25-14 Exhibit E - Reps _ Certs.pdf

REPRESENTATIONS AND CERTIFICATIONS

Exhibit “E”, DACA655240001500 (under $100K)

1. OWNERSHIP.

The Lessor certifies that he is the rightful and legal owner of the property and has the legal right to enter into this lease. If the title of the Lessor shall fail, or it be discovered that the Lessor did not have authority to lease the property, the Government may terminate.

The Lessor, the Lessor’s heirs, executors, adminis-trators, successors, or assigns agree to indemnify the Lessee by reason of such failure and to refund all rentals paid.

2. TAXPAYER IDENTIFICATION (OCT 1998) - 52.204-

a. Definitions.

“Common parent,” as used in this provision, means that corporate entity that owns or controls an affiliated group of corporations that files its Federal income tax returns on a consolidated basis, and of which the Offeror is a member.

“Taxpayer Identification Number (TIN),” as used in this provision, means the number required by the Internal Revenue Service (IRS) to be used by the Offeror in reporting income tax and other returns. The TIN may be either a Social Security Number or an Employer Identification Number.

b. All Offerors must submit the information required in paragraphs (d) through (f) of this provision to comply with debt collection requirements of 31 U.S.C. 7701(c) and 3325(d), reporting requirements of 26 U.S.C. 6041, 6041A, and 6050M, and implementing regulations issued by the IRS. If the resulting contract is subject to the payment reporting requirements described in Federal Acquisition Regulation (FAR) 4.904, the failure or refusal by the Offeror to furnish the information may result in a 31 percent reduction of payments otherwise due under the contract.

c. The TIN may be used by the Government to collect and report on any delinquent amounts arising out of the Offeror’s relationship with the Government (31 U.S.C. 7701(c)(3)). If the resulting contract is subject to the payment reporting requirements described in FAR 4.904, the TIN provided hereunder may be matched with IRS records to verify the accuracy of the Offeror’s TIN.

d. Taxpayer Identification Number (TIN).

[X] TIN:

[ ] TIN has been applied for.

[ ] TIN is not required because:

[ ] Offeror is a nonresident alien, foreign corporation, or foreign partnership that does not have income effectively connected with the conduct of a trade or business in the United States and does not have an office or place of business or a fiscal paying agent in the United States;

[ ] Offeror is an agency or instrumentality of a foreign government;

[ ] Offeror is an agency or instrumentality of the Federal government;

e. Type of organization.

[ ] Sole proprietorship;

[ ] Government entity (Federal, State, or Local);

[ X ] Partnership;

[ ] Foreign government;

[] Corporate entity (not tax-exempt);

[ ] International organization per 26 CFR 1.6049-4;

[ ] Corporate entity (tax-exempt);

[ ] Other ____________

f. Common Parent.

[X] Offeror is not owned or controlled by a common parent as defined in paragraph (a) of this provision.

[ ] Name and TIN of common parent:

Name _____________________

TIN _____________________

3. SMALL BUSINESS REPRESENTATION (JAN 2007)

- 52.219-1

a. (1) The North American Industry Classification System (NAICS) code for this acquisition is 531190.

(2) The small business size standard is $19.0 Million in annual average gross revenue of the concern for the last 3 fiscal years.

(3) The small business size standard for a concern which submits an offer in its own name, other than on a construction or service contract, but which proposes to furnish a product which it did not itself manufacture, is 500 employees.

b. Representations.

(1) The Offeror represents as part of its offer that it [ ] is, [X ] is not a small business concern.

(2) [Complete only if the Offeror represented itself as a small business concern in paragraph (b)(1) of this provision.] The Offeror represents, for general statistical purposes, that it [ ] is, [ X ] is not, a small disadvantaged business concern as defined in 13 CFR 124.1002.

(3) [Complete only if the Offeror represented itself as a small business concern in paragraph (b)(1) of this provision.] The Offeror represents as part of its offer that it [ ] is, [ ] is not a women-owned small business concern.

(4) [Complete only if the Offeror represented itself as a small business concern in paragraph (b)(1) of this provision.] The Offeror represents as part of its offer that it [ ] is, [ ] is not a veteran-owned small business concern.

(5) [Complete only if the Offeror represented itself as a veteran-owned small business concern in paragraph (b)(4) of this provision.] The Offeror represents as part of its offer that it [ ] is, [ ] is not a service-disabled veteran-owned small business concern.

