SPE7M418Q0290.PDF

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.

SPE7M4-18-Q-0290

2. DATE ISSUED

2018 JUN 07

3. REQUISITION/PURCHASE REQUEST NO.

0073237190

RATING

DO-C9

DLA LAND AND MARITIME

FLUID HANDLING DIVISION

PO BOX 3990

COLUMBUS OH 43218-3990

USA

Buyer: Heinrick Alfman PMCMDB2 Tel: 614-692-2970 Fax: 614-693-1521 Email: Heinrick.Alfman@dla.mil

6. DELIVER BY (Date)

220 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 JUN 18

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

SPE7M4-18-Q-0290

CONTINUED ON NEXT PAGE

Special Emergency Procurement Authority (SEPA) PROCEDURES APPLY.

REQUIREMENT MAY BE AWARDED PRIOR TO RETURN DATE

Special Emergency Procurement Authority (a)(2) SAT is up to $750,000 for acquisitions awarded and performed or purchases to be made within the US; ($1.5 million for acquisitions awarded and performed or purchases to be made outside the US). FAR 2.101;

THIS IS A PERFORMANCE REVIEW INSTITUTE (PRI) QML OR QPL ITEM.

QUALIFIED / APPROVED QPL SOLE SOURCE IS PTI TECHNOLOGIES INC (05228).

THIS NSN HAS BEEN IDENTIFIED BY THE US AIR FORCE AS FIELD LEVEL REPARABLE. ANY ALTERNATE SOURCE OFFER MUST INCLUDE

REPAIR MANUAL / PROCEDURES AS WELL AS RECOMMENDED SPARE PARTS LIST.

PROSPECTIVE SOURCES THAT ARE NOT APPROVED FOR THIS NSN must include the QPL qualification package to the government with their offer prior to the solicitation's closing date. Non-qualified/prospective offerors must be able to demonstrate to the government their abilities to meet the standards specified for qualification, first article test might be required to qualify by approval authority. The specification containing the requirement is MIL-DTL-25531 and can be located on DLA's Qualified Product Database website at http://qpldocs.dla.mil/default.aspx under QPL-25531. Due to the criticality of this item, the timeframe for review and qualifications approval may take up to 180 days from the date it was received by the designated Engineering Support Activity (ESA). Information pertaining to qualification of products may be obtained from Oklahoma City Air Logistics Center/ENSDAA (AF-71), 3001 Staff Drive, Suite 1AB81A, Tinker AFB, OK 73145 or email tinker.dsp@tinker.af.mil.

The package SHOULD BE SUBMITTED TO THE SOURCE APPROVAL AUTHORITY AND THEY WILL DETERMINE IF THE SOURCE IS ACCEPTABLE.

NON-QUALIFIED OFFERS MAY NOT RECEIVE CONSIDERATION FOR CURRENT PROCUREMENT DUE TO LENGTHY PROCESS FOR ESA EVALUATION

AND TIMEFRAME REQUIRED TO MEET COUPLING REPLACEMENT SCHEDULE.

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

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.

NORTH AMERICAN INDUSTRY CLASSIFICATION SYSTEM 332996

SEE http://www.sba.gov/content/table-small-business-sizestandards

OFFER SUBMISSION INSTRUCTIONS:

ALL OFFERORS MUST SUBMIT THIER QUOTES THROUGH DIBBS AT: https://www.dibbs.bsm.dla.mil

Because DIBBS system has constraints that lead to delay in posting RFQ solicitations above $150,000, buyer need to add the following statement to the continuation page “This solicitation will be available on the Internet at http://www.

dibbs.bsm.dla.mil. Due to system constraints, it may take as long as three business days from the stated issue date for the solicitation to post to DIBBS”.

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) 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 The following provisions/clauses are hereby incorporated in this solicitation:

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 FAR 52.222-35, Equal Opportunity for Veterans FAR 52.222-37, Employment Reports on Veterans FAR 52.225-13, Restriction on Certain Foreign Purchases DFARS 252.225-7021, Trade Agreements 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

THIS BUY IS NOT ELIGIBLE FOR FAST PAY

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).

