RFLP 376811 Exhibits 002-012 Rev 1.pdf

REQUEST FOR LEASE PROPOSAL NO: 376811, REV. 01

Exhibits The list of Exhibits as outlined in the table below are required as a part of your response to the identified Request for Lease Proposal. Failure to provide and disclose any information requested below may be grounds for disqualification if identified prior to award or termination, if identified after award.

Note: Additional attachments may be outlined within the Request for Lease Proposal.

It is recommended that you refer back to the Request for Lease Proposal document to ensure all attachments have been identified and included in your proposal response.

Exhibit No. Title GO TO

001 Lease Proposal Form Exhibit 001

002 Proposed Lower-Tier Subcontractors Exhibit 002

003 Past Performance Exhibit 003

004 Conflict of Interest Disclosure and Representation Exhibit 004

005 Representation and Certification Exhibit 005

006 Agreement, Exceptions, and Assumptions Exhibit 006

007 Cost Accounting Standards Notices and Certifications REMOVED Exhibit 007

008 Organizational Conflict of Interest Disclosure Exhibit 008

009 Executive Compensation Exhibit 009

FAR 52.203-11 Certification and Disclosure Regarding Payments to Influence

Certain Federal Transactions (Sept 2007) Exhibit 010

011 Certification Regarding Debarment and Suspension Exhibit 011

Prohibited Telecommunications Equipment Lease Addendum & Lessor’s

Representation Exhibit 012

NOTE: IF EXHIBITS ARE DETERMINED NOT APPLICABLE (N/A) PLEASE MARK N/A, PROVIDE

REASON(S), SIGN, AND DATE ACCORDINGLY.

Exhibit 001 – Lease Proposal Form

Please find Exhibit 001– Lease Proposal Worksheet included with this Solicitation as an Adobe PDF file.

Partial picture of the Lease Proposal Worksheet

Exhibit 002 – Proposed Lower-Tier Subcontractors

Please type or print the names and contact information for all of the lower-tier Subcontractors. Use additional sheets if necessary.

LOWER-TIER SUBCONTRACTOR/SUPPLIER

CONTACT NAME:

TELEPHONE NO.:

DESCRIPTION OF SERVICES

TO BE PROVIDED:

**APPROXIMATE

AWARD AMOUNT:

NAME AND ADDRESS OF OFFEROR: NAME OF SIGNER (Print):

TITLE OF SIGNER (Print):

OFFEROR: (Signature of person authorized to sign)

DATE:

** APPROXIMATELY _____% OF TOTAL SUBCONTRACTED AMOUNT TO BE PERFORMED BY LOWER-TIER SUBCONTRACTOR. PERCENTAGE OF LOWER-TIER SUBCONTRACTED WORK SHALL NOT EXCEED 50% FOR SMALL BUSINESS OR 70% FOR A LARGE BUSINESS (FOR SERVICES) OR 85% (FOR CONSTRUCTION) OF TOTAL SUBCONTRACT AMOUNT. SUBCONTRACTOR’S ARE REQUIRED TO NOTIFY PROCUREMENT SPECIALIST WHENEVER _____ % OF LOWER-TIER WORK IS ANTICIPATED OR REACHES 70% (FOR SERVICES) OR 85% (FOR

CONSTRUCTION).

Exhibit 003 – Past Performance Please type or print at least two (2) and as many as five (5) references to recently completed or substantially complete contracts with requirements similar to those described within this solicitation.

CLIENT NAME

CONTACT NAME

TELEPHONE NO.

CONTRACT NO.

CONTRACT DATE

START DATE/

END DATE

CONTRACT

VALUE

CONTRACT

TERMINATED?