(6) [Complete only if the Offeror represented itself as a small business concern in paragraph (b)(1) of this provision.] The Offeror represents, as part of its offer, that—

(i) It [ ] is, [ ] is not a HUBZone small business concern listed, on the date of this representation, on the List of Qualified HUBZone Small Business Concerns maintained by the Small Business Administration, and no material change in ownership and control, principal office, or HUBZone employee percentage has occurred since it was certified by the Small Business Administration in accordance with 13 CFR part 126; and

(ii) It [ ] is, [ X ] is not a joint venture that complies with the requirements of 13 CFR part 126, and the representation in paragraph (b)(6)(i) of this provision is accurate for the HUBZone small business concern or concerns that are participating in the joint venture. [The Offeror shall enter the name or names of the HUBZone small business concern or concerns that are participating in the joint venture:_______________.] Each HUBZone small business concern participating in the joint venture shall submit a separate signed copy of the HUBZone representation.

4. PREVIOUS CONTRACTS AND COMPLIANCE

REPORTS (FEB 1999) - 52.222-22

(Applicable to leases over $10,000.)

The Offeror represents that—

a. It [ ] has, [X ] has not participated in a previous contract or subcontract subject to the Equal Opportunity clause of this solicitation;

(IF “HAS NOT” MARKED, THEN B. IS NOT

APPLICABLE)

b. It [ ] has, [ ] has not filed all required compliance reports; and

c. Representations indicating submission of required compliance reports, signed by proposed subcontractors, will be obtained before subcontract awards. (Approved by OMB under Control Number 1215-0072.)

5. AFFIRMATIVE ACTION COMPLIANCE (APR

1984) - 52.222-25

(Applicable to leases over $10,000 and which include the clause at FAR 52.222-26, Equal Opportunity.)

The Offeror represents that—

a. It [ ] has developed and has on file, [ ] has not developed and does not have on file, at each establishment affirmative action programs required by the rules and regulations of the Secretary of Labor (41 CFR 60-1 and 60-2), or

b. It [ X ] has not previously had contracts subject to the written affirmative action programs requirement of the rules and regulations of the Secretary of Labor.

(Approved by OMB under Control Number 1215-0072.)

6. SYSTEM FOR AWARD MANAGEMENT (SAM)

REGISTRATION (MAY 2012)

The System for Award Management (SAM) Registration is a centrally located, searchable database which assists in the development, maintenance, and provision of sources for future procurements. The offeror must be registered in the SAM prior to lease award. The offeror shall register via the internet at https://www.sam.gov. To remain active, the offeror/lessor is required to update or renew its registration annually.

{] Registration Active and Copy Attached

[X ] Will Activate Registration and Submit Copy to the Government Prior to Award

7. DATA UNIVERSAL NUMBERING SYSTEM (DUNS)

Number (OCT 2003) – 52.204-6

(a) The offeror shall enter, on the upper right-hand corner of the lease, the DUNS number or DUNS+4 that identifies the offeror’s name and address exactly as stated in the body of the lease. The DUNS number is a nine-digit number assigned by Dun and Bradstreet, Inc.

The DUNS+4 is the DUNS number plus a 4-character suffix that may be assigned at the discretion of the offeror to establish additional CCR records for identifying alternative Electronic Funds Transfer (EFT) accounts (see Subpart 32.11) for the same parent concern.

(b) If the offeror does not have a DUNS number, it should contact Duns and Bradstreet directly to obtain one.

(1) An offeror may obtain a DUNS number-https://www.sam.gov/

(i) If located within the United States, by calling Dun and Bradstreet at 1-866-705-5711 or via the internet at http://www.dnb.com; or

(ii) If located outside the United States, by contacting the local Dun and Bradstreet office.

(2) The offeror should be prepared to provide the following information:

(i) Company legal business name.

(ii) Tradestyle, doing business, or other name by which your entity is commonly recognized.

(iii) Company physical street address, city, state and zip code.

(iv) Company mailing address, city, state and zip code (if separate from physical).

(v) Company telephone number.

(vi) Date the company was started.

(vii) Number of employees at your location.

(viii) Chief executive officer/key manager.

(ix) Line of business (industry).

(x) Company headquarters name and address (reporting relationship within your entity).

http://www.dnb.com/