75H70521R00009.pdf

SEE ADDENDUMIS CHECKED

CODE 18a. PAYMENT WILL BE MADE BY

CODE

FACILITYCODE

17b. CHECK IF REMITTANCE IS DIFFERENT AND PUT SUCH ADDRESS IN OFFER

OFFEROR

Red Lake MN 56671-0497 24760 Hospital Drive Indian Health Service

IHSREDLAKE CODE 16. ADMINISTERED BYCODE

X

X

334118

SIZE STANDARD:

% FOR:SET ASIDE:UNRESTRICTED OR235

RFPIFB

10. THIS ACQUISITION ISCODE

RFQ

14. METHOD OF SOLICITATION

13b. RATING

NAICS:

SMALL BUSINESS

06/01/2021 1600 CT

05/20/2021

JENNIFER RICHARDSON

(No collect calls)

INFORMATION CALL:

FOR SOLICITATION 8. OFFER DUE DATE/LOCAL TIMEb. TELEPHONE NUMBERa. NAME

4. ORDER NUMBER3. AWARD/ 6. SOLICITATION

75H70521R00009

5. SOLICITATION NUMBER

SOLICITATION/CONTRACT/ORDER FOR COMMERCIAL ITEMS 1. REQUISITION NUMBER PAGE OF

1 61 IHS1424891OFFEROR TO COMPLETE BLOCKS 12, 17, 23, 24, & 30

TELEPHONE NO.

17a. CONTRACTOR/

Red Lake MN 56671-0497 P.O. Box 497 24760 Hospital Drive Indian Health Service

RED LAKE

15. DELIVER TO

Bemidji MN 56601 2225 Cooperative Ct NW, Rm 200

9. ISSUED BY

7.

2. CONTRACT NO.

EFFECTIVE DATE

18b. SUBMIT INVOICES TO ADDRESS SHOWN IN BLOCK 18a UNLESS BLOCK BELOW

ISSUE DATE

DELIVERY FOR FOB DESTINA-

TION UNLESS BLOCK IS

MARKED

11.

SEE SCHEDULE

12. DISCOUNT TERMS

THIS CONTRACT IS A

RATED ORDER UNDER

DPAS (15 CFR 700)

13a.

SERVICE-DISABLED

VETERAN-OWNED

SMALL BUSINESS

HUBZONE SMALL

BUSINESS

8(A)

Indian Health Service

WOMEN-OWNED SMALL BUSINESS

(WOSB) ELIGIBLE UNDER THE WOMEN-OWNED

SMALL BUSINESS PROGRAM

EDWOSB

24.

AMOUNT

23.

UNIT PRICE

22.

UNIT

21.

QUANTITY

20.

SCHEDULE OF SUPPLIES/SERVICES

19.

ITEM NO.

1 Catalyst 9300 48-port UPOE Network Advantage 15 EA Part C9300-48U-A

Delivery: 90 Days After Award

2 SOLN SUPP 8X5XNBD Catalyst 9300 48-port UPOE 75 EA Continued ...

(Use Reverse and/or Attach Additional Sheets as Necessary)

HEREIN, IS ACCEPTED AS TO ITEMS:

DATED

WILLIAM F. FISHER

. YOUR OFFER ON SOLICITATION (BLOCK 5),

INCLUDING ANY ADDITIONS OR CHANGES WHICH ARE SET FORTH

COPIES TO ISSUING OFFICE. CONTRACTOR AGREES TO FURNISH AND DELIVER

ARE

ARE

31c. DATE SIGNED

27b. CONTRACT/PURCHASE ORDER INCORPORATES BY REFERENCE FAR 52.212-4. FAR 52.212-5 IS ATTACHED. ADDENDA

31a. UNITED STATES OF AMERICA (SIGNATURE OF CONTRACTING OFFICER)

30c. DATE SIGNED 31b. NAME OF CONTRACTING OFFICER (Type or print)

ALL ITEMS SET FORTH OR OTHERWISE IDENTIFIED ABOVE AND ON ANY ADDITIONAL

SHEETS SUBJECT TO THE TERMS AND CONDITIONS SPECIFIED.

27a. SOLICITATION INCORPORATES BY REFERENCE FAR 52.212-1, 52.212-4. FAR 52.212-3 AND 52.212-5 ARE ATTACHED. ADDENDA

26. TOTAL AWARD AMOUNT (For Govt. Use Only)

OFFER

STANDARD FORM 1449 (REV. 2/2012)

Prescribed by GSA - FAR (48 CFR) 53.212

ARE NOT ATTACHED.

ARE NOT ATTACHED.

AUTHORIZED FOR LOCAL REPRODUCTION

PREVIOUS EDITION IS NOT USABLE

30b. NAME AND TITLE OF SIGNER (Type or print)

30a. SIGNATURE OF OFFEROR/CONTRACTOR

28. CONTRACTOR IS REQUIRED TO SIGN THIS DOCUMENT AND RETURN

25. ACCOUNTING AND APPROPRIATION DATA

29. AWARD OF CONTRACT:

REF.

32e. MAILING ADDRESS OF AUTHORIZED GOVERNMENT REPRESENTATIVE

32c. DATE 32b. SIGNATURE OF AUTHORIZED GOVERNMENT REPRESENTATIVE

ACCEPTED, AND CONFORMS TO THE CONTRACT, EXCEPT AS NOTED:

32a. QUANTITY IN COLUMN 21 HAS BEEN

RECEIVED INSPECTED

40. PAID BY39. S/R VOUCHER NUMBER38. S/R ACCOUNT NUMBER

37. CHECK NUMBER

FINALPARTIAL

36. PAYMENT

FINALPARTIAL

35. AMOUNT VERIFIED

CORRECT FOR

34. VOUCHER NUMBER33. SHIP NUMBER

COMPLETE

32g. E-MAIL OF AUTHORIZED GOVERNMENT REPRESENTATIVE

42d. TOTAL CONTAINERS42c. DATE REC'D (YY/MM/DD)

42b. RECEIVED AT (Location)

42a. RECEIVED BY (Print)

41c. DATE41b. SIGNATURE AND TITLE OF CERTIFYING OFFICER

41a. I CERTIFY THIS ACCOUNT IS CORRECT AND PROPER FOR PAYMENT

STANDARD FORM 1449 (REV. 2/2012) BACK

24.