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

CONTINUED ON NEXT PAGE

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/

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

(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).

An invoice and WAWF receiving report (RR) are both required. The invoice and receiving report may be submitted separately or together as a combo type document. See DFARS Appendix F for detailed instructions on preparing the WAWF

RR.

NOTE: For contracts in accordance with Fast Payment Procedures, a Fast Pay (FP) invoice must be connected with a receiving report (RR), so either submit a FP combo or submit a RR and follow with a FP invoice. If there is no registered acceptor, the RR portion of the combo cannot be processed. In this case, submit a stand-alone FP invoice (“accept by” DoDAAC/location is mandatory).

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

See Award.

(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 WAWFData to be entered in WAWF Pay Official DoDAACSee Page 1 Issue By DoDAACSee Page 1 Admin DoDAACSee Page 1 Inspect By DoDAACSee Award Ship To CodeSee Award Ship From CodeSee Award/Purchase Order if applicable Mark For CodeSee Award/Purchase Order if applicable Service Approver (DoDAAC)See Award/Purchase Order if applicable Service Acceptor (DoDAAC)See Award/Purchase Order if applicable Accept at Other DoDAACSee Award/Purchase Order if applicable LPO DoDAAC DCAA Auditor DoDAAC Other DoDAAC(s)

(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.

Additional email notifications are not required.

(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.

Contact the local contract administrator found in block 6 of the DD 1155, block 9 of the SF 1449, or block 5 of the SF 26.

(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 4 OF 7 PAGES

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SECTION B

SUPPLIES/SERVICES: 4730-00-812-3040

ITEM DESCRIPTION:

COUPLING HALF, QUICK DISCONNECT.

RP001: DLA PACKAGING REQUIREMENTS FOR PROCUREMENT

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

THIS IS A PERFORMANCE REVIEW INSTITUTE (PRI) QML OR QPL ITEM. PRODUCT

SUPPLIED TO THIS SPECIFICATION SHALL BE MANUFACTURED BY AN ACCREDITED

MANUFACTURER (FOR COMPONENTS) AND/OR ASSEMBLED BY AN ACCREDITIED

MANUFACTURER OR ACCREDITED ASSEMBLING DISTRIBUTOR (FOR ASSEMBLIES) AS

LISTED IN THE PRI QUALIFIED MANUFACTURER LIST (QML)OR QUALIFIED PRODUCTS

LIST (QPL) FOR THIS STANDARD. THE QML OR QPL IS AVAILABLE AT

WWW.EAUDITNET.COM .

"CERTIFICATE OF QUALITY COMPLIANCE IS MANDATORY"

THIS NSN HAS BEEN IDENTIFIED BY THE US AIR FORCE AS FIELD LEVEL

REPARABLE. ANY ALTERNATE SOURCE OFFER MUST INCLUDE REPAIR

MANUAL/PROCEDURES AS WELL AS RECOMMENDED SPARE PARTS LIST.

CLASS I OZONE DEPLETING CHEMICALS ARE NOT TO BE

USED NOR INCORPORATED IN ANY ITEMS TO BE

DELIVERED UNDER THIS CONTRACT.THIS PROHIBITION

SUPERSEDES ALL SPECIFICATION REQUIREMENTS BUT

DOES NOT ALLEVIATE ANY PRODUCT REQUIREMENTS.

SUBSTITUTE CHEMICALS MUST BE SUBMITTED FOR

APPROVAL UNLESS THEY ARE AUTHORIZED BY THE

SPECIFICATION REQUIREMENTS.

CRITICAL APPLICATION ITEM

IAW BASIC SPEC NR MIL-DTL-25531F

REVISION NR DTD 07/31/2013

PART PIECE NUMBER:

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

0001 4730-00-812-3040 27.000 EA $ ________________ $ ________________

COUPLING HALF

,QUICK

QTY VARIANCE: PLUS 0% MINUS 0%

INSPECTION POINT: DESTINATION

ACCEPTANCE POINT: DESTINATION

FOB: ORIGIN DELIVERY DATE: 220 DAYS ADO

PREP FOR DELIVERY:

PKGING DATA-QUP:001

SHALL BE PACKAGED IN ACCORDANCE WITH ASTM D 3951.