(Y/N) Explain in attachment

NAME AND ADDRESS OF SUBCONTRACTOR NAME OF SIGNER (Print):

SUBCONTRACTOR (Signature of person authorized to sign)

DATE

Exhibit 004 – Conflict of Interest Disclosure and Representation It is Hanford Mission Integration Solutions, LLC (HMIS) policy to avoid situations which place a Subcontractor or Subcontractor’s employees in a position in which it may not be able to participate or perform on an equal basis for Buyer-controlled work with other qualified contractors due to impermissible Conflicts of Interest. See, FAR 3.1101. To address this matter, the Subcontractor is to consider the relevant circumstances surrounding this effort to determine if there are any past, present or future interests (financial, contractual, organizational or personal) that could be viewed as a conflict of interest. In addition, the Subcontractor is to consider potential conflicts of interest of all personnel working in a staff augmentation or direct services role for familial relationships at Hanford in answering the following.

A conflict of interest occurs when one's personal or financial interest could interfere with the ability to make object business decisions of behalf of the Company. Employees must avoid, at all times, situations that give rise to such bias or even the appearance of such bias.

It is required that conflicts are identified, declared, and if required, mitigated.

DEFINITIONS:

• Company - Includes your responsible company and company affiliates.

• Conflict of Interest(s) - When one's personal or financial interest may interfere with the ability to make business decisions on behalf of the company.

• Perceived Conflict of Interest - Situation that could give rise to the perception that a conflict exists and may interfere with the ability to make business decisions on behalf of the Company.

• Members of Household/Family Members - Employee’s spouse, child parent, brother, sister, mother-in-law, father-in-law, sister-in-law, brother-in-law, son-in-law, daughter-in-law, roommates, significant others, cousins, aunts, uncles, dating partners, or any other person where the relationship could lend itself to an actual or perceived Conflict of Interest.

Government agencies affiliated with Hanford, for purposes of this COI Disclosure includes -

• Department of Energy

• U.S. Environmental Protection agency

• U.S. Department of Interior

• Defense Nuclear Facilities Safety Board

• Washington State Department of Ecology

• Washington State Department of Health

• Richland Fire Department

• Benton County Sheriff Office

Subcontractor hereby certifies that ☐ there is not or ☐there is a potential conflict of interest by the company or company personnel, to include individuals that will be working under any possible subcontract. If the answer is affirmative, the details associated with the real or potential concerns are disclosed and highlighted in the Subcontractor’s proposal. Any such disclosure may result in the need for additional discussions relative to the Subcontractor’s continued participation in this effort. Failure to disclose any real or potential concerns may be grounds for disqualification if identified prior to award or termination if identified after award.

https://www.acquisition.gov/far/3.1101

Exhibit 005 – Representation and Certification

Offeror hereby certifies their socioeconomic size status as ☐ SMALL or ☐LARGE based on the North American Industry Classification System (NAICS) _____________ (input NAICS identified in the subject Request for Lease Proposal). Offeror also identifies as: (list additional socioeconomic status applicable, i.e., Woman Owned, HubZone, Veteran owned, etc.) ________________________________.

Offeror certifies that the disclosure of size status as listed above corresponds to the size status as identified in the System for Award Management (SAM.gov) in reference to identified NAICS for the subject Request for Lease Proposal. Any such disclosure may result in the need for additional discussions relative to the Offeror’s continued participation in this effort.

Failure to disclose any real or potential concerns may be grounds for disqualification if identified prior to award or termination if identified after award.

NAME AND ADDRESS OF OFFEROR: NAME OF SIGNER (Print):

TITLE OF SIGNER (Print):

OFFEROR: (Signature of person authorized to sign)

DATE:

Please complete section below if your company is a Joint Venture.

Offeror certifies that they ☐ Do or ☐ Do Not have an active Joint Venture agreement. If Offeror does have an active joint venture, please identify the following: Joint Venture Name: ___________________________________________

Please list companies that make up the Joint Venture and the socioeconomic status of each:

Company: ________________________________________ hereby certifies their socioeconomic size status as ☐ SMALL or ☐LARGE based on the North American Industry Classification System (NAICS) _____________ (input NAICS identified in the subject Request for Lease Proposal).

Offeror also identifies as: ☐Woman Owned, ☐HUBZone, ☐ Service-Disabled Veteran Owned, ☐Veteran Owned, ☐ Small Disadvantage Business, ☐Other (list all that apply) ________________________________.

