Draft PO

Purchase Order
Brookhaven National Laboratory
Brookhaven National Laboratory
Upton, NY 11973-5000

Dispatch via E-Mail

Purchase Order
Date
Revision
Page
BNL-0000484554
10/21/2026
Payment Terms
Freight Terms
Ship Via
Net 30
FOB Factory, Freight Collect FEDEX P3
Contractual Representative
Phone
Currency

BENINCASE,ALYSHA J

USD

DRAFT

Vendor:
0000026188

ANY VENDOR

ANY STREET

ANYTOWN, NY 11973

Bill To: Brookhaven National Lab
Fiscal Division Building 400-D
PO Box 5000
Upton, NY 11973-5000
[email protected]

Ship To: Brookhaven National Lab
Ref PO#:
0000484554
Receiving: Bldg 98 Rochester St
Upton, NY 11973

Brookhaven Science Associates (BSA), LLC is placing this Purchase Order under its Prime Contract with the U.S. Department of Energy and is pursuant to the General and/or Supplemental terms and conditions which can be viewed via the internet at: https://www.bnl.gov/ppm/terms-and-conditions.php Should contractor have any questions and/or not have access to these terms and conditions, contact the contractual representative immediately.

Tax Exempt? Y

Tax Exempt

NYS216880

Line-Sch Item/Description

1- 1

Replenishment Option: Standard
Mfg ID

TFLN-G2-IM-1550-65-V-LV

65GHz packaged TFLN intensity
modulator - C-band, Low Vpi
version, Cryo-compatible

Quantity UOM

PO Price

1.000 EA

T
AF

ESH&Q Risk Level: A2 - Major

R

D

QA Paragraph(S): 3.1.3, 4.43, 3.1.4

Schedule Total

Item Total

This is a Firm Fixed Price Purchase Order (PO). The said sum shall constitute full compensation for all services/items furnished hereunder. The Total PO Amount listed shall not be exceeded without a signed modification/change order.

The provisions of Brookhaven Science Associates, LLC General Terms and Conditions for Commercial Items and Services, Rev. 25.0 (Sep 2026) are incorporated herein and made a part hereof. Reference is made to the Brookhaven National Laboratory Supplier Quality Assurance requirements, BNL-QA-101, which is incorporated herein and made a part of the purchase order. In addition to all the General Provisions, the Supplier agrees all material delivered against this purchase order will conform to the Quality Assurance paragraphs indicated in the line description(s). Any and all product recall alerts should be communicated by email directly to [email protected]. Provide all available information, such as Purchase Order Number(s), date of order, and names of purchaser with the notification to assist BNL in locating and