AMOUNT

23.

UNIT PRICE

22.

UNIT

21.

QUANTITY

20.

SCHEDULE OF SUPPLIES/SERVICES

19.

ITEM NO.

Network Advantage Part CONSSSNT-C93004UA

Delivery: 90 Days After Award

3 1100W AC 80 Platinum Config 1 Secondary Power 15 EA

Supply Part PWR-C1-1100WAC-P 2

Delivery: 90 Days After Award

4 Cisco pluggable USB3 0 SSD storage Part SSD-120G 15 EA

Delivery: 90 Days After Award

5 50CM Type 1 Stacking Cable Part Stack-T1-50CM 15 EA

Delivery: 90 Days After Award

6 Catalyst Stack Power Cable 30 CM Part 15 EA

CAB-SPWR-30CM

Delivery: 90 Days After Award

Continued ...

32f. TELEPHONE NUMBER OF AUTHORIZED GOVERNMENT REPRESENTATIVE

32d. PRINTED NAME AND TITLE OF AUTHORIZED GOVERNMENT REPRESENTATIVE

61 2 of

ITEM NO. SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT

NAME OF OFFEROR OR CONTRACTOR

3 61

CONTINUATION SHEET

REFERENCE NO. OF DOCUMENT BEING CONTINUED PAGE OF

(A) (B) (C) (D) (E) (F)

75H70521R00009

7 Catalyst 9300 8 x 10GE Network Module Part 15 EA

C9300-NM-8X

Delivery: 90 Days After Award

8 C9300 DNA Premier 48-Port 5 Year Term License 15 EA

Part C9300-DNA-P-48-5Y

Delivery: 90 Days After Award

9 Catalyst DNA Premier Add-on Term Licenses Part 15 EA

CAT-DNA-P-ADD

Delivery: 90 Days After Award

10 Performance on Demand License for 4350 Series 1 EA

Part FL-4350-PERF-K9

Delivery: 90 Days After Award

11 Calayst 9500 48-port x 1 10 25G 4port 40 100G 2 EA

Advantage Part C9500-48Y4C-A

Delivery: 90 Days After Award

12 SOLN SUPP 8X5XNBD Catalyst 9500 48-port 25 100G 10 EA only Advantage Part CON-SSSNT-C9504YA4

Delivery: 90 Days After Award

13 650W AC Config 4 Power Supply front to back 2 EA cooling Part C9K-PWR-650WAC-R

Continued ...

NSN 7540-01-152-8067 OPTIONAL FORM 336 (4-86)

Sponsored by GSA

FAR (48 CFR) 53.110

4 61

CONTINUATION SHEET

REFERENCE NO. OF DOCUMENT BEING CONTINUED PAGE OF

(A) (B) (C) (D) (E) (F)

75H70521R00009

Delivery: 90 Days After Award

14 Console Cable 6ft wit USB Type A and mini-B PART 2 EA

CAB-CONSOLE-USB

Delivery: 90 Days After Award

15 C9500 DNA Premier 40X 24Q 48Y4C 32C 32QC 5 Year 2 EA

Term License Part C9500-DNA-P-5Y

Delivery: 90 Days After Award

16 100G and 40GBASE SR-BiDi QSFP Transceiver LC 8 EA

100m OM4 MMF Part QSFP-40 100-SRBD

Delivery: 90 Days After Award

17 CISCO DNA Center Appliance (Gen 2) - 44 Core 1 EA

Part DN2-HW-APL

Delivery: 90 Days After Award

18 SOLN SUPP 8x5xNBD DNA Center Appliance (Gen 2) 5 EA

Part CON-SSSNT-DN2HWPL

Delivery: 90 Days After Award

19 10GBASE-SR SFP Module Enterprise-Class Part 2 EA

SFP-10G-SR-S

Delivery: 90 Days After Award

Continued ...

NSN 7540-01-152-8067 OPTIONAL FORM 336 (4-86)

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CONTINUATION SHEET

REFERENCE NO. OF DOCUMENT BEING CONTINUED PAGE OF

(A) (B) (C) (D) (E) (F)

75H70521R00009

20 CISCO Hyperflex HX240c M5 Node Part HX240C-M5SX 4 EA

Delivery: 90 Days After Award

21 SNTC 8X5XNBD Cicso Hyperflex HX240c M5 Node Part 20 EA

CON-SNT-240CM5SX

Delivery: 03/13/2021

22 Cisco 12G Modular SAS HBA for up to 26 drives 4 EA

Part HX-SAS-M5HD

Delivery: 03/13/2021

23 1 6TB 2 5in Enterprise Performance 12G SAS SSD 4 EA

(3X endurance) Part HX-SD16T123X-EP

Delivery: 03/13/2021

24 240GB 2 5 inch Enterprise Value 6G SATA SSD Part 4 EA

HX-2SD240GM1X-EV

Delivery: 03/13/2021

25 240GB SATA M 2 Part HX-M2-240GB 4 EA

Delivery: 03/13/2021

26 32GM Micro SD Card for UCS M5 servers Part 4 EA

HX-MSD-32G

Delivery: 03/13/2021

Continued ...

