PurchaseRequisitionWorksheet_POTs_22-004452.pdf

Purchase Request POTS Number : 22-004452 Vendor Confirmation # :

Credit Card Reference # :

NBS Order No : N/A

1. Requester Requester's Name Amy Parkhurst

Date Needed

2. Recommended Sources

Name of First Vendor

Nikon Instruments, Inc.

Phone No.

Company Clerk's Name

Date Ordered : Buyer's Name

John Burton2/25/2022

3. Ordering Information 4. Totals

Item No

Exp Type

Cat # CAN - Task Catalog No

DESCRIPTION QTY Unit of Issue LIST PRICE DISC. PRICE ESTIMATED

PRICE

1 25723 J066 8021663- 2022.100

NA Preventative maintena (See page 3)

1.00 EACH $27,000.00 $27,000.00 $27,000.00

Total Item : 1 please continue to page 3 Grand Total List Price: $27,000.00 Grand Total : $27,000.00

1-800-526-4566 /

AO Approved by Charlene Patrick Date :2/24/2022 3:22:56 PM

Approved by Brant Weinstein Date:2/22/2022 11:21:44 AM

Submitted by Amy Parkhurst

Instructions:

The Requester completes Sections 1, 2, and 3. The

NBS Order No.

N/A completes the rest of the form.Buyer

Date Submitted:

02/18/2022

CAN O.C Code

Delivery Point Phone No.

Bldg/Room: 6B/4B413 +13014961855 2/18/2022

257238021663/ Organization

HNT4B

Decal/Cost Adjust. Needed

Requester's Signature Internal Approval Internal Approval(signature) (signature)

(Provide three sources, if possible. Competition is required for open market and non-mandatory FSS orders over $3,000)

Name of Second Vendor

Name of Third Vendor

Phone No.

Company Clerk's Name

Phone No.

Company Clerk's Name

EIN FSS No.

EIN FSS No.

EIN FSS No.

5. Ordering Mechanism

For radioisotope orders only :

Complete Form NIH 88-1, "Request for Purchase and Use of Radioactive Materials."

Clearance no. of approved radioisotope purchaser

BPA/IDC Source No. Competition Required ? Clearances Required ? Clearances Obtained ?

Yes No Yes No Yes No

6. Mandatory Source Availability

Are any of the items available from these sources? If “yes,” and you are not using the mandatory source, explain why in Item 7.

YES NO

NIH Surplus

NIH Required Source (MAPB, Glassware, etc)

NIH/GSA Stock

YES NO

UNICOR

Blind/Severely

Mandatory FSS Schedules

7. Justification for Not Selecting Mandatory Source

(Emergency Order)

YES NO

OPEN-MARKET Supplies

NIH/GSA Self Service

BPA Call (OM)

SF 44

Internal To/Do

NIH Stock Requisition External To/Do

Purchase Card(s)GSA Fedstrip

BPA Call (FSS) Purchase Order(s)

Purchase Cards/Convenience Checks

Cust Code: 90701

N/A Date:N/A

Internal Approval (signature)

See section 11 Required Sources list

Page 1 of 3NIH 1861-1 (Rev. 3/08) FRONT See Reverse

Compatibility with existing equipment.

Other

Mandatory FSS vendor is unacceptable because:

NIH stock item is unacceptable because:

NIH Stores out of stock and urgently needed.

Explain :

Explain :

(specify) :

8. Justification for Sole-source or Other than Small Business on Either Open Market or Non-mandatory FSS

Sole-source: Proprietary data/patent, etc. (FAR 6.302-1.)

Other

Small business is unable to deliver within required timeframe.

Sole-source: Urgent and compelling requirement. (FAR 6.302-2.)

Sole-source: Quality of product required for on-going experiments. (FAR 6.302-1.)

Explain :

Explain :

(specify) :

Explain :

Explain :

Unable to locate small business source(s) for item(s). Explain :

9. Competition (For open market and non-mandatory FSS orders over $3,000.)

Vendor 1

List Price Discount Price Phone No.

Comments

Date Called Company Clerk's Name

Vendor 2

List Price Discount Price Phone No.

Comments

Date Called Company Clerk's Name

Vendor 3

List Price Discount Price Phone No.

Comments

Date Called Company Clerk's Name

10. Price Reasonableness (Check all that apply.)

Lowest price quoted.

Comparison with prices on previous buys where price analysis performed.

Other

Previous order no. Date

(specify) :

See Sole Source Justification in Attachment

See Sole Source Justification in Attachment

YES NO

UNICOR, NIH FSS BPA, FSSI, GSA Advantage or GWAC's

YES NO

NIH OM BPA

The Open Market

Ability One Programs

11.Required Sources for Services

Page 2 of 3NIH 1861-1 (Rev. 3/08) BACK See Reverse

Item List

Item No

Exp Type

Cat # CAN - Task Catalog

DESCRIPTION QTY Unit of Issue

LIST PRICE DISC.

PRICE

ESTIMATED

PRICE

1 25723 J066 8021663- 2022.100

NA Preventative maintenance contract for Nikon Ti2 Microscope system with Spinning Disk (s/n 95TB00017). NIS Elements Software Updates. One preventative maintenance (PM) visit per contract year.

Period of coverage is 04/01/2022 - 03/31/2023.

Reference Quote 95TB00017.

1.00 EACH $27,000.00 $27,000.00 $27,000.00

Total List Price

$27,000.00 Total : $27,000.00

PA Notes : NA

Requester Notes : One-year preventative maintenance contract on a Division-owned Nikon Ti2 Microscope system with Spinning Disk (s/n 95TB00017) technology. Period of coverage is 03/01/2022 - 02/28/2023. Placed as an emergency order due to the start date and the total cost of the contract. Please see quote for sole source statement and new FAR document as requested.

Justification : One-year preventative maintenance contract on a Division-owned Nikon Ti2 Microscope system with Spinning Disk (s/n 95TB00017) technology.

Period of coverage is 03/01/2022 - 02/28/2023. Placed as an emergency order due to the start date and the total cost of the contract. Please see quote for sole source statement and new FAR document as requested.

Page 3 of 3NIH 1861-1 (Rev. 3/08) BACK