Enclosure 4 - Vendor ACH Authorization Form.pdf
PDF 717 KB Posted
- Attached to
- Amendment to RFQ 446913AB-Bio-Diesel Fuel (B20)
- Solicitation number
- 446913AB
- Issued by
-
Department of Energy Office of Science
About this file
The document provided is an Enclosure 4 - Vendor ACH Authorization Form, which is related to a federal contract opportunity for Bio-Diesel Fuel (B20) solicited by Brookhaven Science Associates, LLC (BSA), the operator of Brookhaven National Laboratory (BNL), on behalf of the U.S. Department of Energy (DOE).
The federal contract opportunity, with Solicitation Number 446913AB, is a Firm Fixed Price Request for Quote (RFQ) for Bio-Diesel Fuel (B20). The RFQ requires vendors to provide the origin of manufacture and their Unique Entity Identifier (UEI) number. Vendors must also submit a published price list or web screenshot showing pricing and part numbers, and confirm they are registered in the System for Award Management (SAM) database. The award will be made to the responsive and responsible offeror who submits the lowest total price and meets BSA's technical requirements. Pricing must remain valid for 60 days, and the due date for submissions is 6/6/2024.
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Other files
| File | Type | Posted |
|---|---|---|
| ENCLOSURE_1_DRAFT_PO_446913.pdf | ||
| AttachmentC-NYSEnvironConservation.pdf | ||
| Questions RFQ 446913.docx | DOCX document | |
| Attachment_A_-_Specifications_-B20.pdf | ||
| Enclosure 6 W-8 Form (Foreign vendors).pdf | ||
| Enclosure 5 W-9 Form (Domestic vendors).pdf | ||
| RFQ Letter 446913.docx | DOCX document | |
| Enclosure 2 - AMS Form 050.pdf | ||
| Attachment_B_-_BNL_QA_101_.pdf | ||
| Attachment_A_-_Specifications_-B20.docx | DOCX document | |
| Enclosure 3- AMS Form 043.docx | DOCX document | |
| BSA _Commerical_Items_Rev 22.0 Sep _2022.pdf | ||
| ENCLOSURE_1_DRAFT_PO_446913.pdf |
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Text version
Managed by Brookhaven Science Associates, LLC under contract with the
U.S. Department of Energy
Vendor ACH Authorization Form
VENDOR INFORMATION
Vendor/Company Name or DBA:
Vendor Number (if Applicable):
Tax ID Number (TIN):
DEPOSITORY INFORMATION
Financial Institution:
Routing/Transit/ABA Number:
Checking Account Number:
AUTHORIZATION
I (we) hereby authorize Brookhaven National Laboratory/Brookhaven Science Associates to make payments by initiating ACH (Automated Clearing House) credit entries or correcting entries to the account indicated above and associated with the financial institution named above. This authorization will remain in effect until BNL/BSA receives written notification to terminate or modify the same. It is my (our) understanding that credit authorizations may be revoked only by notification of the originator as described by NACHA (National Automated Clearing House Association) law.
Authorized Representative:
Email:
Phone:
Signature: Date:
Enclosure 4
File details come from the government source that posted it. Updated .