUPPLIES/SERVICES

QUANTITY

UNIT

UNIT

PRICE

(US$)

AMOUNT

(US$)

0001 Base Period:

10/01/2016 to 09/30/2017

Daily scheduled non-armored courier service in accordance with the attached Statement of Work

MO

1001 Option Period I:

10/01/2017 to 09/30/2018

Daily scheduled non-armored courier service in accordance with the

2001 Option Period II:

10/01/2018 to 09/30/2019

Daily scheduled non-armored courier service in accordance with the

TOTAL $______________________

(Base plus all Option Periods)