SPE7M318Q0416.PDF

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ACTUATOR, ELECTRO-ME Federal contract opportunity
Solicitation number
SPE7M318Q0416
Issued by
Defense Logistics Agency Land and Maritime

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REQUEST FOR QUOTATIONS THIS RFQ IS IS NOT A SMALL BUSINESS SET-ASIDE

4. CERT.FOR NAT. DEF.

UNDER BDSA REG. 2

AND/OR DMS REG. 1

5. ISSUED BY

7. DELIVERY

9. DESTINATION

10. PLEASE FURNISH QUOTATIONS TO THE

ISSUING OFFICE IN BLOCK 5 ON OR

BEFORE CLOSE OF BUSINESS (Date)

IMPORTANT: This is a request for information, and quotations furnished are not offers. If you are unable to quote, please so indicate on this form and return it to the address in Block 5. This request does not commit the Government to pay any costs incurred in the preparation of the submission of this quotation or to contract for supplies or services. Supplies are of domestic origin unless otherwise indicated by quoter. Any representations and/or certifications attached to this Request for Quotations must be completed by the quoter.

11. SCHEDULE (See Continuation Sheets)

12. DISCOUNT FOR PROMPT PAYMENT

d. CALENDAR DAYS

NUMBER PERCENTAGE

NOTE: Additional provisions and representations are are not attached.

13. NAME AND ADDRESS OF QUOTER

a. NAME OF QUOTER

14. SIGNATURE OF PERSON AUTHORIZED TO SIGN

QUOTATION

16. SIGNER

AUTHORIZED FOR LOCAL REPRODUCTION

Previous edition not useable

STANDARD FORM 18 (REV. 6-95)

Prescribed by GSA-FAR (48 CFR) 53.215-1(a)

1. REQUEST NO.

SPE7M3-18-Q-0416

2. DATE ISSUED

2018 MAY 15

3. REQUISITION/PURCHASE REQUEST NO.

0073352549

RATING

DO-C9

DLA LAND AND MARITIME

FLUID HANDLING DIVISION

PO BOX 3990

COLUMBUS OH 43218-3990

USA

Buyer: Ryane Stone PMCM1KB Tel: DSN-850-3135 Email: Ryane.Stone@dla.mil

6. DELIVER BY (Date)

350 DAYS ADO

8. TO:

c. CITY

d. STATE

b. STREET ADDRESS

a. NAME OF CONSIGNEE

e. ZIP CODE

a. 10 CALENDAR DAYS

b. 20 CALENDAR DAYS (%) c. 30 CALENDAR DAYS

15. DATE OF QUOTATION

a. NAME (Type or Print)

AREA CODE

c. TITLE (Type or Print)d. CITY

c. COUNTY

b. STREET ADDRESS

e. STATE f. ZIP CODE

See Schedule

2018 MAY 30

NUMBER

FOB DESTINATION

OTHER

(See Schedule)

CAGE

b. TELEPHONE

See attached schedule to complete quote information.

Quoter must also complete the following:

a. Quotation is valid for 90 days from date specified in Block 10 above unless otherwise indicated: _____________ .

b. Prices quoted are:

___ Contained in Commercial Catalog or Published Price List No. ___________________ dated _______________ page __________ .

___ Contained in Internal Price List No. _______________dated ____________________, which may be examined at our facility.

___ Commercial sales of comparable quantities: Quantity ____________ ; Price _____________;

___ Customer ________________________.

___ Other (provide basis) ______________________________________ _______________________________________ .

c. FOB Point: ____ Destination ____ Origin Shipping Point (City, State) _________________________________________ .

d. If delivery period shown in Block 6 is unacceptable, provide best possible delivery: _________________________________.

e. Remittance Address (Name, Street, City, State, ZIP): Same as Block 13 unless otherwise indicated below:

f. Vendor FAX Number: ____________________ Vendor Toll-Free Number: ____________________ Vendor E-mail: ______________________________

CONTINUATION SHEET REFERENCE NO. OF DOCUMENT BEING CONTINUED: PAGE 2 OF 7 PAGES

SPE7M3-18-Q-0416

CONTINUED ON NEXT PAGE

**THIS SOLICITATION IS BEING ISSUED UNDER SEPA AUTHORITY**

DAG 18.202 (a) Special Emergency Procurement Authority (SEPA) authorizes increased acquisition thresholds for supplies or services that are to be used to support a contingency operation (FAR 18.201). (ii) Simplified Acquisition:

$750,000 for acquisitions awarded and performed or purchases made within the U.S.; $1.5 million for acquisitions awarded and performed or purchases made outside the U.S.