Company: ________________________________________ hereby certifies their socioeconomic size status as ☐ SMALL or ☐LARGE based on the North American Industry Classification System (NAICS) _____________ (input NAICS identified in the subject Request for Lease Proposal).

Offeror also identifies as: ☐Woman Owned, ☐HUBZone, ☐ Service-Disabled Veteran Owned, ☐Veteran Owned, ☐ Small Disadvantage Business, ☐Other (list all that apply) ________________________________.

If you are submitting as a Joint Venture, please provide the date of 1st award and the number of contracts awarded under the agreement to date. ________________________

**Offeror must provide a copy of the SBA Joint Venture Agreement as a part of the proposal package**

Please complete section below if your company has an active SBA Mentor Protégé agreement.

Offeror certifies that they ☐ Do or ☐ Do Not have an active SBA Mentor Protégé agreement. If Offeror does have an active SBA Mentor/Protégé agreement, please identify the following:

Mentor or Protégé Name: __________________________

Date the Mentor/Protégé was approved under the Small Business Administration: ______________________

**Offeror must provide a copy of the SBA Mentor/Protégé Agreement and SBA Program Mentor/Protégé Letter as a part of the proposal package**

Exhibit 006 – Agreement, Exceptions, and Assumptions

Any agreement, exceptions, and/or assumptions to the proposed subcontract terms and conditions, Request for Lease Proposal and/or Performance Work Statement must be indicated below. Hanford Mission Integration Solutions, LLC (HMIS or Buyer), however, reserves the right to disqualify offers which deviate from the Solicitation. If the Offeror has no exceptions or assumptions, please write “None” below.

Exhibit 007 – Cost Accounting Standards Notices and Certifications (*FAR 52.230-1)

REMOVED

This exhibit has been intentionally removed.

Exhibit 008 – Organizational Conflict of Interest Disclosure Statement It is Hanford Mission Integration Solutions, LLC (HMIS or Buyer) policy to avoid situations, which place an Offeror in a position wherein it may not be able to compete on an equal basis for Buyer’s-controlled work with other qualified Offerors.

This representation, and the information disclosed thereby, will serve to advise Buyer whether or not an Offeror's judgment may be biased because of any past, present, or currently planned interest, financial or otherwise, the Offeror may have or appear to have which relates to the work to be performed under a subcontract which may result from this solicitation, thus providing the Offeror an unfair competitive advantage over others. The term "Offeror" herein means the proposing entity or any of its affiliates or proposed consultants or Subcontractors of any tier. Therefore:

Offeror shall provide Buyer a statement which describes in a concise manner, all relevant facts concerning any past, present, or currently planned interest (financial, contractual, organizational, or otherwise) relating to the work described in the Performance Work Statement of this solicitation. Offeror may also provide relevant facts that show how its organizational structure and/or management systems limit its knowledge of affiliates or other divisions or sections of the proposing entity and how that structure or system would avoid or mitigate an organizational conflict of interest.

Offeror shall assure that any consultants and/or Subcontractors identified in its proposal which will perform part or all of any resulting subcontract submit the same information as required above, either as part of the Offeror’s proposal or directly to Buyer, prior to the time and date set forth for the receipt of proposals, including identification of the solicitation number and the (Offeror's) proposal to which it relates.

Offeror shall assure that each of its chief officers or directors, if any, who will be directly involved in the actual performance of the subcontract, submit such information.

Offeror shall promptly provide to Buyer information concerning any changes, including additions, in its relevant facts reported, that occur between the time of submission of its proposal and the award of a subcontract or the time the Offeror is notified that it is no longer being considered for an award.

Buyer will review the information submitted and may require additional relevant information or certifications from the Offeror.

All such information, and any other relevant information known to Buyer , will be used to determine whether an award to the Offeror may create an organizational conflict of interest with respect to the Offeror's (1) bias caused by financial, contractual, organizational, or other interests which relate to the work to be performed under the subcontract, resulting in Offeror being unable to render impartial, technically sound, and objective assistance or advice, or (2)obtaining an unfair competitive advantage over other parties. If Buyer determines a conflict exists which would require some action to mitigate an actual or potential conflict of interest that would otherwise represent an unacceptable risk to Buyer, it may, at its sole discretion: (1) impose appropriate terms or conditions necessary to avoid or mitigate the conflict, (2) disqualify the offer, or (3) proceed with an award despite the conflict.

