Enclosure C - AMS-Form-043 Pricing Sheet.docx
DOCX document 21 KB Posted
- Attached to
- Helium Refrigeration System
- Solicitation number
- 481327
- Issued by
-
Department of Energy Office of Science
About this file
This is a Quotation Pricing Sheet (Enclosure C) template for Brookhaven National Laboratory's Request for Quotation No. 481327 for a Helium Refrigeration System. Offerors must complete this form to submit their price quote in U.S. Dollars, with pricing remaining firm for 120 days. The sheet requires vendors to specify the total price, country of origin or place of manufacture (to comply with FAR Part 25 Buy American Act requirements), and anticipated delivery terms of FOB Destination Freight Prepaid for domestic shipments or Delivered Duty Paid (DDP) for international shipments. For items manufactured outside the United States, vendors must provide the Harmonized Tariff Schedule (HTS) code and designate an Export Control Point of Contact with associated phone number and email address.
The form requires company signature and concurrence, confirming the offeror's agreement to BSA's requirements, terms, conditions, and delivery schedule. The solicitation is managed by Brookhaven Science Associates, LLC on behalf of the U.S. Department of Energy, with submission inquiries directed to Kevin Kirkendall. Offerors must also submit a SAM Unique Entity Identification (UEI) Number, confirm current Representations and Certifications in SAM (or complete AMS-Form-050 if not registered), and submit a Small Business Subcontracting Plan if the offer exceeds $900,000 and the offeror is not a small or foreign business.
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Text version
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. 481327 |
| Helium Refrigeration System |
Brookhaven National Laboratory Brookhaven Science Associates, LLC P.O. Box 5000 – Bldg. 1001 Upton, NY 11973
Attention: Kevin Kirkendall
To whom it may concern:
In compliance with your letter of solicitation dated [insert date], we submit our Quotation No. ___________________________ dated _______________, for Helium Refrigeration System.
Total Price $_____________
This price shall remain firm for 120 days.
North American Shipments:
• FOB Destination, Freight Prepaid International Shipments:
• DDP (Delivered Duty Paid)
Country of Origin or Place of Manufacture: [insert place] *Item HTS CODE: [insert HTS code]
*Company’s Export Control Point of Contact (POC): [insert POC] *Phone #: [insert phone #] *Email Address: [insert email address] *Required if country of origin or manufacture is located outside of the U.S.
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 _________________________ |
Date Printed 7/30/2026 1 of 1 Date Approved 12/14/2020
File details come from the government source that posted it. Updated .