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CONTINUATION SHEET

REFERENCE NO. OF DOCUMENT BEING CONTINUED PAGE OF

(A) (B) (C) (D) (E) (F)

75H70521R00009

27 Cisco UCC 1600W AC Power Supply for Rack Server 8 EA

Part HX-PSU1-1600W

Delivery: 03/13/2021

28 Ball Bearing Rail Kit for C220 M4 and C240 M4 4 EA rack servers Part HX-RAILB-M4

Delivery: 03/13/2021

29 Intel 4214R 2 4GHz 100W 12C 16 50MB DDR4 2400MHz 8 EA

Part HX-CPU-I4214R

Delivery: 03/13/2021

30 32GB DDR4-2933-MHz RDIMM 2Rx4 1 2v Part 48 EA

HX-MR-X32G2RT-H

Delivery: 03/13/2021

31 Riser 1 3PCIe slots (x8 x16 x8) slot 3 req 4 EA

CPU2 For T4 Part HX-RIS-1-240M5

Delivery: 03/13/2021

32 2 4 TB 12G SAS 10K RPM SFF HDD (4k) Part 32 EA

HX-HD24TB10K4KN

Delivery: 03/13/2021

33 Cisco UCS VIC 1457 Quad Port 10 25G SFP28 CNA 4 EA

MLOM Part HX-MLOM-C25Q-04

Delivery: 03/13/2021

Continued ...

NSN 7540-01-152-8067 OPTIONAL FORM 336 (4-86)

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CONTINUATION SHEET

REFERENCE NO. OF DOCUMENT BEING CONTINUED PAGE OF

(A) (B) (C) (D) (E) (F)

75H70521R00009

34 HyperFlex Data Platform Datacenter Advantage 4 EA

Subscription Part HXDPS001-5YR

Delivery: 03/13/2021

35 Cisco HyperFlex HX240c M5 Node Part HX250C-M5SX 4 EA

Delivery: 03/13/2021

36 SNTC 8X5XNBD Cisco HyperFlex HX240c M5 Node Part 20 EA

CON-SNT-250CM5SX

Delivery: 03/13/2021

37 Cisco 12G Modular SAS HBA for up to 26 drives 4 EA

Part HX-SAS-M5HD

Delivery: 03/13/2021

38 1 6TB 2 5in Enterprise Performance 12G SAS SSD 4 EA

(3X endurance) Part HX-SD16T123X-EP

Delivery: 03/13/2021

39 240GB 2 5 inch Enterprise Value 6G SATA SSD Part 4 EA

HX-SD240GM1X-EV

Delivery: 03/13/2021

40 240GB SATA M 2 Part HX-M2-240GB 4 EA

Delivery: 03/13/2021

Continued ...

NSN 7540-01-152-8067 OPTIONAL FORM 336 (4-86)

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CONTINUATION SHEET

REFERENCE NO. OF DOCUMENT BEING CONTINUED PAGE OF

(A) (B) (C) (D) (E) (F)

75H70521R00009

41 32GB Micro SD Card for UCS M5 servers Part 4 EA

HX-MSD-32GB

Delivery: 03/13/2021

42 Cisco UCS 1600W AC Power Supply for Rack Server 8 EA

Part HX-PSU1-1600W

Delivery: 03/13/2021

43 Ball Bearing Rail Kit for C220 M4 and C240 M4 4 EA rack servers Part HX-RAILB-M4

Delivery: 03/13/2021

44 Intel 4214R 2 5GHz 100W 12C 16 50MB DDR4 2400MHz 8 EA

Part HX-CPU-I4214R

Delivery: 03/13/2021

45 32GB DDR4-2933-MHz RDIMM 2Rx4 1 2v Part 48 EA

HX-MR-X32G2RT-H

Delivery: 03/13/2021

46 Riser 1 3PCIe slots (x8 x16 x8) slot 3 req 4 EA

CPU2 for T4 Part HX-RIS-1-240M5

Delivery: 03/13/2021

47 2 4 TB 12G SAS 10K RPM SFF HDD (4K) Part 32 EA

HX-HD24TB10K4KN

Continued ...

NSN 7540-01-152-8067 OPTIONAL FORM 336 (4-86)

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CONTINUATION SHEET

REFERENCE NO. OF DOCUMENT BEING CONTINUED PAGE OF

(A) (B) (C) (D) (E) (F)

75H70521R00009

Delivery: 03/13/2021

48 Cisco UCS VIC 1457 Quad Port 10 25G SFP28 CNA 4 EA

MLOM Part HX-MLOM-C25Q-04

Delivery: 03/13/2021

49 HyperFlex Data Platform Datacenter Advantage 4 EA

Subscription Part HXDPS001-5Y

Delivery: 03/13/2021

50 40GBASE-CR4 Passive Copper Cable 3m Part 8 EA

QSFP0H40G-CU3M

Delivery: 03/13/2021

51 UCS Fabric Interconnect 6454 Part HX-FI-6454 2 EA

Delivery: 03/13/2021

52 SNTC-8X5XNBD UCS Fabric Interconnect 6454 Part 10 EA

CON-SNT-HXFI6454

Delivery: 03/13/2021

53 UCS 6332 6454 Power Supply 100-240VAC Part 4 EA

UCS-PSU-6332-AC

Delivery: 03/13/2021

54 25GBASE-CU SFP28 Cable 3 Meter Part 16 EA

SFP-H25G-CU3M

Continued ...

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CONTINUATION SHEET

REFERENCE NO. OF DOCUMENT BEING CONTINUED PAGE OF

(A) (B) (C) (D) (E) (F)

75H70521R00009

Delivery: 03/13/2021

55 UCS Fabric Interconnect 6454 Part HX-FI-6454 2 EA

Delivery: 03/13/2021

56 SNTC-8X5XNBD UCS Fabric Interconnect 6454 Part 10 EA

CON-SNT-HXFI6454

Delivery: 03/13/2021

57 UCS 6332 6454 Power Supply 100-240VAC Part 4 EA

UCS-PSU-6332-AC

Delivery: 03/13/2021

58 2 4 TB 12G SAS 10K RPM SFF HDD (4K) Part 16 EA

HX-HD24TB10K4KN

Delivery: 03/13/2021

59 Level 3 Engineer Part STPS-SE3 136 HR

Delivery: 03/13/2021

60 Sr Project Manager Part STPS-PM 28 HR

Delivery: 03/13/2021

61 Direct - Travel and Expenses Part STPS-TNE 1 DO

Delivery: 03/13/2021

Continued ...

