SPE7M519Q0105.PDF

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SWITCH, PUSH Federal contract opportunity
Solicitation number
SPE7M519Q0105
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.

SPE7M5-19-Q-0105

2. DATE ISSUED

2018 OCT 24

3. REQUISITION/PURCHASE REQUEST NO.

0076606010

RATING

DO-C9

DLA LAND AND MARITIME

ACTIVE DEVICES DIVISION

PO BOX 3990

COLUMBUS OH 43218-3990

USA

Buyer: Desmond Forshey PMCMTA9 Tel: 614-692-6154 Fax: 614-692-6930 Email: Desmond.Forshey@dla.mil

6. DELIVER BY (Date)

200 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 NOV 05

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 8 PAGES

SPE7M5-19-Q-0105

CONTINUED ON NEXT PAGE

“ THIS SOLICITATION IS BEING ISSUED UNDER SEPA AUTHORITY.”

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

THE FOLLOWING CLAUSES ALSO APPLY TO 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 DFARS 252.209-7004 Subcontracting with Firms that are owned or controlled by the government of a Terrorist country FAR 52.222-35, Equal Opportunity for Veterans FAR 52.222-37, Employment Reports on Veterans FAR 52.223-9, Estimate of Percentage of Recovered Material Content for EPA-Designated Items DFARS 252.225-7050, Disclosure of Ownership or Control by the Government of a Country that is a State Sponsor of Terrorism FAR 52.203-12 LIMITATION ON PAYMENTS TO INFLUENCE CERTAIN FEDERAL TRANSACTIONS (OCT 2010) DFARS 252.209-7004 SUBCONTRACTING WITH FIRMS THAT ARE OWNED OR CONTROLLED BY THE GOVERNMENT OF A TERRORIST COUNTRY.

CONTINUATION SHEET REFERENCE NO. OF DOCUMENT BEING CONTINUED: PAGE 3 OF 8 PAGES

CONTINUED ON NEXT PAGE

SECTION B

SUPPLIES/SERVICES: 5930-01-540-9183

ITEM DESCRIPTION:

SWITCH,PUSH

RP001: DLA PACKAGING REQUIREMENTS FOR PROCUREMENT

A. Data required by this document will be included in the price of the procured item(s).

B. The supplier shall prepare and furnish one (1) copy of the Certificate of Quality Compliance (COQC) for all delivered supplies. If the supplies delivered under this contract are from more than one manufacturing lot, a separate one (1) copy of the COQC shall be prepared and furnished for each manufacturing lot represented by, manufactured or produced under a product specification, original equipment manufacturer (OEM)/manufacturer's part number, commercial, industry or military standard, or drawings, or other technical data. Each Certificate shall be prepared in accordance with the Supplemental Quality Assurance Provision (SQAP).

C. For contracts assigned for Government inspection at source, the supplier shall have the completed Certificate available for review by the Government representative when the material is presented for acceptance by the Government. The Government representative can sign off on the WAWF receiving report so long as the Contractor complied with the COQC and the documentation is uploaded as an attachment to the Production CLIN in iRAPT.

D. An electronic copy of each COQC, for Government records retention, shall be entered into the Invoicing, Receipt, Acceptance and Property Transfer (iRAPT) system by the supplier via the Attachment tab of the Receiving Report (RR). Instructions for entering Attachments can be found in the iRAPT - Web Based Training Main Menu under "Attachments which can be viewed at https://wawfraid.nit.disa.mil/wawfwbt/xhtml/unaut h/web/wbt/wawfra/Attachments.xhtml. If the supplier offering the material to the Government is not the manufacturer of the material, the supplier is responsible for obtaining a certified test report from the manufacturer, including it as part of this COQC, and for demonstrating that the specific material being offered under this Certificate is covered by the certified test report. The data submittal listed above is in addition to the other iRAPT requirements included in this contract. Whenever access to the iRAPT system is limited or not available, the supplier shall notify the PCO and request permission to submit documents manually until the iRAPT system is again available for use. Unless otherwise specified by the contract, the supplier shall be responsible for retaining the Certificate for a period of 4 years. When requested by the Contracting Officer, the supplier shall make the Certificate available for review by the Government at any time during the period the Certificate is required to be retained.