Offeror refusal to submit the representation and/or to provide the disclosure or any additional information requested by Buyer may result in disqualification of the Offeror for an award. Misrepresentation of material facts or other reported information may also result in disqualification. If any such misrepresentation is discovered following award, Buyer may terminate the contract for default or seek other remedies including actions pursuant to 18 U.S.C. 1001.

Depending on the nature of the subcontract activities, Offeror may, because of the existence of possible organizational conflicts of interest, propose to exclude specific kinds of work from the Performance Work Statement contained in the original solicitation, unless the solicitation specifically prohibits such exclusion. Any proposed exclusion may be considered by Buyer in the evaluation of proposals but may ultimately determine the proposal to be unacceptable.

No work shall be performed, and Buyer will not authorize work to begin, until representations and disclosure information has been evaluated. Buyer may also, at its option, permit missing representations or disclosure information to be provided by an Offeror at any time during the pre-award process.

In lieu of or in addition to the above and/or when requested by Buyer, Offeror shall provide a certification similar to the following, altered only to reflect the relevant facts:

ORGANIZATIONAL CONFLICT OF INTEREST DISCLOSURE STATEMENT

I hereby certify that, to the best of my knowledge and belief, no facts exist relevant to any past, present, or currently planned interest or activity (financial, contractual, personal, organizational, or otherwise) that relate to the proposed work; and bear on whether the Buyer and the Offeror have a possible conflict of interest with respect to being able to render impartial, technically sound, and objective assistance or advice, or being given unfair competitive advantage.

Exhibit 009 – Executive Compensation HMIS First-Tier Subcontractor Transparency Act Reporting Form

Name of Subcontractor (Offeror):

Subcontractor’s Physical Address:

Street

City, State & Nine-Digit Zip Code Country Congressional District

Subcontractor’s Fiscal Year

Street City, State & Nine-Digit Zip Code Country Congressional District

Performing Entity

Parent Company

a) During the previous tax year was the Subcontractor’s gross income from all sources under $300,000?

b) During preceding fiscal year was 80% or more of Subcontractor’s annual gross revenues from Federal contracts (and subcontracts), loans, grants (and subgrants) and cooperative agreements?

c) During preceding fiscal year did Subcontractor have $25,000,000 or more in annual gross revenues from Federal contracts (and subcontracts), loans, grants (and subgrants) and cooperative agreements?

d) Does the public have access to information about the compensation of Subcontractor’s executives through periodic reports filed under section 13(a) or 15(d) of the Securities Exchange Act of 1934 (15 USC 78m(a), 780(d)) or section 6104 of the Internal Revenue Code of 1986

e) Subcontractor’s Top Five Most Highly Compensated Officers

Yes – skip to signature block No – answer 4(b)Yes – answer 4(c) No – skip to signature block

Yes – answer 4(d) No – skip to signature block

Yes – skip to signature block No – complete 4(e)

Officer Name Total Compensation for Preceding Fiscal Year

Print Name & Title of Representative Completing Form

Signature of Authorized Representative Date

4. Subcontractor’s Top Five Most Highly Compensated Officers Reporting

1. Subcontractor Information

2. Place of Performance

3. Subcontractor’s Unique Entity Identifier (UEI) Number

HMIS First-Tier Subcontractor Transparency Act Reporting Form Guidance FAR 52.204-10 Reporting Executive Compensation and First-Tier Subcontract Awards (Oct 2016)

Subcontractor's Compensation Reporting Guidelines

Upon award of any Subcontractor award of $30,000 or more, and annually thereafter, HMIS as the prime contractor must report the total compensation and names of the Subcontractor’s top five most highly compensated executives if:

(a) In the Subcontractor’s preceding fiscal year, the Subcontractor received:

(i) 80% or more of its annual gross revenues from Federal contracts (and subcontracts), loans, grants

(and subgrants) and cooperative agreements, and other forms of Federal financial assistance; and

(ii) $25,000,000 or more in annual gross revenues from Federal contracts (and subcontracts), loans, grants (and subgrants) and cooperative agreements, and other forms of Federal financial assistance; and

(b) The public does not have access to information about the compensation of the executives through period reports filed under section 13(a) or 15(d) of the Securities Exchange Act of 1934 (15 USC 78m(a), 78o(d)) or section 6104 of the Internal Revenue Code of 1986.

