M-Drive Power System

Form / Attachment / Pricing Sheet

This document, AMS-FORM-050, is a form for Annual Representations & Certifications required by Brookhaven National Laboratory (BNL/BSA) for offerors providing goods or services in support of a U.S. Government (USG) Contract. It gathers necessary registration information and additional representations and certifications.

• Section A.1: Business Information: Collects basic business name, address, contact information, and Unique Entity Identifier (UEI) from SAM.gov. It also captures NAICS code and physical/performance location details.
• Section A.2: Applicable Only to Small Business Offerors: Requires small business offerors to certify their business size and subcategory (e.g., Woman-Owned, Service-Disabled Veteran-Owned, HUBZone) and acknowledges that SAM.gov certification is required. It references FAR 52.219-1 for Small Business Program Representations.
• Section B: Additional Representations and Certifications: Includes various FAR clauses related to:
  • FAR 52.203-11: Certification and Disclosure Regarding Payments to Influence Certain Federal Transactions.
  • FAR 52.204-10: Reporting Executive Compensation and First-Tier Subcontract Awards.
  • FAR 52.209-5: Certification Regarding Responsibility Matters.
  • FAR 52.209-7: Information Regarding Responsibility Matters.
  • FAR 52.222-22: Previous Contracts and Compliance Reports.
  • FAR 52.222-25: Affirmative Action Compliance.
  • Government Property Certification.
  • FAR 52.225-1 & 52.225-9: Buy American Supplies and Construction Materials.
• Section C: Authorized Signature of Offeror: Requires the offeror's authorized representative to certify the accuracy of the information provided.

This form is critical for any offeror seeking to do business with Brookhaven National Laboratory under a USG contract. Bidders must accurately complete all relevant sections to be considered eligible. Failure to provide accurate information or complete the form may result in the offeror not being considered a small business or potentially being deemed non-responsible. The information provided here is essential for compliance with federal acquisition regulations and for BNL/BSA's evaluation of offeror responsibility and eligibility.

Form / Attachment / Pricing Sheet

This document is a Quotation Pricing Sheet (Form No. AMS-Form-043, Revision No. 0.1) for the M-Drive Power System, referenced under Brookhaven National Laboratory's Request for Quotation (RFQ) No. 473749. Bidders are required to complete and submit this form as part of their quotation.

• Quotation Number and Date: To be filled in by the bidder.
• Description: Specific item is "LT-EL-BL-PD-PDU-0101_REV-A".
• Quantity: 20
• Unit of Measure (UoM): Each
• Unit Price and Extended Amount: Fields for bidder to complete.
• Total Price: To be calculated and inserted.
• Price Firmness: Bidder must specify the number of days the price will remain firm.
• Terms of Delivery: Bidder must select either DAP or FOB Destination.
• Payment Terms: Bidder must select either Net 30 Days or Net 10 Days (for small businesses).
• Place of Manufacture: Bidder must insert the place of manufacture.
• Company Information: Fields for Company Name, Signature, Address, Typed Name, Title, Telephone Number, and Date.

This form is critical for bidders to provide their pricing and terms for the M-Drive Power System. Completing this sheet accurately and in compliance with the specified fields (including delivery terms, payment terms, and price validity) is essential for a compliant quotation submission. By signing, the bidder agrees to Brookhaven Science Associates' (BSA) requirements, terms, conditions, and delivery schedule.

Form / Attachment / Pricing Sheet

This document is IRS Form W-9, Request for Taxpayer Identification Number and Certification. It is used by individuals and entities to provide their correct Taxpayer Identification Number (TIN) to a requester who is required to file an information return with the IRS.

• Part I: Taxpayer Identification Number (TIN): Requires the entry of a Social Security Number (SSN), Individual Taxpayer Identification Number (ITIN), 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: Fields for name, business name, address, city, state, ZIP code, and optional account numbers.
• Line 3a: Federal tax classification of the entity/individual.
• Line 3b: Indicates if the entity has foreign partners, owners, or beneficiaries.
• Line 4: Exemptions from backup withholding or FATCA reporting.

Bidders may be required to complete and submit this form to the government agency or prime contractor as part of the contracting process. It is essential for accurate tax reporting and to avoid backup withholding on payments. Failure to provide a correct TIN can result in penalties and delays in payment.

Form / Attachment / Pricing Sheet

This document is a Vendor ACH Authorization Form required by Brookhaven National Laboratory (BNL)/Brookhaven Science Associates (BSA), managed under contract with the U.S. Department of Energy. It authorizes BNL/BSA to make payments to the vendor via Automated Clearing House (ACH) credit entries or to correct erroneous entries.

• 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 its duration until written notification to terminate or modify is received. It also notes that credit authorizations may be revoked as per NACHA law.
• Authorized Representative Details: Fields for the representative's name, email, phone number, signature, and date.

