Offer Price Breakdwon - KDRT.pdf

OFFER PRICE BREAKDOWN SHEET (Domestic version)

Jet A w/o FSII and Jet A w/FSII

AIRPORT NAME AND ICAO CODE: KDRT - Del Rio International

Located in Del Rio, TX, USA

VENDOR CAGE CODE: LARGE OR SMALL BUSINESS:

CLIN NUMBER: STATE/ COUNTRY:

EST QUANTITY GALLONS:

IF THE INCUMBENT, STATE YOUR CONTRACT NUMBER #:

Base Reference Publication (Escalator): PGCSPJ54T6- IP PL USGC JK54

SPOT PIPE PWA EFF TUES

Base Reference Date: 09/20/2022 Base Reference Price: $3.137200

MARKET PRICE (PLATTS/OPIS) FOR THE ABOVE REFERENCE DATE:

INTO-PLANE FEE (Differential & additional fees not including FET )

JET A TOTAL UNIT PRICE: (Sum of A and B)

FSII PRICE: (If none, state “None.”)

INTO TRUCK (If applicable if none, state none):

RAPID REFUEL PRICE (If applicable, if none state NONE)

TOTAL PRICE ( Sum of C thru F)

PUBLICATION/REFERENCE SELECTED FOR MARKET PRICE ADJUSTMENT

PLATTS: __________________________________________________________________________

OPIS: __________________________________________________________________________

OTHER: __________________________________________________________________________

Prices will change on [ ] Monday [ ] Tuesday [ ] Weekly [ ] Monthly [ ] Other_____________

($ USD Currency)

$ A.

$ B.

$ C.

$ D.

$ E.

$ F.

$________________G.

Refinery/

Hours of Operations [ ] 24 hours per day, 7 days per week (preferred) OR [ ] Other (Specify hours/call-out, and phone number for call-outs):

Circle One

Holidays Included: YES or NO

Are you the REFUELER for this offer under this location? (Please check one)

**** (Commitment letter must match the name and Address of the Refueler/FBO information below. COA or COQ must be in English)

Refueler (FBO) Point of Contact Name:

Full Physical Address (Country & State)

Person at Facility Phone Number:

Source Name:

Physical Address:

Phone Number:

K-0002 - K33.01 Authorized Negotiators (Reference: DLA Energy APR 2007)

Name & Title: Email &Phone:

Name & Title: Email & Phone:

YES NO