Request for Quotations NO

REQUEST FOR QUOTATION

THIS RFQ

(THIS IS NOT AN ORDER)

IS

PAGE

IS NOT A SMALL BUSINESS SET-ASIDE

OF

1. REQUEST NUMBER

RATING

 '5

2. DATE ISSUED 3. REQUISITION/PURCHASE REQUEST NUMBER 4. CERT. FOR NAT. DEF.

UNDER BDSA REG. 2

 ,*0)'346

AND/OR DMS REG. 1

5a. ISSUED BY *)()6%0,-+,;%=%(1-2-786%8-32

6. DELIVER BY (Date)

)%78)62*)()6%00%2(7,-+,;%=(-:-7-32
 
59%28914%6/039(392'3928=4/;=
79-8))
6)+-2%1'(32%0(

7. DELIVERY

%7,&962:%

„

6)+-2%1'(32%0(

9. DESTINATION

AREA CODE

NUMBER





a. NAME OF CONSIGNEE

*IHIVEP,MKL[E]%HQMRMWXVEXMSR

8. TO:

b. STREET ADDRESS

)EWXIVR*IHIVEP0ERHW,MKL[E](MZ

'968-7,)6(  

 .EGO(IPS^MIV(V

b. COMPANY

a. NAME



OTHER

(See Schedule)

FOB DESTINATION

5b. FOR INFORMATION CALL (NO COLLECT CALLS)

TELEPHONE NUMBER

NAME

PAGES



„

c. STREET ADDRESS

c. CITY

7IZMIVZMPPI

d. CITY

e. STATE

f. ZIP CODE

„

„

d. STATE

e. ZIP CODE

 

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 5a. 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 service. Supplies are of domestic origin unless otherwise indicated by quoter. Any representations and/or certifications attached to this Request for Quotation must be completed by the quoter.

10. PLEASE FURNISH QUOTATIONS TO THE

ISSUING OFFICE IN BLOCK 5a ON OR

BEFORE CLOSE OF BUSINESS (Date)

)8

11. SCHEDULE (Include applicable Federal, State and local taxes)

ITEM NUMBER

SUPPLIES/SERVICES

QUANTITY

UNIT

UNIT PRICE

AMOUNT

(a)

(b)

(c)

(d)

(e)

(f)

8,-7730-'-8%8-32-746)4%6)(-2
%''36(%2');-8,*)()6%0%'59-7-8-32
6)+90%8-324%687-140-*-)(
463')(96)7
40)%7)463:-()46-'-2+*368,)
*3003;-2+


*=7TSRWSVMRK%KIRG]JIIJSV%%7,83

VI WSYVGI %160

%GGVIHMXEXMSRERH-RWTIGXMSR7IVZMGIW

WIIEXXEGLIH7GSTISJ;SVO

5YERXMX] $

a. 10 CALENDAR DAYS (%) b. 20 CALENDAR DAYS (%) c. 30 CALENDAR DAYS (%)

d. CALENDAR DAYS

NUMBER

12. DISCOUNT FOR PROMPT PAYMENT

„
NOTE: Additional provisions and representations

are

„

„

PERCENTAGE

„

are not attached.

13. NAME AND ADDRESS OF QUOTER

a. NAME OF QUOTER

14. SIGNATURE OF PERSON AUTHORIZED TO

SIGN QUOTATION

15. DATE OF QUOTATION

„

„

b. STREET ADDRESS

16. SIGNER

a. NAME (Type or print)

b. TELEPHONE

AREA CODE

c. COUNTY

„

d. CITY