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REFERENCE NO. OF DOCUMENT BEING CONTINUED PAGE OF

(A) (B) (C) (D) (E) (F)

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DEPARTMENT OF HEALTH & HUMAN SERVICES Indian Owned Economic Enterprise INDIAN HEALTH SERVICE Representation

(July 2013)

Solicitation / Contract No.:______________________________

Project No. / Project Title: ______________________________

Date: _______________________

In accordance with 48 CFR 1452.280‐4, Indian economic enterprise representation, the signature below constitutes self‐certification that the offeror meets the definition of “Indian Owned Economic

Enterprise”, as defined in 48 CFR 1480.201, in response to the solicitation and resultant contract, in accordance with 25 U.S.C. 47 the Buy‐Indian Act. The enterprise must meet the definition of “Indian‐

Owned Economic Enterprise” throughout the following time periods: (1) At the time an offer is made in response to a solicitation, (2) At the time of contract award; and (3) During the full term of the contract performance period. At any point during these time periods, if the contractor no longer meets the eligibility requirements, the contractor must provide immediate written notification to the Contracting

Officer.

Any false or misleading information submitted by an enterprise when submitting an offer in consideration of an award set‐aside under the authority of the Buy‐Indian Act is a violation of the law and punishable under 18 U.S.C. 1001. False claims submitted as part of contract performance are subject to the penalties enumerated in 31 U.S.C § 3729 to § 3731 and 18 U.S.C. 287.

REPRESENTATION

1452‐280‐4 INDIAN ECONOMIC ENTERPRISE REPRESENTATION (JUL 2013)

Prescription: 1480‐801(a)

Provision: The offeror represents as part of its offer that is [ ] does, [ ] does not meet the definition of Indian Economic Enterprise as defined in 1480.201.

(Legal Business Name) (Certifying Signature)

(Dun & Bradstreet Number) (Printed Name)

RFP 75H70521R0009

IT Upgrade

05/20/2021

100% set aside for IEE

75H70521R0009

RLSU

SECTION B - SUPPLIES OR SERVICES AND PRICE/COSTS

B.1 CONTRACT ADMINISTRATION DATA

Contract Administration: All contract administration matters will be handled by the following individuals:

CONTRACTOR NAME AND ADDRESS:

TAX ID#________________________

DUNS # ________________________

Phone:_________________________

E-Mail:_________________________

Person responsible for Contractor Performance Assessment Reporting System (CPARS), reporting if different from above:

Name: _________________________________ Title: _________________________________ Email:_________________________________

CONTRACTOR REGISTRATION: All required information must be in the System for Award Management (SAM) at www.beta.sam.gov.

GOVERNMENT:

Jennifer Richardson Indian Health Service 2225 Cooperative Ct NW, Rm 202 Bemidji, MN 56601

Jennifer.Richardson@IHS.Gov

The associated North American Industrial Classification System (NAICS) code for this procurement is 812320 with a small business size standard of $35.5M

CONTRACT TYPE: Firm-Fixed Price

Contractor shall email all invoices to:

BEM_AOInvoices@ihs.gov

Indian Health Service Attn: Accounts Payable 2225 Cooperative Ct NW Bemidji, MN 56601

At a minimum, a properly prepared invoice shall include:

1. Name and address of Contractor

2. Invoice date and invoice number

3. IHS Contract Number:

4. Description, quantity, unit of measure, unit price and extended price of supplies delivered or services performed.

5. Shipping and payment terms

6. Name and address of Contractor official to whom payment is sent (must be the same as that in the contract or in a proper notice of assignment).

7. Name, title, phone number, and mailing address of person to notify in the event of a defective invoice.

8. Contractor Taxpayer Identification (TIN)

9. Contractor Dun & Bradstreet Number (DUNS)

Improperly prepared invoices or statements shall be returned to the contractor and may delay payment.

Payment:

1. Payment shall be made by electronic funds transfer (EFT). Payment shall be made in arrears.

2. The Contractors rate identified for services described herein is considered as an all-inclusive rate. All-inclusive is defined to but not limited to services, travel, lodging, liability insurance, fringe benefits, federal, state and local taxes, and all other costs pertinent to the performance of this contract.

Contract Type: Firm Fixed Price

Delivery/Ship Location:

Indian Health Service 24760 Hospital Drive Red Lake MN 56671-0497

ADMINISTRATIVE DATA

Contracting Officer Representative (COR).

The role of program and technical personnel in monitoring the contract is to assist and advise the Contracting Officer, and act as the COR when designated by the Contracting Officer.

The COR does not have the authority to change or alter the order amounts, terms, and conditions.

The COR shall be responsible for the following:

1. Provide technical monitoring during contract performance and advising the Contracting Officer relating to delivery, acceptance, or rejection of deliverable I accordance with the terms of the contract;

2. Assessing contractor performance

3. Recommending necessary changes to the schedule of work and period of performance to accomplish the objectives of the contract (the COR shall provide the Contracting Officer a written request along with an appropriate justification an funding document, if additional funds are needed.);

4. Reviewing invoices/vouchers and recommending approval/disapproval by the Contracting Officer, including providing comments regarding anything unusual discovered in the review;

5. Reviewing and recommending approval or disapproval of technical submissions, subcontractors, overtime, travel, and key personnel changes;

6. Assisting the Contractor in resolution of technical problems encountered during performance;

7. Participate s necessary in various phases of the contract closeout process;

8. Provide receiving authorization within two days of services/items received or invoiced.

IHS/RLSU (COR)

CINDY GUNDERSON

Phone: 218-679-3912 E-Mail: cindy.gunderson@ihs.gov

Payment Terms:

In arrears, Net 15, upon receipt of product, after inspection, acceptance, and upon receipt of proper invoice, whichever comes later.