REQUIREMENT MAY BE AWARDED PRIOR TO SOLICITATION RETURN DATE.

OFFER SUBMISSION INSTRUCTIONS: ALL OFFERORS MUST SUBMIT THIER QUOTES THROUGH DIBBS . Once the evaluation process begins, late quotations will only be considered if the contracting officer determines that considering the late quotation is in the best interest of the Government and would not unduly delay the award.

EVALUATION FACTORS FOR AWARD: Award will be made to the offeror(s) whose quote(s) conforms to the solicitation requirements and represents the best value to the Government. Past performance, offered delivery, and price will be evaluated when making a comparative assessment of quotes. An award may be made to other than the lowest priced, technically acceptable, responsible offeror(s).

THIS SOLICITATION INCORPORATES THE TERMS AND CONDITIONS SET FORTH IN THE REVISION OF THE DLA MASTER SOLICITATION FOR EPROCUREMENT AUTOMATED SIMPLIFIED ACQUISITIONS IN EFFECT ON THE SOLICITATION ISSUE DATE. ALL REVISIONS OF THE DLA MASTER SOLICITATION FOR EPROCUREMENT AUTOMATED SIMPLIFIED ACQUISITIONS CAN BE FOUND ON THE WEB AT: http://www.dla.mil/ HQ/Acquisition/Offers/eProcurement.aspx

THE FOLLOWING CLAUSES ALSO APPLY:

FAR 52.203-11 CERTIFICATION AND DISCLOSURE REGARDING PAYMENTS TO INFLUENCE CERTAIN FEDERAL TRANSACTIONS

FAR 52.203-12 LIMITATION ON PAYMENTS TO INFLUENCE CERTAIN FEDERAL TRANSACTIONS (OCT 2010)

FAR 52.222-35, EQUAL OPPORTUNITY FOR VETERANS

FAR 52.222-37, EMPLOYMENT REPORTS ON VETERANS

DFARS 252.209-7004 SUBCONTRACTING WITH FIRMS THAT ARE OWNED OR CONTROLLED BY THE GOVERNMENT OF A TERRORIST COUNTRY.

DFARS 252.225-7050, DISCLOSURE OF OWNERSHIP OR CONTROL BY THE GOVERNMENT OF A COUNTRY THAT IS A STATE SPONSOR OF

TERRORISM

FAR 52.225-13 RESTRICTIONS ON CERTAIN FOREIGN PURCHASES

DFARS 252.225-7000 BUY AMERICAN ACT — BALANCE OF PAYMENTS PROGRAM CERTIFICATE-BASIC

DFARS 252.225-7001 BUY AMERICAN ACT AND BALANCE OF PAYMENTS PROGRAM

DFAR 52.225-7002 QUALIFYING COUNTRY SOURCES AS SUBCONTRACTORS

DLAD PROCUREMENT NOTES

DLAD Procurement Notes are incorporated by reference, with the same force and effect as if they were in full text. The full text of a DLAD Procurement Note may be accessed electronically at http://www.dla.mil/HQ/Acquisition/Offers/ eProcurement.aspx and via 'References' on the DIBBS homepage.

FDT

This solicitation is issued under the First Destination Transportation (FDT) program to reduce the cost of transportation through the use of Government-arranged transportation utilizing Government contracts and rates. If this award is for FMS or has an APO/FPO ship-to address, these instructions do not apply.

For FDT Program Transportation Requirements, see Procurement Note C16 First Destination Transportation (FDT) Program, Government-Arranged Transportation for Manual Awards, C17 First Destination Transportation (FDT) Program – Shipments Originating from Outside the Contiguous United States, and Procurement Note C20 – Vendor Shipment Module (VSM).

Offers should be submitted based on FOB origin. For offerors whose shipments will originate from outside the contiguous United States, the offeror’s f.o.b. origin price shall include transportation to a contiguous United States location that the offeror selects based on cost-effectiveness or other variables at the offeror’s discretion.

Additional information about FDT can be found at http://www.dla.mil/LandandMaritime/Business/Selling/DLA-Land-and- Maritime-Procurement-Initiatives/FDTPI/ C16 First Destination Transportation (FDT) Program, Government-Arranged Transportation for Manual Awards (AUG 2017)

(1) Definitions. “Government-arranged transportation” means the Government is responsible for transportation costs, providing the carrier, and scheduling the shipment pickup contingent upon proper contractor notification in VSM (see procurement note C20).

