470945 - Enclosure B - Annual Reps and Certs (AMS-Form-050).pdf
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- Solicitation number
- 470945
- Issued by
-
Department of Energy Office of Science
About this file
This document is an Annual Representations and Certifications form (AMS-Form-050) from Brookhaven National Laboratory (BNL/BSA), designed to gather registration data and representations from potential offerors seeking to provide goods or services in support of a U.S. Government contract. The form requires all offerors, regardless of business size, to complete Sections A.1 and C, with small business offerors also required to complete Section A.2.
The form collects comprehensive business information including business name, address, contact details, NAICS codes, and various representations such as business type (e.g., small business, women-owned, veteran-owned), federal contract history, and compliance certifications. Key sections include business information, small business representations, additional certifications regarding government contracts, executive compensation reporting, and responsibility matters. The document emphasizes the need for accurate information and warns of potential penalties for false or misleading representations, with a final section requiring an authorized signature to attest to the accuracy of the provided information.
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Text version
ANNUAL REPRESENTATIONS ERTIFICATIONS
Offeror: Offerors Offeror
All Offerors Section A.1. Section C all Small Business Offerors Section A.
Section A.1.:
A.1. Part I:
A.1. Part II:
Offeror
Offeror’s
AMS-Form-050 Rev. 1.0 - 09/2023
Offeror Yes No
Yes Offeror Offeror’s
Offeror
Section A. .: Applicable Only to Small Business Offerors
Offeror Offeror
Offeror
Offeror Offeror’s Section C, “Authorized Signature of Offeror ” Offeror Offeror Offeror
A. .1. Reference:
Offeror Offeror Offeror
Offeror
AND
Offeror Offeror
Offeror
Representations
NAICS Code : Small Business Concern ( Yes):
Offeror
Offeror
Offeror
Offeror
Offeror
Offeror
Offeror
Offeror
Offeror
Offeror and
Offeror
Offeror
Definitions and and and
Notice and
A. .2. Reference:
Offeror Offeror’s
Section B: Additional Representations and Certifications Required for Work Under U.S. Government Prime Contracts
B.1. FAR 52.203-11 (SEP 2007)
Offeror’s designated representative hereby certifies that he or she has read and understands (a) – (e), below.
Offeror
Offeror Offeror
Offeror Offeror
B.2 FAR 52.204-10 ( )
B. Offeror’s
Offeror Offeror
Offeror’s
Offeror’s Offeror
Yes No Yes
Offeror Offeror
Offeror
Yes No
Offeror’s Offeror
Yes No
Yes
No Offeror
Yes No
Yes Offeror
No
Offeror Offeror’s Offeror’s Offeror
Offeror Offeror’s
Executive Name: Executive Total Compensation:
Offeror Offeror
B. . FAR 52.209-5 ( )
Offeror:
Offeror
Offeror
This Certification Concerns a Matter Within the Jurisdiction of an Agency of the United States and the Making of a False, Fictitious, or Fraudulent Certification May Render the Maker Subject to Prosecution Pursuant to 18 U.S.C. 1001.
Offeror Offeror
Offeror’s Offeror Offeror
Offeror
Offeror
B. . FAR 52.209-7 ( ) —
Offeror
Definitions
Offeror Offeror
Offeror Offeror
Offeror Offeror
Offeror
B. . FAR 52.222-22 (FEB 1999)
Offeror
B. . FAR 52.222-25 (APR 1984)
Offeror
OR
B. . Government Property Certification
Offeror
Section C: Authorized Signature of Offeror
Certification of Offeror or Offeror’s Authorized Representative:
Offeror Offeror Offeror’s
Offeror
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