Contractor Registration: All required information must be in the System for Award Management (SAM) at www.sam.gov

ACQUISITION REGULATIONS

SOLICITATION – PROVISIONS

This solicitation incorporates one or more solicitation provisions by reference, with the same force and effect as if they were given in full text. Upon request, the Contracting Officer will make their full text available. The offeror is cautioned that the listed provisions may include blocks that must be completed by the offeror and submitted with its quotation or offer. In lieu of submitting the full text of those provisions, the offeror may identify the provision by paragraph identifier and provide the appropriate information with its quotation or offer.

Health & Human Service Acquisition Regulation (HHSAR) The full text of a solicitation provision may be accessed electronically at this/these address:

https://www.hhs.gov/grants/contracts/contract‐policies‐regulations/hhsar/part‐352‐solicitation‐provisions‐contract‐ clauses/index.html

352.239‐73 Electronic Information and Technology Accessibility Notice.

Federal Acquisition Regulations (FAR) The full text of a solicitation provision may be accessed electronically at this/these address:

https://www.acquisition.gov/

52.203‐11 Certification and Disclosure Regarding Payments to Influence Certain Federal Transactions.

52.203‐18 Prohibition on Contracting with Entities that Require Certain Internal Confidentiality Agreements or

Statements‐Representation.

52.204‐7 System for Award Management.

52.204‐16 Commercial and Government Entity Code Reporting.

52.204‐22 Alternative Line Item Proposal.

52.204‐24 Representation Regarding Certain Telecommunications and Video Surveillance Services or Equipment.

52.212‐1 Instructions to Offerors‐Commercial Items.

52.217‐5 Evaluation of Options.

52.225‐20 Prohibition on Conducting Restricted Business Operations in Sudan‐Certification.

52.225‐25 Prohibition on Contracting With Entities Engaging in Certain Activities or Transactions Relating to Iran—

Representation and Certifications.

The Provisions listed below contain fillable sections. Prospective vendors shall complete and submit the provisions with offer unless these Provisions have been completed and are available within the company SAM registration.

52.203‐2 Certificate of Independent Price Determination (Apr 1985)

(a) The offeror certifies that‐

(1) The prices in this offer have been arrived at independently, without, for the purpose of restricting competition, any consultation, communication, or agreement with any other offeror or competitor relating to‐

(i) Those prices;

(ii) The intention to submit an offer; or

(iii) The methods or factors used to calculate the prices offered.

(2) The prices in this offer have not been and will not be knowingly disclosed by the offeror, directly or indirectly, to any other offeror or competitor before bid opening (in the case of a sealed bid solicitation) or contract award (in the case of a negotiated solicitation) unless otherwise required by law; and

(3) No attempt has been made or will be made by the offeror to induce any other concern to submit or not to submit an offer for the purpose of restricting competition.

(b) Each signature on the offer is considered to be a certification by the signatory that the signatory‐

(1) Is the person in the offeror’s organization responsible for determining the prices being offered in this bid or proposal, and that the signatory has not participated and will not participate in any action contrary to paragraphs (a)(1) through (a)(3) of this provision; or

(2) (i) Has been authorized, in writing, to act as agent for the following principals in certifying that those principals have not participated, and will not participate in any action contrary to paragraphs (a)(1) through (a)(3) of this provision ____________________ [insert full name of person(s) in the offeror’s organization responsible for determining the prices offered in this bid or proposal, and the title of his or her position in the offeror’s organization];

(ii) As an authorized agent, does certify that the principals named in subdivision (b)(2)(i) of this provision have not participated, and will not participate, in any action contrary to paragraphs (a)(1) through (a)(3) of this provision; and

(iii) As an agent, has not personally participated, and will not participate, in any action contrary to paragraphs (a)(1) through (a)(3) of this provision.

(c) If the offeror deletes or modifies paragraph (a)(2) of this provision, the offeror must furnish with its offer a signed statement setting forth in detail the circumstances of the dis‐closure. (End of provision)

52.204‐17 Ownership or Control of Offeror (Aug 2020)

(a) Definitions. As used in this provision–Commercial and Government Entity (CAGE) code means–

(1) An identifier assigned to entities located in the United States or its outlying areas by the Defense Logistics Agency (DLA) Commercial and Government Entity (CAGE) Branch to identify a commercial or government entity by unique location; or

(2) An identifier assigned by a member of the North Atlantic Treaty Organization (NATO) or by the NATO Support and Procurement Agency (NSPA) to entities located outside the United States and its outlying areas that the DLA Commercial and Government Entity (CAGE) Branch records and maintains in the CAGE master file. This type of code is known as a NATO CAGE (NCAGE) code.

Highest‐level owner means the entity that owns or controls an immediate owner of the offeror, or that owns or controls one or more entities that control an immediate owner of the offeror. No entity owns or exercises control of the highest level owner.

Immediate owner means an entity, other than the offeror, that has direct control of the offeror. Indicators of control include, but are not limited to, one or more of the following: ownership or interlocking management, identity of interests among family members, shared facilities and equipment, and the common use of employees.

(b) The Offeror represents that it □ has or □ does not have an immediate owner. If the Offeror has more than one immediate owner (such as a joint venture), then the Offeror shall respond to paragraph (c) and if applicable, paragraph

(d) of this provision for each participant in the joint venture.

(c) If the Offeror indicates “has” in paragraph (b) of this provision, enter the following information:

Immediate owner CAGE code: ____________________ Immediate owner legal name: ______________________ (Do not use a “doing business as” name) Is the immediate owner owned or controlled by another entity?: □ Yes or □ No.

