Enclosure C - AMS-Form-043.pdf
PDF 205 KB Posted
- Attached to
- Prototype Stripline Kickers
- Solicitation number
- MB483335
- Issued by
-
Department of Energy Office of Science
About this file
This is a Quotation/Proposal Pricing Sheet template for Brookhaven National Laboratory (managed by Brookhaven Science Associates, LLC under contract to the U.S. Department of Energy). The form is used to solicit pricing for the procurement of one (1) stripline kicker prototype under BSA Request for Quotation/Proposal No. 483335. The designated buyer/contract specialist is Mark Bryan.
Offerors must submit their total price in U.S. dollars, inclusive of all taxes, fees, customs, duties, and other charges. The quoted price shall remain firm for 60 days, with delivery on an FOB Destination basis. Payment terms are Net 30 days for large or foreign businesses and Net 10 days for small businesses. Offerors must identify the country of origin or place of manufacture and provide the Harmonized Tariff Schedule (HTS) code; if the item originates outside the U.S., export control point of contact information, phone number, and email address are required. By signing the form, offerors acknowledge agreement to BSA's requirements and delivery schedule, certify current SAM registration and representations/certifications, designate the item as either commercial or non-commercial per FAR 2.101, and confirm their ability to meet the delivery timeline. Offerors must also certify acceptance of BSA's Terms and Conditions as incorporated into the solicitation and attached documents. The form requires company name, signature, email address, typed name, SAM UEI number, title, telephone number, and date of submission.
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Text version
Date Printed 10/20/2026 1 of 2
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: 2.0
Effective Date: 9/15/2026
APPROVED BY:
Dedra Blood
Quotation/Proposal Pricing Sheet Reference: BSA Request for Quotation/Proposal No. 483335 Description: one (1) stripline kicker prototype
Attention: Buyer/Contract Specialist: Mark Bryan
To whom it may concern: In compliance with your letter of solicitation dated ____________, we submit our
Quotation/Proposal No. ___________________________
Total Price* $_____________ *Must be in U.S. Dollars and inclusive of all taxes, fees, customs, duties and other charges.
This price shall remain firm for 60 days.
Delivery is FOB Destination.
Payment terms are Net 30 (Large or Foreign Businesses), Net 10 (Small Businesses) Days.
Country of Origin or Place of Manufacture:___________ *Item HTS CODE:______________
*Company’s Export Control Point of Contact (POC):
*Phone #: *Email Address:
*Required if country of origin or manufacture is located outside of the U.S.
Date Printed 10/20/2026 2 of 2
Concurrence:
By signing this Quotation/Proposal Pricing Sheet, our firm hereby acknowledges and agrees to BSA's requirements 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. Additionally, please certify the following:
Item commercial status. Check one of the following by clicking the ☐ next to the associated option:
☐ Commercial item as defined in FAR 2.101 ☐ Non-commercial item
Can you meet delivery timeline? If yes, check this box: ☐ If not, please provide your forecasted delivery date:
Notice is hereby provided that BSA may disclose offeror proposals to U.S. Government personnel for review.
In such case, BSA will furnish the proposal to the Government with any confidentiality legends included by the Offeror, but BSA is not responsible for any subsequent disclosure by the U.S. Government.
Certification: By signing this Quotation/Proposal Pricing Sheet, our firm hereby acknowledges and agrees to BSA's Terms and Conditions, as incorporated into the solicitation and attached documents.
Company ____________________ Signature __________________
Email Address ________________ Typed Name __________________
SAM UEI #___________________ Title _________________________
Telephone No.(___)____________ Date _________________________
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