Pricing Sheet - Hydrogen deliveries.docx

Pricing Sheet Pricing sheet for your convenience. You may submit on this sheet or on the SF 1449.

AMOUNT OF HYDROGEN TO BE DELIVERED WEEKLY, ON AN ANNUAL BASIS APPX. 55,200 TO 62,640 CUBIC FEET, AMOUNT OF HYDROGEN IS AN ESTIMATE. THIS SITE INCLUDES AN ANNUAL REQUIREMENT OF ONE TANK OF HELIUM 291 CF.

THE CONTRACTOR SHALL BE PAID FOR ACTUAL USAGE.

APPROXIMATELY 240 CYLINDERS PER YEAR.

AN E-MAIL ADDRESS WHERE YOU CAN BE REACHED FOR FUTURE CORRESPONDENCE.

BUSINESS NAME: ____________________

EMAIL_____________________________

CONTACT NAME_____________________

CONTACT #_________________________

UNIQUE ENTITY IDENTIFICATION NUMBER

UEI#____________________________

BASE YEAR

Hydrogen Gas $ ___________ per cylinder (197 cf not to exceed 261 cf-preferred) Cubic Feet _____________ per cylinder

Helium B-T (1-2 tanks per year) $____________ per cylinder (preferred 291cf.)

Delivery Fee $ ____________ per delivery (52 WEEKS)

Hazmat Charges $ _____________ per delivery

Cylinder Rent $ _____________ per cylinder per day or per month (circle one)

Additional Fees $ _____________ (identify name of fee, price, and frequency, if applicable)

OPTION YEAR 1

Hydrogen Gas $ ___________ per cylinder (197 cf not to exceed 261 cf-preferred) Cubic Feet _____________ per cylinder

Helium B-T (1-2 tanks per year) $____________ per cylinder (preferred 291cf.)

Delivery Fee $ ____________ per delivery (52 WEEKS)

Hazmat Charges $ _____________ per delivery

Cylinder Rent $ _____________ per cylinder per day or per month (circle one)

Additional Fees $ _____________ (identify name of fee, price, and frequency, if applicable)

OPTION YEAR 2

Hydrogen Gas $ ___________ per cylinder (197 cf not to exceed 261 cf-preferred) Cubic Feet _____________ per cylinder

Helium B-T (1-2 tanks per year) $____________ per cylinder (preferred 291cf.)

Delivery Fee $ ____________ per delivery (52 WEEKS)

Hazmat Charges $ _____________ per delivery

Cylinder Rent $ _____________ per cylinder per day or per month (circle one)

Additional Fees $ _____________ (identify name of fee, price, and frequency, if applicable)

OPTION YEAR 3

Hydrogen Gas $ ___________ per cylinder (197 cf not to exceed 261 cf-preferred) Cubic Feet _____________ per cylinder

Helium B-T (1-2 tanks per year) $____________ per cylinder (preferred 291 cf.)

Delivery Fee $ ____________ per delivery (52 WEEKS)

Hazmat Charges $ _____________ per delivery

Cylinder Rent $ _____________ per cylinder per day or per month (circle one)

Additional Fees $ _____________ (identify name of fee, price, and frequency, if applicable)

OPTION YEAR 4

Hydrogen Gas $ ___________ per cylinder (197 cf not to exceed 261 cf-preferred) Cubic Feet _____________ per cylinder

Helium B-T (1-2 tanks per year) $____________ per cylinder (preferred 291cf.)

Delivery Fee $ ____________ per delivery (52 WEEKS)

Hazmat Charges $ _____________ per delivery

Cylinder Rent $ _____________ per cylinder per day or per month (circle one)

Additional Fees $ _____________ (identify name of fee, price, and frequency, if applicable)

Hydrogen gas shall be industrial grade with a purity of 99.9% or better.

THIS PURCHASE ORDER SHALL NOT EXCEED THE TOTAL AMOUNT FUNDED. SHOULD ANY ADDITIONAL SERVICES AND/OR PARTS BE REQUIRED TO COMPLETE THE SERVICE/SUPPLY, THE CONTRACTOR SHALL NOT CONTINUE WITHOUT WRITTEN AUTHORIZATION BY THE CONTRACTING OFFICER(CO). ANY SERVICES/SUPPLIES PROVIDED WITHOUT WRITTEN AUTHORIZATION FROM THE CO MAY RESULT IN NON-PAYMENT BY THE GOVERNMENT FOR SERVICES/SUPPLIES RENDERED. NO FUNDING WILL BE PROVIDED FOR THE OPTION PERIOD UNLESS THE OPTION PERIOD IS EXERCISED BY A MODIFICATION TO THIS PURCHASE ORDER.