(d) If the Offeror indicates “yes” in paragraph (c) of this provision, indicating that the immediate owner is owned or controlled by another entity, then enter the following information:

Highest‐level owner CAGE code: ___________________ Highest‐level owner legal name: ___________________ (Do not use a “doing business as” name) (End of provision)

52.204‐20 Predecessor of Offeror (Aug 2020)

(a) Definitions. As used in this provision–Commercial and Government Entity (CAGE) code means–

(1) An identifier assigned to entities located in the United States or its outlying areas by the Defense Logistics Agency (DLA) Commercial and Government Entity (CAGE) Branch to identify a commercial or government entity by unique location; or

(2) An identifier assigned by a member of the North Atlantic Treaty Organization (NATO) or by the NATO Support and Procurement Agency (NSPA) to entities located outside the United States and its outlying areas that the DLA Commercial and Government Entity (CAGE) Branch records and maintains in the CAGE master file. This type of code is known as a NATO CAGE (NCAGE) code.

Predecessor means an entity that is replaced by a successor and includes any predecessors of the predecessor.

Successor means an entity that has replaced a predecessor by acquiring the assets and carrying out the affairs of the predecessor under a new name (often through acquisition or merger). The term “successor” does not include new offices/divisions of the same company or a company that only changes its name. The extent of the responsibility of the successor for the liabilities of the predecessor may vary, depending on State law and specific circumstances.

(b) The Offeror represents that it □ is or □ is not a successor to a predecessor that held a Federal contract or grant within the last three years.

(c) If the Offeror has indicated “is” in paragraph (b) of this provision, enter the following information for all predecessors that held a Federal contract or grant within the last three years (if more than one predecessor, list in reverse chronological order):

Predecessor CAGE code:___________________(or mark “Unknown”).

Predecessor legal name:___________________ (Do not use a “doing business as” name). (End of provision)

52.204‐26 Covered Telecommunications Equipment or Services‐Representation (Dec 2019)

(a) Definitions. As used in this provision, “covered telecommunications equipment or services” has the meaning provided in the clause 52.204‐25, Prohibition on Contracting for Certain Telecommunications and Video Surveillance Services or Equipment.

(b) 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”.

(c) Representation. The Offeror represents that it □ does, □ 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. (End of provision)

52.209‐2 Prohibition on Contracting with Inverted Domestic Corporations‐Representation (Nov 2015)

(a) Definitions. “Inverted domestic corporation” and “subsidiary” have the meaning given in the clause of this contract entitled Prohibition on Contracting with Inverted Domestic Corporations (52.209‐10).

(b) Government agencies are not permitted to use appropriated (or otherwise made available) funds for contracts with either an inverted domestic corporation, or a subsidiary of an inverted domestic corporation, unless the exception at 9.108‐2(b) applies or the requirement is waived in accordance with the procedures at 9.108‐4.

(c) Representation. The Offeror represents that‐

(1) It □ is, □ is not an inverted domes c corpora on; and

(2) It □ is, □ is not a subsidiary of an inverted domestic corporation. (End of provision)

52.209‐5 Certification Regarding Responsibility Matters (Oct 2015)

(a) (1) The Offeror certifies, to the best of its knowledge and belief, that‐

(i) The Offeror and/or any of its Principals‐

(A) Are □ are not □ presently debarred, suspended, proposed for debarment, or declared ineligible for the award of contracts by any Federal agency;

(B) Have □ have not □, within a three‐year period preceding this offer, been convicted of or had a civil judgment rendered against them for: commission of fraud or a criminal offense in connection with obtaining, attempting to obtain, or performing a public (Federal, State, or local) contract or subcontract; violation of Federal or State antitrust statutes relating to the submission of offers; or commission of embezzlement, theft, forgery, bribery, falsification or destruction of records, making false statements, tax evasion, violating Federal criminal tax laws, or receiving stolen property (if offeror checks “have”, the offeror shall also see 52.209‐7, if included in this solicitation);

(C) Are □ are not □ presently indicted for, or otherwise criminally or civilly charged by a governmental entity with, commission of any of the offenses enumerated in paragraph (a)(1)(i)(B) of this provision;

(D) Have □, have not □, within a three‐year period preceding this offer, been notified of any delinquent Federal taxes in an amount that exceeds $3,500 for which the liability remains unsatisfied.

(1) Federal taxes are considered delinquent if both of the following criteria apply:

(i) The tax liability is finally determined. The liability is finally determined if it has been assessed. A liability is not finally determined if there is a pending administrative or judicial challenge. In the case of a judicial challenge to the liability, the liability is not finally determined until all judicial appeal rights have been exhausted.

(ii) The taxpayer is delinquent in making payment. A taxpayer is delinquent if the taxpayer has failed to pay the tax liability when full payment was due and required. A taxpayer is not delinquent in cases where enforced collection action is precluded.

(2) Examples.

(i) The taxpayer has received a statutory notice of deficiency, under I.R.C. § 6212, which entitles the taxpayer to seek Tax Court review of a proposed tax deficiency. This is not a delinquent tax because it is not a final tax liability. Should the taxpayer seek Tax Court review, this will not be a final tax liability until the taxpayer has exercised all judicial appeal rights.

(ii) The IRS has filed a notice of Federal tax lien with respect to an assessed tax liability, and the taxpayer has been issued a notice under I.R.C. § 6320 entitling the taxpayer to request a hearing with the IRS Office of Appeals contesting the lien filing, and to further appeal to the Tax Court if the IRS determines to sustain the lien filing. In the course of the hearing, the taxpayer is entitled to contest the underlying tax liability because the taxpayer has had no prior opportunity to contest the liability. This is not a delinquent tax because it is not a final tax liability. Should the taxpayer seek tax court review, this will not be a final tax liability until the taxpayer has exercised all judicial appeal rights.

(iii) The taxpayer has entered into an installment agreement pursuant to I.R.C. § 6159. The taxpayer is making timely payments and is in full compliance with the agreement terms. The taxpayer is not delinquent because the taxpayer is not currently required to make full payment.

(iv) The taxpayer has filed for bankruptcy protection. The taxpayer is not delinquent because enforced collection action is stayed under 11 U.S.C. 362 (the Bankruptcy Code).

