Enclosure 3 - AMS Form 043.pdf
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- Solicitation number
- 458368CE
- Issued by
-
Department of Energy Office of Science
About this file
This is a Quotation Pricing Sheet form (AMS-Form-043) for Brookhaven National Laboratory's Request for Quotation No. 458368CE for Clear ULSD Fuel Grade #2 Diesel. The form is dated January 15, 2025, and was approved on December 14, 2020.
The pricing structure requires vendors to quote a fixed add-on rate to the maximum published price from the Oil Price Daily's weekly fuel prices for Long Island, New York. The form includes fields for Fixed Rate Add-On, Oil Spill Fee, Winterized (Additives), Excise Tax, and Lust Tax for the fuel type DS2 (NSN: 9140-01-524-0139). The fuel is intended for BNL's Central Steam Facility multi-fuel boilers, with quantities varying based on season, environmental requirements, market price, and local legislation. Delivery terms are FOB Destination with Net 30 Days payment terms. The form requires vendor information, signature, and acknowledgment of BSA's requirements, terms, conditions, and delivery schedule.
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Text version
Enclosure 3
Date Printed 1/15/2025 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. 458368CE
Brookhaven National Laboratory - Clear ULSD Fuel Grade # 2 Diesel
Brookhaven National Laboratory
Brookhaven Science Associates, LLC
P.O. Box 5000 – Bldg. 902
Upton, NY 11973
Attention: Cheryl Eleazer
Sr. Buyer
To whom it may concern:
In compliance with your letter of solicitation dated January 15, 2025, we submit our Quotation No. ____________ dated _______________, for the procurement of Clear ULSD Fuel Grade # 2 Diesel in strict accordance with Enclosure 1, Draft Purchase Order.
Pricing for the fuel shall be in accordance with the maximum published price in the section of the Oil Price Daily (formerly the Journal of Commerce) under weekly fuel prices for Long Island, New York. The actual price of the fuel may vary but the fixed add-on rate shall remain consistent throughout the Purchase Order, including option years.
Note: Offeror’s quote price should represent the fixed add-on to the “mid-point” published weekly price only.
Fuel Type
Product
Code
National Stock
Number
Fixed
Rate
Add-
On
Oil Spill
Fee
Winterized
(Additives)
Excise
Tax
Lust
Tax
Clear ULSD Fuel Grade # 2 Diesel
DS2 9140-01-524-0139
*These fuels are for BNL’s Central Steam Facility multi-fuel boilers and fuel quantities may vary greatly depending on the season, environmental requirements, market price and local legislation.
Total Price $_____________
The terms of delivery and payment terms are FOB Destination, Net 30 Days.
Enclosure 3
Date Printed 1/15/2025 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.
Company _____________________ Signature _____________________
Address ______________________ Typed Name __________________
______________________________ Title _________________________
Telephone No.___(___)__________ Date _________________________
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