(2) The contractor determines its transportation processes, controls, or costs. The contractor may submit an offer based on f.o.b. destination if it offers a better value to the Government.

(3) The contractor shall:

(a) Use the VSM to notify the Government that the materiel is ready to ship. The Government can take up to two (2) full business days to schedule the shipment. Pick-up should occur within five (5) business days of the contractor’s notification. The contractor shall plan for sufficient time for scheduling the shipment and standard ground transportation for its material to arrive at the destination by the Contract Delivery Date (CDD).

(b) Address the following special accommodations:

(i) If an order specifies carrier equipment when requested by the Government; or

(ii) If an order does not specify carrier equipment, the order appropriate carrier equipment should not be in excess

CONTINUATION SHEET REFERENCE NO. OF DOCUMENT BEING CONTINUED: PAGE 3 OF 7 PAGES

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of capacity to accommodate shipment;

(c) Deliver the shipment in good order and condition to the carrier, and load, stow, trim, block, and/or brace carload or truckload shipment (when loaded by the contractor) on or in the carrier’s conveyance as required by carrier rules and regulations

(4) The contractor is responsible for any loss and/or damage to the goods occurring before delivery to the carrier as a result of improper loading, stowing, trimming, blocking, and/or bracing of the shipment if loaded by the contractor on or in the carrier’s conveyance. _______________________________________________________________________________

252.232-7006 WIDE AREA WORKFLOW PAYMENT INSTRUCTIONS (MAY 2013) DFARS

As prescribed in 232.7004(b), use the following clause:

(a) Definitions. As used in this clause- “Department of Defense Activity Address Code (DoDAAC)” is a six position code that uniquely identifies a unit, activity, or organization. “Document type” means the type of payment request or receiving report available for creation in Wide Area WorkFlow (WAWF).

“Local processing office (LPO)” is the office responsible for payment certification when payment certification is done external to the entitlement system.

(b) Electronic invoicing. The WAWF system is the method to electronically process vendor payment requests and receiving reports, as authorized by DFARS 252.232-7003, Electronic Submission of Payment Requests and Receiving Reports.

(c) WAWF access. To access WAWF, the Contractor shall-

(1) Have a designated electronic business point of contact in the System for Award Management at https://www.

acquisition.gov; and

(2) Be registered to use WAWF at https://wawf.eb.mil/ following the step-by-step procedures for self-registration available at this web site.

(d) WAWF training. The Contractor should follow the training instructions of the WAWF Web-Based Training Course and use the Practice Training Site before submitting payment requests through WAWF. Both can be accessed by selecting the “Web Based Training” link on the WAWF home page at https://wawf.eb.mil/

(e) WAWF methods of document submission. Document submissions may be via web entry, Electronic Data Interchange, or File Transfer Protocol.

(f) WAWF payment instructions. The Contractor must use the following information when submitting payment requests and receiving reports in WAWF for this contract/order:

(1) Document type.

The Contractor shall use the following document type(s).

SOLICITATION

(Contracting Officer: Insert applicable document type(s).

Note: If a “Combo” document type is identified but not supportable by the Contractor's business systems, an “Invoice” (stand-alone) and “Receiving Report” (stand-alone) document type may be used instead.)

(2) Inspection/acceptance location. The Contractor shall select the following inspection/acceptance location(s) in WAWF, as specified by the contracting officer.

NA

(Contracting Officer: Insert inspection and acceptance locations or “Not applicable.”)

3) Document routing. The Contractor shall use the information in the Routing Data Table below only to fill in applicable fields in WAWF when creating payment requests and receiving reports in the system.

Routing Data Table* Field Name in WAWF Data to be entered in WAWF

Pay Official DoDAACTBD Issue By DoDAACTBD Admin DoDAACTBD Inspect By DoDAACTBD Ship To CodeSEE SOLICITATION (IF APPLICABLE) Ship From CodeTBD Mark For CodeTBD Service Approver (DoDAAC)NA Service Acceptor (DoDAAC)NA Accept at Other DoDAACNA LPO DoDAACNA DCAA Auditor DoDAACNA Field Name in WAWFData to be entered in

WAWF

Other DoDAAC(s)NA (*Contracting Officer: Insert applicable DoDAAC information or “See schedule” if multiple ship to/acceptance locations apply, or “Not applicable.”)