(ii) The Offeror has □ has not □, within a three‐year period preceding this offer, had one or more contracts terminated for default by any Federal agency.

(2) “Principal,” for the purposes of this certification, means an officer, director, owner, partner, or a person having primary management or supervisory responsibilities within a business entity (e.g., general manager; plant manager;

head of a division or business segment; and similar positions).

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 Under Section 1001, Title 18, United States Code.

(b) The Offeror shall provide immediate written notice to the Contracting Officer if, at any time prior to contract award, the Offeror learns that its certification was erroneous when submitted or has become erroneous by reason of changed circumstances.

(c) A certification that any of the items in paragraph (a) of this provision exists will not necessarily result in withholding of an award under this solicitation. However, the certification will be considered in connection with a determination of the Offeror’s responsibility. Failure of the Offeror to furnish a certification or provide such additional information as requested by the Contracting Officer may render the Offeror nonresponsible.

(d) Nothing contained in the foregoing shall be construed to require establishment of a system of records in order to render, in good faith, the certification required by paragraph (a) of this provision. The knowledge and information of an

Offeror is not required to exceed that which is normally possessed by a prudent person in the ordinary course of business dealings.

(e) The certification in paragraph (a) of this provision is a material representation of fact upon which reliance was placed when making award. If it is later determined that the Offeror knowingly rendered an erroneous certification, in addition to other remedies available to the Government, the Contracting Officer may terminate the contract resulting from this solicitation for default. (End of provision)

52.209‐7 Information Regarding Responsibility Matters (Oct 2018)

(a) Definitions. As used in this provision— Administrative proceeding means a non‐judicial process that is adjudicatory in nature in order to make a determination of fault or liability (e.g., Securities and Exchange Commission Administrative Proceedings, Civilian Board of Contract Appeals Proceedings, and Armed Services Board of Contract Appeals Proceedings). This includes administrative proceedings at the Federal and State level but only in connection with performance of a Federal contract or grant. It does not include agency actions such as contract audits, site visits, corrective plans, or inspection of deliverables.

Federal contracts and grants with total value greater than $10,000,000 means—

(1) The total value of all current, active contracts and grants, including all priced options; and

(2) The total value of all current, active orders including all priced options under indefinite‐delivery, indefinite‐ quantity, 8(a), or requirements contracts (including task and delivery and multiple‐award Schedules).

Principal means an officer, director, owner, partner, or a person having primary management or supervisory responsibilities within a business entity (e.g., general manager; plant manager; head of a division or business segment;

and similar positions).

(b) The offeror □ has □ does not have current ac ve Federal contracts and grants with total value greater than $10,000,000.

(c) If the offeror checked “has” in paragraph (b) of this provision, the offeror represents, by submission of this offer, that the information it has entered in the Federal Awardee Performance and Integrity Information System (FAPIIS) is current, accurate, and complete as of the date of submission of this offer with regard to the following information:

(1) Whether the offeror, and/or any of its principals, has or has not, within the last five years, in connection with the award to or performance by the offeror of a Federal contract or grant, been the subject of a proceeding, at the Federal or State level that resulted in any of the following dispositions:

(i) In a criminal proceeding, a conviction.

(ii) In a civil proceeding, a finding of fault and liability that results in the payment of a monetary fine, penalty, reimbursement, restitution, or damages of $5,000 or more.

(iii) In an administrative proceeding, a finding of fault and liability that results in–

(A) The payment of a monetary fine or penalty of $5,000 or more; or

(B) The payment of a reimbursement, restitution, or damages in excess of $100,000.

(iv) In a criminal, civil, or administrative proceeding, a disposition of the matter by consent or compromise with an acknowledgment of fault by the Contractor if the proceeding could have led to any of the outcomes specified in paragraphs (c)(1)(i), (c)(1)(ii), or (c)(1)(iii) of this provision.

(2) If the offeror has been involved in the last five years in any of the occurrences listed in (c)(1) of this provision, whether the offeror has provided the requested information with regard to each occurrence.

(d) The offeror shall post the information in paragraphs (c)(1)(i) through (c)(1)(iv) of this provision in FAPIIS as required through maintaining an active registration in the System for Award Management, which can be accessed viahttps://www.sam.gov (see 52.204‐7). (End of provision)

52.209‐11 Representation by Corporations Regarding Delinquent Tax Liability or a Felony Conviction under any Federal Law (Feb 2016)

(a) As required by sections 744 and 745 of Division E of the Consolidated and Further Continuing Appropriations Act, 2015 (Pub. L. 113‐235), and similar provisions, if contained in subsequent appropriations acts, the Government will not enter into a contract with any corporation that–

(1) Has any unpaid Federal tax liability that has been assessed, for which all judicial and administrative remedies have been exhausted or have lapsed, and that is not being paid in a timely manner pursuant to an agreement with the authority responsible for collecting the tax liability, where the awarding agency is aware of the unpaid tax liability, unless an agency has considered suspension or debarment of the corporation and made a determination that suspension or debarment is not necessary to protect the interests of the Government; or

(2) Was convicted of a felony criminal violation under any Federal law within the preceding 24 months, where the awarding agency is aware of the conviction, unless an agency has considered suspension or debarment of the corporation and made a determination that this action is not necessary to protect the interests of the Government.

(b) The Offeror represents that–

(1) It is □ is not □ a corpora on that has any unpaid Federal tax liability that has been assessed, for which all judicial and administrative remedies have been exhausted or have lapsed, and that is not being paid in a timely manner pursuant to an agreement with the authority responsible for collecting the tax liability; and

(2) It is □ is not □ a corpora on that was convicted of a felony criminal viola on under a Federal law within the preceding 24 months. (End of provision)

52.212‐3 Offeror Representations and Certifications‐Commercial Items (Jun 2020) The Offeror shall complete only paragraph (b) of this provision if the Offeror has completed the annual representations and certification electronically in the System for Award Management (SAM) accessed through https://www.sam.gov. If the Offeror has not completed the annual representations and certifications electronically, the Offeror shall complete only paragraphs (c) through (v)) of this provision.