E. No Certificate of Conformance (COC) or alternate release is authorized.

End of Requirement

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

NOTE: THE CITED DRAWING IS A SOURCE CONTROLLED

DRAWING AND AS OF THE DATE OF THIS SOLICITATION

ONLY THE SOURCE(S) CITED ON THE DRAWING HAVE

CONTINUATION SHEET REFERENCE NO. OF DOCUMENT BEING CONTINUED: PAGE 4 OF 8 PAGES

CONTINUED ON NEXT PAGE

SECTION B

SUPPLY/SERVICE: 5930-01-540-9183 CONT'D

BEEN APPROVED. EVEN THOUGH SOURCES AND APPROVED

PART NUMBERS ARE PROVIDED, THE ITEMS

FURNISHED MUST MEET THE REQUIREMENTS OF THE

CITED DRAWING. OFFERORS WHO ARE INTERESTED

IN QUALIFYING THEIR PRODUCT FOR PURPOSE OF

FUTURE ACQUISITION MUST CONTACT THE

COGNIZANT DESIGN ACTIVITY SPECIFIED ON THE

SOURCE CONTROLLED DRAWING.

ALSO, MAY INCLUDE ADDITIONAL APPROVED SOURCES

THAT HAVE NOT BEEN REFLECTED ON THE DRAWING AT

THIS TIME.

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.

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.

Honeywell International Inc. DBA 91929 P/N EPM22BYG6BCL-4001

IAW BASIC DRAWING NR 19200 12550004

REVISION NR B DTD 10/23/2006

PART PIECE NUMBER:

IAW REFERENCE DRAWING NR 19200 12550005

REVISION NR A DTD 03/03/1997

PART PIECE NUMBER:

IAW REFERENCE DRAWING NR 19207 ATPD-2167

REVISION NR DTD 01/05/1990

PART PIECE NUMBER:

IAW REFERENCE DRAWING NR 19200 12579607

REVISION NR C DTD 08/04/2009

PART PIECE NUMBER:

IAW REFERENCE SPEC NR MIL-PRF-8805/4P(1) NOT 1

REVISION NR 1 DTD 03/19/2015

PART PIECE NUMBER:

IAW REFERENCE DRAWING NR 19200 12550004

REVISION NR DTD 09/09/2009

PART PIECE NUMBER:

IAW REFERENCE QAP 19200 12550004

REVISION NR A DTD 03/31/1997

CONTINUATION SHEET REFERENCE NO. OF DOCUMENT BEING CONTINUED: PAGE 5 OF 8 PAGES

CONTINUED ON NEXT PAGE

SECTION B

SUPPLY/SERVICE: 5930-01-540-9183 CONT'D

PART PIECE NUMBER:

IAW REFERENCE DRAWING NR 19200 12550004-13

REVISION NR DTD 04/17/2017

PART PIECE NUMBER:

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

0001 5930-01-540-9183 660.000 EA $ ________________ $ ________________

SWITCH,PUSH

PRICING TERMS: Firm Fixed Price

QTY VARIANCE: PLUS 0% MINUS 0%

INSPECTION POINT: DESTINATION

ACCEPTANCE POINT: DESTINATION

FOB: ORIGIN DELIVERY DATE: 200 DAYS ADO

PREP FOR DELIVERY:

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

QUP:001 PRES MTHD:ZZ CLNG/DRY:Z PRESV MAT:ZZ

WRAP MAT:ZZ CUSH/DUNN MAT:ZZ CUSH/DUNN THKNESS:Z

UNIT CONT:ZZ OPI:A

INTRMDTE CONT:ZZ INTRMDTE CONT QTY:ZZZ

PACK CODE:U

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

SPECIAL MARKING CODE:ZZ -ZZ Special Requirements

Packaging shall be in accordance with Special Packaging Instruction - SPI - 12550004, dated 09 September 2009, with changes;

"BLOCK 4, NATIONAL STOCK NO., CHANGE:

FROM: "1015-00-730-7083"

TO: "5930-01-540-9183""

IP025: PACKAGING, MARKING, AND SHIPPING OF HAZARDOUS MATERIALS

PARCEL POST ADDRESS:

W62G2T

W1A8 DLA DIST SAN JOAQUIN

25600 S CHRISMAN ROAD

REC WHSE 57

TRACY CA 95304-5000

US

FOR TRANSPORTATION SEE DLAD DLAD PROC NOTE C19. FOR FIRST DESTINATION TRANSPORTATION SEE DLAD PROC NOTE C20 AND

CONTRACT

FREIGHT SHIPPING ADDRESS:

W62G2T

W1A8 DLA DIST SAN JOAQUIN

25600 S CHRISMAN ROAD

REC WHSE 57

TRACY CA 95304-5000

US

CONTINUATION SHEET REFERENCE NO. OF DOCUMENT BEING CONTINUED: PAGE 6 OF 8 PAGES

CONTINUED ON NEXT PAGE

SECTION B

SUPPLY/SERVICE: 5930-01-540-9183 CONT'D

GOVT USE

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

0001 0076606010 0001 N/A N/A N/A 04/04/2018

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SECTION A - SOLICITATION/CONTRACT FORM