If a Subcontractor in the previous tax year had gross income from all sources under $300,000, the prime contractor does not need to report awards for that subcontractor.

This information will be reported through the Federal Funding Accountability and Transparency Act Subaward Reporting System. The public may view first-tier subcontract award data at http://usaspending.gov.

Definitions

As used in FAR 52.204-10:

Executive means officers, managing partners, or any other employees in management positions.

First-tier subcontract means a subcontract awarded directly by the Contractor for the purpose of acquiring supplies or services (including construction) for performance of a prime contract. It does not include the Contractor's supplier agreements with vendors, such as long-term arrangements for materials or supplies that would benefit multiple contracts and/or the costs of which are normally applied to a Contractor’s general and administrative expenses or indirect cost.

Total compensation means the cash and noncash dollar value earned by the executive during the Contractor's preceding fiscal year and includes the following (for more information see 17 CFR 229.402(c)(2)):

(1) Salary and bonus.

(2) Awards of stock, stock options, and stock appreciation rights. Use the dollar amount recognized for financial statement reporting purposes with respect to the fiscal year in accordance with the Financial Accounting Standards Board's Accounting Standards Codification (FASB ASC) 718, Compensation- Stock Compensation.

(3) Earnings for services under non-equity incentive plans. This does not include group life, health, hospitalization or medical reimbursement plans that do not discriminate in favor of executives and are available generally to all salaried employees.

(4) Change in pension value. This is the change in present value of defined benefit and actuarial pension plans.

(5) Above-market earnings on deferred compensation which is not tax-qualified.

(6) Other compensation, if the aggregate value of all such other compensation (e.g., severance, termination payments, value of life insurance paid on behalf of the employee, perquisites, or property) for the executive exceeds $10,000.

Further information about the Transparency Act is available at: www.USAspending.gov & www.whitehouse.gov/omb/open http://usaspending.gov/ https://www.usaspending.gov/ http://www.whitehouse.gov/omb/open

Exhibit 010 – FAR 52.203-11 Certification and Disclosure Regarding Payments to Influence Certain Federal Transactions (Sept 2007) In accordance with FAR 52.203-12, Limitations on Payments to Influence Certain Federal Transactions (Oct 2010) contained in the General Provisions attached to this solicitation, Offerors who are submitting a proposal for a subcontract expected to exceed $150,000.00 are required to submit a declaration, including certification and disclosure in paragraphs (c) and (d) of the provision at FAR 52.203-11 as shown below.

(a) Definitions. As used in this provision-"Lobbying contact" has the meaning provided at 2 U.S.C. 1602(8).

The terms "agency," "influencing or attempting to influence," "officer or employee of an agency," "person," "reasonable compensation," and "regularly employed" are defined in the FAR clause of this solicitation entitled "Limitation on Payments to Influence Certain Federal Transactions"(52.203-12).

(b) Prohibition. The prohibition and exceptions contained in the FAR clause of this solicitation entitled "Limitation on Payments to Influence Certain Federal Transactions" (52.203-12) are hereby incorporated by reference in this provision.

(c) Certification. The offeror, by signing its offer, hereby certifies to the best of its knowledge and belief that no Federal appropriated funds have been paid or will be paid to any person for influencing or attempting to influence an officer or employee of any agency, a Member of Congress, an officer or employee of Congress, or an employee of a Member of Congress on its behalf in connection with the awarding of this contract.

