Enclosure C. Quotation Pricing Sheet.pdf
PDF 148 KB Posted
- Attached to
- X-ray Refractive Lenses
- Solicitation number
- RFQ_464636
- Issued by
-
Department of Energy Office of Science
About this file
The document is a Quotation Pricing Sheet for a Request for Quotation (RFQ) issued by Brookhaven National Laboratory, managed by Brookhaven Science Associates, LLC under contract to the U.S. Department of Energy. The solicitation (RFQ No. 464636) seeks refractive lenses, specifically 23 AI Refractive Lenses and 1 Be Refractive Lens, with delivery included. The pricing sheet is a standard Acquisition Management System form (AMS-Form-043, Revision 0.1) approved on 12/14/2020, with the quote valid for 90 days from submission. The document requires the vendor to acknowledge BSA's requirements, terms, conditions, and delivery schedule, and confirms the vendor is registered in the System for Award Management (SAM).
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Date Printed 7/2/2025 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. 464636 Refractive Lenses
Brookhaven National Laboratory Brookhaven Science Associates, LLC P.O. Box 5000 – Bldg. 902B Upton, NY 11973
Attention: Crystal Lopez Contract Specialist
In compliance with your letter of solicitation, we submit our Quotation No._______________ dated _______________, for Refractive Lenses for Brookhaven National Lab.
Contractor UEI number associated with SAM profile: _________________________
Includes everything as detailed in the Statement of Work and Specs Package (Attachments A and B):
Description Qty:
AI Refractive Lenses x23 $__________ Be Refractive Lenses x1 $__________ (Including Delivery)
Total: $__________
This price shall remain firm for 90 days.
Date Printed 7/2/2025 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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