Attachment_04_Corrected_Quantity_Quote_Submission_Form_W912HZ19R5694.pdf

QUOTE SUBMISSION FORM

Potassium Chlorate

Range 19, Millcreek Road, Fort Polk LA

Item Quantity Unit Unit Price Total Amount Labor, Equipment and Materials to deliver 7,000 Pounds of Potassium Chlorate Powder (KClO3) in accordance with the Attachment 01 Description of Requirement

7,000 Lbs.

Engineer Research and Development Center ATTN: Leah Cobb

3909 Halls Ferry Rd.

Vicksburg, Mississippi 39180-6199

EMAIL: Leah.B.Cobb@usace.army.mil 601-634-6694

2. REGISTERED IN THE SYSTEM FOR AWARD MANAGMENT (SAM), FORMERLY

CCR?

YES____ NO____

NOTE: If you are not registered with SAM (formerly CCR), an award cannot be made to your institution. You may register electronically at https://sam.gov/SAM/.

Registering electronically will expedite the registration process but may not ensure registration prior to the award of the contract.

3. Please provide the following information:

Contractor Point of Contact: ______________________________________________________

Point of Contact Phone Number: ___________________________________________________

Point of Contact E-mail Address:___________________________________________________

Contractor DUNS #:_____________________________________________________________

Contractor Cage Code: ___________________________________________________________

Contractor Tax ID: ______________________________________________________________ mailto:Leah.B.Cobb@usace.army.mil

This Quote is Valid Through the Following Date:______________________________________