Enclosure D - Vendor ACH Authorization Form.pdf
PDF 114 KB Posted
- Attached to
- MERCURY DISPOSAL, RAILROAD LOGISTICS AND TRANSPORTATION Federal contract opportunity
- Solicitation number
- JF445460
- Issued by
- Department of Energy Office of Science
About this file
This document is a Vendor ACH Authorization Form required for a federal contract opportunity. The form authorizes Brookhaven National Laboratory/Brookhaven Science Associates to make electronic payments to the vendor's indicated checking account. It includes the vendor's contact information, financial institution details, and an authorized signature.
The related federal contract opportunity is for MERCURY DISPOSAL, RAILROAD LOGISTICS AND TRANSPORTATION services. The contractor will provide disposal, railroad logistics, and transportation of mercury-contaminated sand and debris from Brookhaven National Laboratory in New York to a disposal facility in Arkansas. Proposals are due by 5:00 PM on June 14, 2024 and should be emailed to JFAMIGLIE@BNL.GOV. The solicitation is being managed by the Department of Energy Office of Science.
View the file
Other files for this federal contract opportunity
| File | Type | Posted |
|---|---|---|
| Amendment 1 - Enclosure 1 - Draft Contract (Rev1).pdf | ||
| RFQ 445460 - Amendment 1 Rev1 (6-10-24).pdf | ||
| RFQ 445460 - Amendment 1 (6-10-24).pdf | ||
| RFQ 445460_5-21-24.pdf | ||
| Enclosure A - Draft Contract.pdf | ||
| Enclosure A - Attachment 3 - Non-Commercial Ts and Cs.pdf | ||
| Enclosure E - W-9 Form.pdf | ||
| Enclosure A - Attachment 4 - Supplemental Ts and Cs.pdf | ||
| Enclosure A - Attachment 2 - QA-101 dated 4-2024.pdf | ||
| Enclosure B - AMS Form 050 Reps and Certs.pdf | ||
| Enclosure C - Scenario Pricing Sheet.xlsx | XLSX spreadsheet | |
| Enclosure A - Attachment 1 - Statement of Work.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:
| VendorCompany Name or DBA: |
| Vendor Number if Applicable: |
| Tax ID Number TIN: |
| Financial Institution: |
| RoutingTransitABA Number: |
| Checking Account Number: |
| Authorized Representative: |
| Email: |
| Phone: |
| Date: |
File details come from the government source that posted it. Updated .