Vendors responding to opportunities managed by BNL/BSA may be required to complete and submit this form to facilitate electronic payments. It is crucial for bidders to accurately provide their banking and company information to ensure timely and correct payment processing if awarded a contract.

Form / Attachment / Pricing Sheet

This document is IRS 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 provide detailed certifications regarding its status, such as being a disregarded entity, claiming tax treaty benefits, or qualifying for various "deemed-compliant" or "excepted" statuses under FATCA (e.g., Sponsored FFI, Certified Deemed-Compliant Nonregistering Local Bank, Active NFFE, Passive NFFE).
• Part XXX: Certification: Contains the final certifications and signature of the beneficial owner, affirming the accuracy of the information provided and its status as a non-U.S. person.

This form is crucial for any foreign entity that is a beneficial owner of U.S. source income or is involved in transactions subject to U.S. tax withholding. Bidders who are foreign entities will need to complete and submit this form to the withholding agent (the entity making the payment) to claim reduced withholding rates under tax treaties or to certify their status to avoid U.S. tax withholding, particularly under FATCA regulations. Failure to provide a properly completed W-8BEN-E can result in backup withholding at the highest applicable rate.

Solicitation / RFP / RFQ

This solicitation (RFQ Number 473749) is for the procurement of an M-Drive Power System. Brookhaven Science Associates, LLC (BSA), operating Brookhaven National Laboratory for the U.S. Department of Energy, is issuing this request for quotes.

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

• Offerors must submit detailed specifications and test reports for each applicable item.

• Offerors must provide references for at least 3 successfully manufactured, assembled, tested, and delivered power distribution systems of similar complexity.

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

• Contract Type: Firm-fixed Price.

• Anticipated Delivery Date: 18 weeks after receipt of order.

• Payment Terms: Net 30 or 10.

• Anticipated Freight Terms: FOB Destination, Freight Prepaid or Delivered at Place (DAP).

• Questions Due Date: February 13, 2026, 4:00 PM EST.

• Quote Due Date & Time: March 4, 2026, 4:00 PM EST.

• Submission Method: Email only to the Buyer/Contracts Specialist listed on page 1, including the signed Quotation Pricing Sheet (Enclosure C) and BSA RFQ Number in the Subject Line.

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

• Offerors taking exceptions to BSA terms and conditions or failing to provide all requirements may be deemed non-responsive.

• NAICS Code: 33422, with a size standard of 1,250 employees.

• This procurement is being solicited for full and open competition.

• Offerors must be registered in the U.S. Government supplier database System for Award Management (SAM) with their Unique Entity ID (UEI #). Foreign vendors are not required to register in SAM but must fill out AMS-Form-050 (Enclosure B).

• Brookhaven is a tax-exempt entity.

• 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), and W-8 Form (Foreign Vendors).

Form / Attachment / Pricing Sheet

This document is a Purchase Order (PO) issued by Brookhaven National Laboratory (BNL) for the fabrication, assembly, and testing of 20 units of the LT-EL-BL-PD-PDU-0101 M-Drive Power System Rev A. It outlines the terms and conditions for the order, including delivery, payment, and quality assurance requirements.

• Item Description: LT-EL-BL-PD-PDU-0101_REV-A
• Quantity: 20 units
• Contractual Representative: Jayce M Blood
• Technical Representative: Dyon Buitenkamp
• Quality Assurance: References BNL-QA-101 and ISO 9001 standards.
• Attachments: Includes a Statement of Work (SOW) dated December 11, 2025, and multiple drawings related to the M-Drive Power System.
• Delivery: Deliveries accepted Monday-Friday, 8 am to 4 pm. Specific advance notification is required for shipments over 3,000 lbs or longer than 8 feet.
• Shipping: Do not insure the shipment or declare value. Seller to ship via UPS Ground with freight charges collect.
• Invoicing: Electronic invoices preferred via email to APinvoices@bnl.gov.

This PO details the specific item being procured, the quantity, and the associated technical and quality requirements. It also provides crucial information on delivery procedures, invoicing, and points of contact for technical and contractual matters. Bidders can use this to understand the scope of work and the terms of the purchase.

Statement of Work (SOW) / Performance Work Statement (PWS)

This Statement of Work outlines the requirements for the fabrication, assembly, and testing of 20 units of the LT-EL-BL-PD-PDU-0101 M-Drive Power System Rev A.

• The contractor is responsible for providing all personnel, labor, equipment, and supplies.

• Tasks include machining and silk screen printing of surfaces, functional testing, quality verification, and procurement of all necessary materials and equipment.

• Brookhaven National Laboratory (BNL) NSLS-II will supply the documentation for the assembly of the 20 units.

• Not explicitly stated in the document.

• The work must be performed in accordance with the specifications provided in the attached zip file.

• The project includes one primary task: "Assemble and submit completed unit assembly."