HandySCAN Black Elite System

Form / Attachment / Pricing Sheet

This document is IRS Form W-9, "Request for Taxpayer Identification Number and Certification." It is used by U.S. persons (including resident aliens) to provide their correct Taxpayer Identification Number (TIN) to a requester who is required to file an information return with the IRS. This form is used to report amounts paid to the individual or entity.

• Part I: Taxpayer Identification Number (TIN): Requires the individual or entity to provide their Social Security Number (SSN) or Employer Identification Number (EIN).
• Part II: Certification: Requires the individual or entity to certify that the TIN provided is correct, that they are not subject to backup withholding, that they are a U.S. citizen or other U.S. person, and that any FATCA code is correct.
• Lines 1-7: Collects identifying information such as name, business name, address, city, state, and ZIP code.
• Exemptions: Allows for the indication of exemptions from backup withholding and FATCA reporting.

Bidders may be required to complete and submit this Form W-9 to the government agency or prime contractor if they are selected for an award. It is essential for receiving payments and for the government to comply with IRS reporting requirements. Failure to provide a correct TIN can lead to backup withholding on payments.

Form / Attachment / Pricing Sheet

This document is Form W-8BEN-E, "Certificate of Status of Beneficial Owner for United States Tax Withholding and Reporting (Entities)." It is used by foreign entities to certify their status for U.S. tax withholding and reporting purposes, particularly concerning FATCA (Foreign Account Tax Compliance Act) and Chapter 4 status.

• Part I: Identification of Beneficial Owner: Collects basic identifying information about the entity, including its name, country of incorporation, and Chapter 3 and Chapter 4 statuses.
• Parts II-XXIX: These sections allow the entity to claim specific statuses, such as being a disregarded entity, claiming tax treaty benefits, or identifying as various types of foreign financial institutions (FFIs) or non-financial foreign entities (NFFEs) with specific exemptions (e.g., Sponsored FFI, Certified Deemed-Compliant FFI, Active NFFE, Passive NFFE).
• Part XXX: Certification: Contains the final certifications and signature of the authorized representative.

If this form is attached to a SAM.gov opportunity, it indicates that the government is seeking to contract with foreign entities or entities that need to establish their foreign status for tax purposes. Bidders who are foreign entities may need to complete and submit this form as part of their proposal or contract execution to ensure correct tax treatment of payments received from the U.S. government. Understanding the requirements of this form is crucial for accurate tax compliance and avoiding improper withholding.

Solicitation / RFP / RFQ

This document is a combined synopsis/solicitation (RFQ) for the procurement of one HandySCAN BLACK+ Elite device. Brookhaven Science Associates, LLC (BSA), operating Brookhaven National Laboratory for the U.S. Department of Energy, is requesting quotes. This announcement serves as the sole solicitation; a separate written solicitation will not be issued.

• One (1) HandySCAN BLACK+ Elite device.

• The Offeror shall furnish all labor, services, materials, and equipment in strict accordance with the attached Draft Purchase Order/Contract (Enclosure A).

• Offerors must provide all descriptive material necessary to determine if the offered product meets salient characteristics.

• Contract Type: Firm-Fixed Price.

• Anticipated Freight Terms: FOB Destination, Freight Prepaid.

• Anticipated Period of Performance/Delivery Date: To Be Determined (TBD).

• Payment Terms: To Be Determined (TBD).

• Quotations are due by March 18, 2026, 5:00 PM EDT.

• Questions are due by March 10, 2026.

• Award will be made to the responsive and responsible Offeror submitting the lowest total price that meets all technical requirements.

• BSA will only accept email submissions of formal quotations.

• Email submissions must include the signed Quotation Pricing Sheet (Enclosure C) and be sent to the Buyer/Contracts Specialist listed on page 1.

• All questions must be submitted via email.

• This procurement is set for full and open competition.

• NAICS Code: 334519.

• Size Standard: 600 employees.

• Offerors must be registered in the System for Award Management (SAM) and have a Unique Entity ID (UEI).

• Foreign vendors are not required to be registered in SAM but must complete AMS-Form-050 (Enclosure B).

• Brookhaven is a tax-exempt entity.

• The requirement is subject to FAR Part 25, Buy American Act.

• Required enclosures include: Draft Purchase Order/Contract, AMS Form 050 Reps and Certs, AMS Form 043 Quotation Pricing Sheet, Vendor ACH Authorization Form, W-9 Form (Domestic Vendors), or W-8 Form (Foreign Vendors).

Form / Attachment / Pricing Sheet

This document is a "Draft Purchase Order" (PO) from Brookhaven National Laboratory (BNL) to a vendor. It details the procurement of a specific item and outlines terms and conditions for the transaction.