(4) Payment request and supporting documentation. The Contractor shall ensure a payment request includes appropriate contract line item and subline item descriptions of the work performed or supplies delivered, unit price/cost per unit, fee (if applicable), and all relevant back- up documentation, as defined in DFARS Appendix F, (e.g. timesheets) in support of each payment request.

(5) WAWF email notifications. The Contractor shall enter the e-mail address identified below in the “Send Additional Email Notifications” field of WAWF once a document is submitted in the system.

CONTINUATION SHEET REFERENCE NO. OF DOCUMENT BEING CONTINUED: PAGE 4 OF 7 PAGES

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NA

(Contracting Officer: Insert applicable email addresses or “Not applicable.”)

(g) WAWF point of contact.

(1) The Contractor may obtain clarification regarding invoicing in WAWF from the following contracting activity's WAWF point of contact.

NA

(Contracting Officer: Insert applicable information or “Not applicable.”)

(2) For technical WAWF help, contact the WAWF helpdesk at 866-618-5988.

(End of clause)

CONTINUATION SHEET REFERENCE NO. OF DOCUMENT BEING CONTINUED: PAGE 5 OF 7 PAGES

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SECTION B

SUPPLIES/SERVICES: 4810-01-513-3925

ITEM DESCRIPTION:

ACTUATOR,ELECTRO-MECHANICAL,LINEAR

RP001: DLA PACKAGING REQUIREMENTS FOR PROCUREMENT

RQ001: HIGHER LEVEL CONTRACT QUALITY REQUIREMENTS (MANUFACTURERS AND

NON-MANUFACTURERS)

Item Unique Identification is not required by request of the Service customer. DFARS 252.211-7003(c)(1)(i) applies.

RA001: THIS DOCUMENT INCORPORATES TECHNICAL AND/OR QUALITY REQUIREMENTS

(IDENTIFIED BY AN 'R' OR AN 'I' NUMBER) SET FORTH IN FULL TEXT IN THE

DLA MASTER LIST OF TECHNICAL AND QUALITY REQUIREMENTS FOUND ON THE WEB

AT: http://www.dla.mil/HQ/Acquisition/Offers/eProcurement.aspx. FOR

SIMPLIFIED ACQUISITIONS, THE REVISION OF THE MASTER IN EFFECT ON THE

SOLICITATION ISSUE DATE OR THE AWARD DATE CONTROLS. FOR LARGE

ACQUISITIONS, THE REVISION OF THE MASTER IN EFFECT ON THE RFP ISSUE DATE

APPLIES UNLESS A SOLICITATION AMENDMENT INCORPORATES A FOLLOW-ON

REVISION, IN WHICH CASE THE AMENDMENT DATE CONTROLS.

RQ011: REMOVAL OF GOVERNMENT IDENTIFICATION FROM NON-ACCEPTED SUPPLIES

MIL-STD-130N(1) DATED 16 NOV 2012.

IDENTIFICATION MARKING OF U.S. MILITARY PROPERTY

THIS ITEM HAS TECHNICAL DATA SOME OR ALL OF WHICH IS SUBJECT TO

EXPORT-CONTROL REGULATIONS. DISTRIBUTION OF THE TECHNICAL DATA AND

ELIGIBILITY FOR AWARD ARE LIMITED TO THOSE SUPPLIERS QUALIFIED THROUGH

JCP CERTIFICATION, OR TO THOSE LICENSED BY EITHER THE DEPARTMENTS OF

STATE OR COMMERCE; OR TO FOREIGN SUPPLIERS PURSUANT TO INTERNATIONAL

AGREEMENTS.

TO APPLY FOR JCP CERTIFICATION, COMPLETE DD FORM 2345, MILITARY CRITICAL

TECHNICAL DATA AGREEMENT, FORM IS AVAILABLE AT THE WORLD WIDE WEB

ADDRESS:

https://public.logisticsinformationservice.dla.mil/PublicHome/jcp/defaul t.aspx

OR BY WRITING TO:

DLA LOGISTICS INFORMATION SERVICE

FEDERAL CENTER

74 WASHINGTON AVE., NORTH

BATTLE CREEK, MI 49037-3084

TO MANUFACTURE THIS ITEM, NON-JCP CERTIFIED SUPPLIERS MUST SUBMIT A

CURRENT MANUFACTURING LICENSE AGREEMENT, TECHNICAL ASSISTANCE AGREEMENT,

DISTRIBUTION AGREEMENT OR OFF-SHORE PROCUREMENT AGREEMENT APPROVED BY

THE DIRECTORATE OF DEFENSE TRADE CONTROLS WITH THE OFFER, UNLESS AN

EXEMPTION UNDER THE PROVISIONS OF ITAR SECTION, 125.4 EXEMPTIONS OF

GENERAL APPLICABILITY, AND/OR EAR PART 740 ARE APPLICABLE.