(d) Disclosure. If any registrants under the Lobbying Disclosure Act of 1995 have made a lobbying contact on behalf of the offeror with respect to this contract, the offeror shall complete and submit, with its offer, OMB Standard Form LLL, Disclosure of Lobbying Activities, to provide the name of the registrants. The offeror need not report regularly employed officers or employees of the offeror to whom payments of reasonable compensation were made.

(e) Penalty. Submission of this certification and disclosure is a prerequisite for making or entering into this contract imposed by 31 U.S.C. 1352. Any person who makes an expenditure prohibited under this provision or who fails to file or amend the disclosure required to be filed or amended by this provision, shall be subject to a civil penalty of not less than $10,000, and not more than $100,000, for each such failure.

SIGNATURE/CERTIFICATION:

By signing below, the bidder/offeror certifies, under penalty of law, that the above certification is accurate, current, and complete. By signing the below, the Offeror further agrees to include the language of this certification in all subcontract awards at any tier and require that all recipients of subcontract awards in excess of $150,000 shall certify and disclose accordingly as required in FAR 52.203-12.

COMPANY NAME:

NAME OF AUTHORIZED REPRESENTATIVE

(Type/Print):

AUTHORIZED REPRESENTATIVE TITLE

(Type/Print):

AUTHORIZED REPRESENTATIVE

SIGNATURE:

Exhibit 011 –Certification Regarding Debarment and Suspension In accordance with FAR 52.209-6, Protecting the Government’s Interest When Subcontracting With Contractor Debarred, Suspended, or Proposed for Debarment (Oct 2015) (c) contained in the General Provisions attached to this solicitation, Offerors who are submitting a proposal for a subcontract expected to exceed $35,000.00 for other than commercially available off the shelf items are required to submit to HMIS, in writing, whether as of the time of award of the subcontract, the subcontractor, or its principals, is or is not debarred, suspended, or proposed for debarment by the Federal Government.

The Offeror certifies that the Offeror and/or any of its Principals—

☐ Are presently debarred, suspended, proposed for debarment by the Federal Government.

☐ Are not presently debarred, suspended, proposed for debarment by the Federal Government.

SIGNATURE/CERTIFICATION:

By signing below, the bidder/offeror certifies, under penalty of law, that the above certification is accurate, current, and complete.

(Type/Print):

Exhibit 012 – Representation Regarding Certain Telecommunications and Video Surveillance Services or Equipment (August 2020) NOTE: The "Offeror," as used on this form, is the owner of the property offered, not an individual or agent representing the owner.

52.204-24 Representation Regarding Certain Telecommunications and Video Surveillance Services or Equipment (Aug 2020)

The Offeror shall not complete the representation at paragraph (d)(1) of this provision if the Offeror has represented that it “does not provide covered telecommunications equipment or services as a part of its offered products or services to the Government in the performance of any contract, subcontract, or other contractual instrument” in the provision at 52.204-26, Covered Telecommunications Equipment or Services—Representation, or in paragraph (v) of the provision at 52.212-3, Offeror Representations and Certifications-Commercial Items.

(a) Definitions. As used in this provision—

Backhaul, covered telecommunications equipment or services, critical technology, interconnection arrangements, reasonable inquiry, roaming, and substantial or essential component have the meanings provided in the clause 52.204-25, Prohibition on Contracting for Certain Telecommunications and Video Surveillance Services or Equipment.

(b) Prohibition.

(1) Section 889(a)(1)(A) of the John S. McCain National Defense Authorization Act for Fiscal Year 2019 (Pub. L. 115-232) prohibits the head of an executive agency on or after August 13, 2019, from procuring or obtaining, or extending or renewing a contract to procure or obtain, any equipment, system, or service that uses covered telecommunications equipment or services as a substantial or essential component of any system, or as critical technology as part of any system. Nothing in the prohibition shall be construed to—

(i) Prohibit the head of an executive agency from procuring with an entity to provide a service that connects to the facilities of a third-party, such as backhaul, roaming, or interconnection arrangements; or

(ii) Cover telecommunications equipment that cannot route or redirect user data traffic or cannot permit visibility into any user data or packets that such equipment transmits or otherwise handles.

