Enclosure D - ACH Authorization Form.pdf

This is an ACH (Automated Clearing House) Authorization Form managed by Brookhaven Science Associates, LLC (BSA) under contract with the U.S. Department of Energy, designed to facilitate electronic payments to vendors providing services to Brookhaven National Laboratory (BNL). The form is associated with a Construction Manager as Advisor (CMa) Services procurement opportunity for the Electron-Ion Collider (EIC) infrastructure project located in New York. The CMa Services contract requires vendors to provide pre-construction support services during the design phase and preparation for construction of the EIC facility. The authorization form permits BSA to initiate ACH credit entries and correcting entries to the vendor's designated banking account and remains in effect until written termination notification is received by BNL/BSA.

The form requires vendors to provide standard banking information including the financial institution name, routing/transit/ABA number, and checking account number, along with vendor company information, tax identification number (TIN), and vendor number if applicable. The authorization is subject to NACHA (National Automated Clearing House Association) regulations, and vendors must designate an authorized representative to sign and date the form along with providing contact information including email and phone number. No prior contract awards of identical or substantially similar services within the past five years were identified, indicating this represents a new procurement opportunity.