NON-JCP CERTIFIED SUPPLIERS SEEKING EXPORT CONTROLLED TECHNICAL DATA ARE

REQUIRED TO PROVIDE THE CONTRACTING OFFICER WITH AN APPLICABLE AGREEMENT

OR IDENTIFY WHICH ITAR/EAR EXEMPTION APPLIES TO RECEIVE A COPY OF THE

EXPORT CONTROLLED TECHNICAL DATA.

CONTINUATION SHEET REFERENCE NO. OF DOCUMENT BEING CONTINUED: PAGE 6 OF 7 PAGES

CONTINUED ON NEXT PAGE

SECTION B

SUPPLY/SERVICE: 4810-01-513-3925 CONT'D

NOTE: JCP CERTIFIED CONTRACTORS WHO RECEIVE TECHNICAL DATA PURSUANT TO

THEIR DD FORM 2345 CERTIFICATION MAY NOT FURTHER DISSEMINATE SUCH DATA

UNLESS FURTHER DISSEMINATION OF THE TECHNICAL DATA IS EXPRESSLY

PERMITTED BY DODD 5230.25.

SOURCE CONTROLLED DRAWING - BUY DIRECTLY

FROM APPROVED SOURCES ONLY.

CRITICAL APPLICATION ITEM

Boeing Company, The DBA Boeing 82918 P/N 520-12477-1 ITT Aerospace Controls LLC DBA ITT 98087 P/N 6501-1

IAW BASIC DRAWING NR 82918 520-12477

REVISION NR P DTD 01/19/2005

PART PIECE NUMBER: 520-12477

ITEM NO. SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT .

0001 4810-01-513-3925 30.000 EA $ ________________ $ ________________

ACTUATOR

,ELECTRO-ME

QTY VARIANCE: PLUS 0% MINUS 0%

INSPECTION POINT: DESTINATION

ACCEPTANCE POINT: DESTINATION

FOB: ORIGIN DELIVERY DATE: 350 DAYS ADO

PREP FOR DELIVERY:

PKGING DATA - MIL-STD-2073-1D, 15 DEC 1999

QUP:001 PRES MTHD:41 CLNG/DRY:1 PRESV MAT:XX

WRAP MAT:JA CUSH/DUNN MAT:AD CUSH/DUNN THKNESS:X

UNIT CONT:ED OPI:M

PACK CODE:U

MARKING SHALL BE IN ACCORDANCE WITH MIL-STD-129.

SPECIAL MARKING CODE:00 -00 No special marking

PALLETIZATION SHALL BE IN ACCORDANCE WITH MD00100452 REV B DATED JULY 01, 2008

PARCEL POST ADDRESS:

SW3211

DLA DISTRIBUTION DEPOT OKLAHOMA

3301 F AVE CEN REC BLDG 506 DR 22

TINKER AFB OK 73145-8000

US

FREIGHT SHIPPING ADDRESS:

SW3211

DLA DISTRIBUTION DEPOT OKLAHOMA

3301 F AVE CEN REC BLDG 506 DR 22

TINKER AFB OK 73145-8000

US

GOVT USE

External External External Customer RDD/ ITEM PR PRLI PR PRLI Material Need Ship Date .

0001 0073352549 0001 N/A N/A N/A 05/22/2019

CONTINUATION SHEET REFERENCE NO. OF DOCUMENT BEING CONTINUED: PAGE 7 OF 7 PAGES

SECTION B

SUPPLY/SERVICE: 4810-01-513-3925 CONT'D

CONTINUATION SHEET

REFERENCE NO. OF DOCUMENT BEING CONTINUED:

PAGE OF PAGES

CONTINUATION SHEET

REFERENCE NO. OF DOCUMENT BEING CONTINUED:

