Enclosure (2) Quotation Pricing Sheet AMS-Form-043.pdf
PDF 213 KB Posted
- Attached to
- Delivery of ANT Spatial Resolution Test Patterns
- Solicitation number
- 0000466177
- Issued by
-
Department of Energy Office of Science
About this file
This document is a Quotation Pricing Sheet from Brookhaven National Laboratory's Procurement and Property Management Division for ANT Z Resolution Test Patterns. The solicitation (Request for Quotation No. 466177) is for 10 units of resolution test patterns, to be delivered to Brookhaven National Laboratory, managed by Brookhaven Science Associates, LLC under contract with the U.S. Department of Energy. The pricing sheet includes a section for the vendor to complete, requiring the company to acknowledge BSA's requirements, terms, conditions, and delivery schedule, and affirm their registration in the System for Award Management (SAM).
The form, identified as AMS-Form-043 (Revision No. 0.1), was approved on 12/14/2020 by L. McKnight, the PPM Manager. The document specifies that the quoted price shall remain firm for 90 days, and requires the vendor to provide their Unique Entity Identifier (UEI) number associated with their SAM profile. The final section provides space for the vendor to complete their company details, signature, and date of submission, while confirming their ability to meet the laboratory's delivery schedule and current small business status.
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Text version
Date Printed 7/3/2025 1 of 2 Date Approved 12/14/2020
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. 466177 ANT Z Resolution Test Patterns
Brookhaven National Laboratory Brookhaven Science Associates, LLC P.O. Box 5000 – Bldg. 902B Upton, NY 11973
Attention: Yanice Kirkendall Contracts Specialist
In compliance with your letter of solicitation, we submit our Quotation No._______________ dated _______________, for ANT Z Resolution Test Patterns for Brookhaven National Labs.
Contractor UEI number associated with SAM profile: _________________________
Includes everything as detailed in the Statement of Work and Specs Package (Attachments A and B):
Description
Qty 10 (including delivery)
Total: $__________
This price shall remain firm for 90 days.
Date Printed 7/3/2025 2 of 2 Date Approved 12/14/2020
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. 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.
Company _____________________ Signature _____________________
Address ______________________ Typed Name __________________
______________________________ Title _________________________
Telephone No.___(___)__________ Date _________________________
Concurrence:
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