Pricing Sheet - Hydrogen deliveriesDLH.docx

Pricing Sheet AMOUNT OF HYDROGEN TO BE DELIVERED MONTHLY, ON AN ANNUAL BASIS APPX. 54,096 CUBIC FEET, AMOUNT OF HYDROGEN IS AN ESTIMATE.

THE CONTRACTOR SHALL BE PAID FOR ACTUAL USAGE.

APPROXIMATELY 283 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 (preferred 197 cf not to exceed 300 cf)

Cubic Feet ______________ per cylinder

Delivery Fee $ _____________ per month (12 Months)

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 (preferred 197 cf not to exceed 300 cf)

Cubic Feet ______________ per cylinder

Delivery Fee $ _____________ per month (12 Months)

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 (preferred 197 cf not to exceed 300 cf)

Cubic Feet ______________ per cylinder

Delivery Fee $ _____________ per month (12 Months)

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 (preferred 197 cf not to exceed 300 cf)

Cubic Feet ______________ per cylinder

Delivery Fee $ _____________ per month (12 Months)

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 (preferred 197 cf not to exceed 300 cf)

Cubic Feet ______________ per cylinder

Delivery Fee $ _____________ per month (12 Months)

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.