• Item: HandySCAN BLACK+|Elite handheld self-positioning laser scanner system, including scanner unit, Creaform.OS software, carrying case, USB cable, power supply, calibration plate, and reflective targets.
• Quantity: 1.000 EA
• PO Number: BNL-0000476094
• Date: 03/03/2026
• Payment Terms: Net 30
• Contractual Representative: Mark A. Bryan
• Bill To: Brookhaven National Lab, Upton, NY
• Ship To: Brookhaven National Lab, Upton, NY
• General Terms & Conditions: Incorporated by reference (Rev 23.0, May 2025).
• Quality Assurance: References BNL-QA-101.
• Shipping Requirements: Specific instructions for packing slips, shipment value, and delivery locations.
• Invoicing: Electronic submission preferred; PDF format required.
• Acceptance: Confirmation of receipt requested.

This document serves as a draft purchase order, providing potential vendors with specific details about the item being procured, quantities, pricing terms, delivery instructions, and invoicing procedures. It also references key terms and conditions that will govern the transaction, including quality assurance and shipping requirements. Vendors should review this to understand the exact requirements and terms of the potential purchase.

Form / Attachment / Pricing Sheet

This document, AMS-FORM-050, is an "Annual Representations & Certifications" form required by Brookhaven National Laboratory (BNL/BSA). It is designed to gather necessary registration information and additional representations and certifications from Offerors who provide or intend to provide goods or services in support of a U.S. Government (USG) Contract.

• Section A.1: Business Information: Collects basic business name, address, contact information, and remittance details.
• Section A.1, Part II: Additional Business Information: Gathers Unique Entity Identifier (UEI), NAICS code, and physical/performance location information. It also includes questions about multiple performance locations and the Offeror's business size (e.g., Large Business, Small Business).
• Section A.2: Applicable Only to Small Business Offerors: Requires specific subcategory selections for small businesses (e.g., Woman-Owned, Veteran-Owned, HUBZone) and certifications related to SAM.gov registration.
• Section A.2.1 & A.2.2: Details Small Business Program Representations, including NAICS codes, size standards, and specific certifications for various small business categories.
• Section B: Additional Representations and Certifications Required for Work Under U.S. Government Prime Contracts: Includes certifications related to lobbying (FAR 52.203-11), executive compensation reporting (FAR 52.204-10), responsibility matters (FAR 52.209-5), previous contracts (FAR 52.222-22), affirmative action (FAR 52.222-25), and government property.
• Section B.9: Buy American: Requires certification regarding domestic end products.
• Section C: Authorized Signature of Offeror: A signature block for the Offeror's authorized representative to attest to the accuracy of the information provided.

This form is critical for any vendor seeking to do business with Brookhaven National Laboratory under a USG contract. Bidders must accurately complete all relevant sections to establish their business status, certifications, and compliance with federal regulations. Failure to complete this form correctly may impact their eligibility or consideration for awards. The information provided here will be used by BSA to assess responsibility and compliance.

Form / Attachment / Pricing Sheet

This document is the "Quotation Pricing Sheet" (Form No. AMS-Form-043, Revision No. 0.1) for the Brookhaven National Laboratory (BSA) Request for Quotation No. 476094. It is used by vendors to submit their pricing information in response to a solicitation.

• Fields for the vendor to enter their Quotation Number and the date.
• A field for the "Total Price $".
• A statement that the price shall remain firm for 45 days.
• Specifies delivery and payment terms as "FOB Destination, Net XX Days".
• A "Concurrence" section where the signing firm acknowledges and agrees to BSA's requirements, terms and conditions, and delivery schedule.
• Signature block for Company, Address, Typed Name, Title, Telephone No., and Date.

Bidders must complete and submit this form with their quotation. It requires them to state their total price, confirm price firmness, and agree to the specified delivery and payment terms. Signing the form signifies agreement to the solicitation's requirements and delivery schedule.

Form / Attachment / Pricing Sheet

This document is the Vendor ACH Authorization Form, required for vendors to authorize Brookhaven National Laboratory/Brookhaven Science Associates (BNL/BSA) to make payments via Automated Clearing House (ACH) credit entries or to correct such entries. This form is necessary for setting up electronic payment processing.

• Vendor Information: Requires Vendor/Company Name or DBA, Vendor Number (if applicable), and Tax ID Number (TIN).
• Depository Information: Requires Financial Institution name, Routing/Transit/ABA Number, and Checking Account Number.
• Authorization: A statement confirming the vendor's authorization for ACH transactions and understanding of revocation procedures as per NACHA law.
• Authorized Representative Information: Requires the name of the authorized representative, their email, phone number, signature, and the date.

Vendors responding to opportunities managed by Brookhaven National Laboratory/Brookhaven Science Associates may be required to complete and submit this form to facilitate payment processing if awarded a contract. It is essential for setting up direct deposit for contract payments.