Enclosure (2) Quotation Pricing Sheet AMS-Form-043.pdf
PDF 149 KB Posted
- Attached to
- Custom Multi-layer Chips
- Solicitation number
- RFQ_467991
- Issued by
-
Department of Energy Office of Science
About this file
This document is a Quotation Pricing Sheet (AMS-Form-043) for a Request for Quotation (RFQ No. 467991) issued by Brookhaven National Laboratory, managed by Brookhaven Science Associates, LLC under contract to the U.S. Department of Energy. The solicitation seeks custom multi-layer chips, with the pricing sheet designed for potential contractors to submit their pricing and formally acknowledge the laboratory's requirements, terms, and delivery schedule.
The form requires vendors to provide a total price for multi-layer chips including delivery, with the pricing to remain firm for 90 days. Contractors must be registered in the System for Award Management (SAM) and confirm that their representations, certifications, and small business size status are current and complete. The document is dated 12/14/2020 with an approval by L. McKnight, the PPM Manager, and is structured to be completed by the responding vendor, including spaces for company information, signature, contact details, and formal concurrence with the solicitation's terms.
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Text version
Date Printed 8/5/2025 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. 467991 Custom Multi-layer Chips
Brookhaven National Laboratory Brookhaven Science Associates, LLC P.O. Box 5000 – Bldg. 902B Upton, NY 11973
Attention: Eric Nagel Sr. Contracts Specialist
In compliance with your letter of solicitation, we submit our Quotation No._______________ dated _______________, for Custom Multi-layer Chips 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, B and
C):
Description
Multi-layer Chips (Including Delivery) $__________
This price shall remain firm for 90 days.
Date Printed 8/5/2025 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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