PAGE OF PAGES

REQUEST FOR QUOTATIONS

THIS RFQ IS IS NOT A SMALL BUSINESS SET-ASIDE

4. CERT.FOR NAT. DEF.

UNDER BDSA REG. 2

AND/OR DMS REG. 1

5. ISSUED BY

7. DELIVERY

9. DESTINATION

10. PLEASE FURNISH QUOTATIONS TO THE

ISSUING OFFICE IN BLOCK 5 ON OR

BEFORE CLOSE OF BUSINESS (Date) IMPORTANT: This is a request for information, and quotations furnished are not offers. If you are unable to quote, please so indicate on this form and return it to the address in Block 5. This request does not commit the Government to pay any costs incurred in the preparation of the submission of this quotation or to contract for supplies or services. Supplies are of domestic origin unless otherwise indicated by quoter. Any representations and/or certifications attached to this Request for Quotations must be completed by the quoter.

11. SCHEDULE (See Continuation Sheets)

12. DISCOUNT FOR PROMPT PAYMENT

d. CALENDAR DAYS

NUMBER

PERCENTAGE

NOTE: Additional provisions and representations are are not attached.

13. NAME AND ADDRESS OF QUOTER

a. NAME OF QUOTER

16. SIGNER

AUTHORIZED FOR LOCAL REPRODUCTION

Previous edition not useable STANDARD FORM 18 (REV. 6-95) Prescribed by GSA-FAR (48 CFR) 53.215-1(a)

8. TO:

See Schedule See attached schedule to complete quote information.

f. Vendor FAX Number: Vendor Toll-Free Number: Vendor E-mail:

e. Remittance Address (Name, Street, City, State, ZIP): Same as Block 13 unless otherwise indicated below:

d. If delivery period shown in Block 6 is unacceptable, provide best possible delivery:

c. FOB Point:

Origin Shipping Point (City, State) Destination Other (provide basis) Commercial sales of comparable quantities: Quantity ; Price ;

Customer Contained in Internal Price List No. dated , which may be examined at our facility.

Contained in Commercial Catalog or Published Price List No. dated page

b. Prices quoted are:

a. Quotation is valid for 90 days from date specified in Block 10 above unless otherwise indicated: __________________ .

Quoter must also complete the following:

NUMBER

FOB DESTINATION

OTHER

(See Schedule)

CAGE

PAGE OF

1.6 Requet for Quotation skim Standard form - RFQ Acrobat Distiller 4.0 for Windows D:20001024141244Z D:20090429133228-04'00'

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ZSF18_REQ_NO: SPE7M3-18-Q-0416
ISSUE_DATE:
ZSF18_REQ_PR_NO: 0073352549
SPS-RATING:
AGENCY-NAME:
DELIVERY-DATE:
X-FOB:
X-OTHER:
SHIP-CITY:
SHIP-STATE:
SHIP-STREET:
SHIP-NAME:
SHIP-POSTAL-CODE:
DISC_TEN_DAYS:
DISC_TWENTY_DAYS:
DISC_THIRTY_DAYS:
DISC_DAYS:
DISC_OPN_DAYS:
RFQ-QUOTE-DATE:
RFQ_SIGNER_NAME:
RFQ_SIGNER_TEL:
RFQ_SIGNER_TITLE:
OFFEROR_NAME1:
OFFEROR_NAME2:
OFFEROR_CITY:
OFFEROR_STREET2:
OFFEROR_STREET1:
OFFEROR_STATE:
OFFEROR_ZIP4:
AP-YES:
AP-NO:
RFQ-DUE-DATE:
ZSF18_BLOCK11: See attached schedule to complete quote information.

Quoter must also complete the following:

a. Quotation is valid for 90 days from date specified in Block 10 above unless otherwise indicated: _____________ .

b. Prices quoted are:

___ Contained in Commercial Catalog or Published Price List No. ___________________ dated _______________ page __________ .

___ Contained in Internal Price List No. _______________dated ____________________, which may be examined at our facility.

___ Commercial sales of comparable quantities: Quantity ____________ ; Price _____________;

___ Customer ________________________.

___ Other (provide basis) ______________________________________ _______________________________________ .

c. FOB Point: ____ Destination ____ Origin Shipping Point (City, State) _________________________________________ .

d. If delivery period shown in Block 6 is unacceptable, provide best possible delivery: _________________________________.

e. Remittance Address (Name, Street, City, State, ZIP): Same as Block 13 unless otherwise indicated below:

f. Vendor FAX Number: ____________________ Vendor Toll-Free Number: ____________________ Vendor E-mail: ______________________________

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