(2) Section 889(a)(1)(B) of the John S. McCain National Defense Authorization Act for Fiscal Year 2019 (Pub. L. 115-232) prohibits the head of an executive agency on or after August 13, 2020, from entering into a contract or extending or renewing a contract with an entity that uses any equipment, system, or service that uses covered telecommunications equipment or services as a substantial or essential component of any system, or as critical technology as part of any system. This prohibition applies to the use of covered telecommunications equipment or services, regardless of whether that use is in performance of work under a Federal contract. Nothing in the prohibition shall be construed to—

(i) Prohibit the head of an executive agency from procuring with an entity to provide a service that connects to the facilities of a third-party, such as backhaul, roaming, or interconnection arrangements; or

(ii) Cover telecommunications equipment that cannot route or redirect user data traffic or cannot permit visibility into any user data or packets that such equipment transmits or otherwise handles.

(c) Procedures. The Offeror shall review the list of excluded parties in the System for Award Management (SAM) (https://www.sam.gov) for entities excluded from receiving federal awards for “covered telecommunications equipment or services”.

(d) Representation. The Offeror represents that—

(1) It □ will, □ will not provide covered telecommunications equipment or services to the Government in the performance of any contract, subcontract or other contractual instrument resulting from this solicitation. The Offeror shall provide the additional disclosure information required at paragraph (e)(1) of this section if the Offeror responds “will” in paragraph (d)(1) of this section; and

(2) After conducting a reasonable inquiry, for purposes of this representation, the Offeror represents that—

It □ does, □ does not use covered telecommunications equipment or services, or use any equipment, system, or service that uses covered telecommunications equipment or services. The Offeror shall provide the additional disclosure information required at paragraph (e)(2) of this section if the Offeror responds “does” in paragraph (d)(2) of this section.

(e) Disclosures. (1) Disclosure for the representation in paragraph (d)(1) of this provision. If the Offeror has responded “will” in the representation in paragraph (d)(1) of this provision, the Offeror shall provide the following information as part of the offer:

(i) For covered equipment—

(A) The entity that produced the covered telecommunications equipment (include entity name, unique entity identifier, CAGE code, and whether the entity was the original equipment manufacturer (OEM) or a distributor, if known);

(B) A description of all covered telecommunications equipment offered (include brand; model number, such as OEM number, manufacturer part number, or wholesaler number; and item description, as applicable); and

(C) Explanation of the proposed use of covered telecommunications equipment and any factors relevant to determining if such use would be permissible under the prohibition in paragraph (b)(1) of this provision.

(ii) For covered services—

(A) If the service is related to item maintenance: A description of all covered telecommunications services offered (include on the item being maintained: Brand; model number, such as OEM number, manufacturer part number, or wholesaler number; and item description, as applicable); or (

(B) If not associated with maintenance, the Product Service Code (PSC) of the service being provided; and explanation of the proposed use of covered telecommunications services and any factors relevant to determining if such use would be permissible under the prohibition in paragraph (b)(1) of this provision.

(2) Disclosure for the representation in paragraph (d)(2) of this provision. If the Offeror has responded “does” in the representation in paragraph (d)(2) of this provision, the Offeror shall provide the following information as part of the offer:

(i) For covered equipment—

(A) The entity that produced the covered telecommunications equipment (include entity name, unique entity identifier, CAGE code, and whether the entity was the OEM or a distributor, if known);

(B) A description of all covered telecommunications equipment offered (include brand; model number, such as OEM number, manufacturer part number, or wholesaler number; and item description, as applicable); and

(C) Explanation of the proposed use of covered telecommunications equipment and any factors relevant to determining if such use would be permissible under the prohibition in paragraph (b)(2) of this provision.

(ii) For covered services—

(A) If the service is related to item maintenance: A description of all covered telecommunications services offered (include on the item being maintained: Brand; model number, such as OEM number, manufacturer part number, or wholesaler number; and item description, as applicable); or

(B) If not associated with maintenance, the PSC of the service being provided; and explanation of the proposed use of covered telecommunications services and any factors relevant to determining if such use would be permissible under the prohibition in paragraph (b)(2) of this provision.

(Type/Print):