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SECTION B

SUPPLY/SERVICE: 4730-00-812-3040 CONT'D

Markings Paragraph When ASTM D3951, Commercial Packaging is specified, the following apply:

•,,All Section “D” Packaging and Marking Clauses take precedence over

ASTM D3951.

•,,In addition to requirements in MIL-STD-129, when Commercial Packaging is used, the Method of Preservation for all MIL-STD-129 marking and labeling shall be “CP” Commercial Pack.

•,,The Unit of Issue (U/I) and Quantity per Unit Pack (QUP) as specified in the contract take precedence over QUP in ASTM D3951.

PARCEL POST ADDRESS:

SW3210

DLA DISTRIBUTION DEPOT HILL

7537 WARDLEIGH RD

HILL AFB UT 84056-5734

US

FREIGHT SHIPPING ADDRESS:

SW3210

DLA DISTRIBUTION DEPOT HILL

7537 WARDLEIGH RD BLDG 849W

CML 385 519 8898

HILL AFB UT 84056-5734

US

0002 4730-00-812-3040 129.000 EA $ ________________ $ ________________

ACCEPTANCE POINT: DESTINATION

FOB: ORIGIN DELIVERY DATE: 220 DAYS ADO

PREP FOR DELIVERY:

Markings Paragraph When ASTM D3951, Commercial Packaging is specified, the following apply:

•,,All Section “D” Packaging and Marking Clauses take precedence over

ASTM D3951.

•,,In addition to requirements in MIL-STD-129, when Commercial Packaging is used, the Method of Preservation for all MIL-STD-129 marking and labeling shall be “CP” Commercial Pack.

SW3211

DLA DISTRIBUTION DEPOT OKLAHOMA

3301 F AVE CEN REC BLDG 506 DR 22

TINKER AFB OK 73145-8000

US

FOR TRANSPORTATION ASSISTANCE SEE DLAD PROC NOTE C19. FOR FIRST DESTINATION TRANSPORTATION (FDT) AWARDS SEE DLAD PROC

NOTE C20 AND

CONTRACT INSTRUCTIONS.

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CONTINUED ON NEXT PAGE

SECTION B

SUPPLY/SERVICE: 4730-00-812-3040 CONT'D

FREIGHT SHIPPING ADDRESS:

SW3211

DLA DISTRIBUTION DEPOT OKLAHOMA

3301 F AVE CEN REC BLDG 506 DR 22

TINKER AFB OK 73145-8000

0003 4730-00-812-3040 129.000 EA $ ________________ $ ________________

ACCEPTANCE POINT: DESTINATION

FOB: ORIGIN DELIVERY DATE: 220 DAYS ADO

PREP FOR DELIVERY:

Markings Paragraph When ASTM D3951, Commercial Packaging is specified, the following apply:

•,,All Section “D” Packaging and Marking Clauses take precedence over

ASTM D3951.

•,,In addition to requirements in MIL-STD-129, when Commercial Packaging is used, the Method of Preservation for all MIL-STD-129 marking and labeling shall be “CP” Commercial Pack.

SW3119

DLA DISTRIBUTION WARNER ROBINS

455 BYRON STREET

BLDG 376

ROBINS A F B GA 31098-1887

US

FOR TRANSPORTATION ASSISTANCE SEE DLAD PROC NOTE C19. FOR FIRST DESTINATION TRANSPORTATION (FDT) AWARDS SEE DLAD PROC

NOTE C20 AND

CONTRACT INSTRUCTIONS.

FREIGHT SHIPPING ADDRESS:

SW3119

DLA DISTRIBUTION WARNER ROBINS

455 BYRON STREET BLDG 376

ROBINS A F B GA 31098-1887

GOVT USE

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

0001 0073237190 0001 N/A N/A N/A 04/05/2019

0002 0073237190 0002 N/A N/A N/A 04/05/2019

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

SECTION B

SUPPLY/SERVICE: 4730-00-812-3040 CONT'D

GOVT USE

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

0003 0073237190 0003 N/A N/A N/A 04/05/2019

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'

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: ______________________________