52.204-16 COMMERCIAL AND GOVERNMENT ENTITY CODE REPORTING (JUL 2016) FAR

SECTION I - CONTRACT CLAUSES

52.204-14 SERVICE CONTRACT REPORTING REQUIREMENTS (OCT 2016) FAR

52.204-15 SERVICE CONTRACT REPORTING REQUIREMENTS FOR INDEFINITE-DELIVERY CONTRACTS (OCT 2016) FAR

52.204-18 COMMERCIAL AND GOVERNMENT ENTITY CODE MAINTENANCE (JUL 2016) FAR

52.204-20 PREDECESSOR OF OFFEROR (JUL 2016) FAR

As prescribed in 4.1804(d), insert the following provision:

(a) Definitions. As used in this provision -

“Commercial and Government Entity (CAGE) code” means -

(1) An identifier assigned to entities located in the United States or its outlying areas by the Defense Logistics Agency (DLA) Commercial and Government Entity (CAGE) Branch to identify a commercial or government entity; or

(2) An identifier assigned by a member of the North Atlantic Treaty Organization (NATO) or by the NATO Support and Procurement Agency (NSPA) to entities located outside the United States and its outlying areas that the DLA Commercial and Government Entity (CAGE) Branch records and maintains in the CAGE master file. This type of code is known as a NATO CAGE (NCAGE) code.

“Predecessor” means an entity that is replaced by a successor and includes any predecessors of the predecessor.

“Successor” means an entity that has replaced a predecessor by acquiring the assets and carrying out the affairs of the predecessor under a new name (often through acquisition or merger). The term “successor” does not include new offices/divisions of the same company or a company that only changes its name. The extent of the responsibility of the successor for the liabilities of the predecessor may vary, depending on State law and specific circumstances.

(b) The Offeror represents that it [ ] is or [ ] is not a successor to a predecessor that held a Federal contract or grant within the last three years.

(c) If the Offeror has indicated “is” in paragraph (b) of this provision, enter the following information for all predecessors that held a Federal contract or grant within the last three years (if more than one predecessor, list in reverse chronological order):

Predecessor CAGE code:

Predecessor legal name:

(Do not use a “doing business as” name)

(End of provision)

SECTION K - REPRESENTATIONS, CERTIFICATIONS AND STATEMENTS

52.204-17 OWNERSHIP OR CONTROL OF OFFEROR (JUL 2016) FAR

As prescribed in 4.1804(b), use the following provision:

(a) Definitions. As used in this provision -

“Commercial and Government Entity (CAGE) code” means -

(1) An identifier assigned to entities located in the United States or its outlying areas by the Defense Logistics Agency (DLA) Commercial and Government Entity (CAGE) Branch to identify a commercial or government entity; or

(2) An identifier assigned by a member of the North Atlantic Treaty Organization (NATO) or by the NATO Support and Procurement Agency

CONTINUATION SHEET REFERENCE NO. OF DOCUMENT BEING CONTINUED: PAGE 8 OF 8 PAGES

SECTION K - REPRESENTATIONS, CERTIFICATIONS AND STATEMENTS (CONTINUED)

(NSPA) to entities located outside the United States and its outlying areas that the DLA Commercial and Government Entity (CAGE) Branch records and maintains in the CAGE master file. This type of code is known as a NATO CAGE (NCAGE) code.

“Highest-level owner” means the entity that owns or controls an immediate owner of the offeror, or that owns or controls one or more entities that control an immediate owner of the offeror. No entity owns or exercises control of the highest level owner.

“Immediate owner” means an entity, other than the offeror, that has direct control of the offeror. Indicators of control include, but are not limited to, one or more of the following: ownership or interlocking management, identity of interests among family members, shared facilities and equipment, and the common use of employees.

(b) The Offeror represents that it [ ] has or [ ] does not have an immediate owner. If the Offeror has more than one immediate owner (such as a joint venture), then the Offeror shall respond to paragraph (c) and if applicable, paragraph (d) of this provision for each participant in the joint venture.

(c) If the Offeror indicates “has” in paragraph (b) of this provision, enter the following information:

Immediate owner CAGE code:

Immediate owner legal name:

(Do not use a “doing business as” name)

Is the immediate owner owned or controlled by another entity?: [ ] Yes or [ ] No.

(d) If the Offeror indicates “yes” in paragraph (c) of this provision, indicating that the immediate owner is owned or controlled by another entity, then enter the following information:

Highest-level owner CAGE code:

Highest-level owner legal name:

(Do not use a “doing business as” name)

(End of provision)

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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

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: SPE7M5-19-Q-0105
ISSUE_DATE:
ZSF18_REQ_PR_NO: 0076606010
SPS-RATING:
AGENCY-NAME:
DELIVERY-DATE:
X-FOB:
X-OTHER:
SHIP-CITY:
SHIP-STATE:
SHIP-STREET:
SHIP-NAME:
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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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