Enclosure C AMS Form 043 Quotation Pricing Sheet

PROCUREMENT AND PROPERTY MANAGEMENT DIVISION

BROOKHAVEN NATIONAL LABORATORY

Managed by Brookhaven Science Associates, LLC
under contract to the U.S. Department of Energy

ACQUISITION MANAGEMENT SYSTEM FORM

Form No. AMS-Form-043

Revision No. 0.1

APPROVED BY:

-920755969000
PPM Manager/Date
Quotation/Proposal Pricing Sheet
Reference:Brookhaven Science Associates (BSA) Request for Quotation/Proposal No. 478026 Description: Analytical Services

Attention:Buyer/Contract Specialist: Mark Brock

Complete RFQ Enclosure C1 Fee Schedule. Fill in TAB’s “Format for Fee Schedule” and “Full Data Price Sheet.” For the “Full Data Price Sheet” fill in prices for the 3 Day TAT, 7 Day TAT, 14 Day TAT, and 30 Day TAT for all categories. Fill in pricing for each option period. Add up pricing for all TATS and place total price below.

Note: Enclosure C1 Fee Schedule: the pricing for the “24-48hr turn around %” and the “Preparation Cost” and the “Compound Cost” (found at the bottom of each page in Enclosure C1 Fee Schedule) will not be added to the TAT pricing and will not be evaluated in the LPTA total evaluated price. Note: The last TAB “Historical Quantities” provides the average quantity samples over the last 5 years.

*Must be in U.S. Dollars and inclusive of all taxes, fees, customs, duties and other charges.

This price shall remain firm for [90] days.

Delivery is FOB Destination, Freight Prepaid.
Payment terms are Net 30 (Large or Foreign Businesses), Net 10 (Small Businesses) Days.

*Phone #: [insert phone #] *Email Address: [insert email address]

Company Address: [insert address]

Concurrence:

By signing this Quotation/Proposal Pricing Sheet, our firm hereby acknowledges and agrees to BSA's requirements, terms and conditions, and delivery schedule, and agrees to provide the resources necessary to meet BSA's delivery schedule. We affirm we are registered in SAM and our representations and certifications as well as our small business size status (if applicable) are current and complete. Additionally, please certify the following:

Can you meet timelines listed in the SOW, Section 7, Deliverables, Reporting Results and Electronic Data Management? If yes, check this box: ☐

Notice is hereby provided that BSA may disclose offeror proposals to U.S. Government personnel for review. In such case, BSA will furnish the proposal to the Government with any confidentiality legends included by the Offeror, but BSA is not responsible for any subsequent disclosure by the U.S. Government.