(a) Definitions. As used in this provision— “Covered telecommunications equipment or services” has the meaning provided in the clause 52.204‐25, Prohibition on Contracting for Certain Telecommunications and Video Surveillance Services or Equipment.

Economically disadvantaged women‐owned small business (EDWOSB) concern means a small business concern that is at least 51 percent directly and unconditionally owned by, and the management and daily business operations of which are controlled by, one or more women who are citizens of the United States and who are economically disadvantaged in accordance with 13 CFR part 127. It automatically qualifies as a women‐owned small business eligible under the WOSB Program.

Forced or indentured child labor means all work or service—

(1) Exacted from any person under the age of 18 under the menace of any penalty for its nonperformance and for which the worker does not offer himself voluntarily; or

(2) Performed by any person under the age of 18 pursuant to a contract the enforcement of which can be accomplished by process or penalties.

Highest‐level owner means the entity that owns or controls an immediate owner of the offeror, or that owns or controls one or more entities that control an immediate owner of the offeror. No entity owns or exercises control of the highest level owner.

Immediate owner means an entity, other than the offeror, that has direct control of the offeror. Indicators of control include, but are not limited to, one or more of the following: ownership or interlocking management, identity of interests among family members, shared facilities and equipment, and the common use of employees.

Inverted domestic corporation, means a foreign incorporated entity that meets the definition of an inverted domestic corporation under 6 U.S.C. 395(b), applied in accordance with the rules and definitions of 6 U.S.C. 395(c).

Manufactured end product means any end product in product and service codes (PSCs) 1000‐9999, except—

(1) PSC 5510, Lumber and Related Basic Wood Materials;

(2) Product or Service Group (PSG) 87, Agricultural Supplies;

(3) PSG 88, Live Animals;

(4) PSG 89, Subsistence;

(5) PSC 9410, Crude Grades of Plant Materials;

(6) PSC 9430, Miscellaneous Crude Animal Products, Inedible;

(7) PSC 9440, Miscellaneous Crude Agricultural and Forestry Products;

(8) PSC 9610, Ores;

(9) PSC 9620, Minerals, Natural and Synthetic; and

(10) PSC 9630, Additive Metal Materials.

Place of manufacture means the place where an end product is assembled out of components, or otherwise made or processed from raw materials into the finished product that is to be provided to the Government. If a product is disassembled and reassembled, the place of reassembly is not the place of manufacture.

Predecessor means an entity that is replaced by a successor and includes any predecessors of the predecessor.

Restricted business operations means business operations in Sudan that include power production activities, mineral extraction activities, oil‐related activities, or the production of military equipment, as those terms are defined in the Sudan Accountability and Divestment Act of 2007 (Pub. L. 110‐174). Restricted business operations do not include business operations that the person (as that term is defined in Section 2 of the Sudan Accountability and Divestment Act of 2007) conducting the business can demonstrate—

(1) Are conducted under contract directly and exclusively with the regional government of southern Sudan;

(2) Are conducted pursuant to specific authorization from the Office of Foreign Assets Control in the Department of the Treasury, or are expressly exempted under Federal law from the requirement to be conducted under such authorization;

(3) Consist of providing goods or services to marginalized populations of Sudan;

(4) Consist of providing goods or services to an internationally recognized peacekeeping force or humanitarian organization;

(5) Consist of providing goods or services that are used only to promote health or education; or

(6) Have been voluntarily suspended.“Sensitive technology”—

Sensitive technology—

(1) Means hardware, software, telecommunications equipment, or any other technology that is to be used specifically—

(i) To restrict the free flow of unbiased information in Iran; or

(ii) To disrupt, monitor, or otherwise restrict speech of the people of Iran; and

(2) Does not include information or informational materials the export of which the President does not have the authority to regulate or prohibit pursuant to section 203(b)(3)of the International Emergency Economic Powers Act (50 U.S.C. 1702(b)(3)).

Service‐disabled veteran‐owned small business concern—

(1) Means a small business concern—

(i) Not less than 51 percent of which is owned by one or more service‐disabled veterans or, in the case of any publicly owned business, not less than 51 percent of the stock of which is owned by one or more service‐disabled veterans; and

(ii) The management and daily business operations of which are controlled by one or more service‐disabled veteransor, in the case of a service‐disabled veteran with permanent and severe disability, the spouse or permanent caregiver of such veteran.

(2) Service‐disabled veteran means a veteran, as defined in 38 U.S.C. 101(2), with a disability that is service connected, as defined in 38 U.S.C. 101(16).

Small business concern means a concern, including its affiliates, that is independently owned and operated, not dominant in the field of operation in which it is bidding on Government contracts, and qualified as a small business under the criteria in 13 CFR Part 121 and size standards in this solicitation.

Small disadvantaged business concern, consistent with13 CFR 124.1002, means a small business concern under the size standard applicable to the acquisition, that—

(1) Is at least 51 percent unconditionally and directly owned (as defined at 13 CFR 124.105) by—

(i) One or more socially disadvantaged (as defined at13 CFR 124.103) and economically disadvantaged (as defined at 13 CFR 124.104) individuals who are citizens of the United States; and

(ii) Each individual claiming economic disadvantage has a net worth not exceeding $750,000 after taking into account the applicable exclusions set forth at 13 CFR124.104(c)(2); and

(2) The management and daily business operations of which are controlled (as defined at 13.CFR 124.106) by individuals, who meet the criteria in paragraphs (1)(i) and (ii) of this definition.

Subsidiary means an entity in which more than 50 percent of the entity is owned—

(1) Directly by a parent corporation; or

(2) Through another subsidiary of a parent corporation

Successor means an entity that has replaced a predecessor by acquiring the assets and carrying out the affairs of the predecessor under a new name (often through acquisition or merger). The term “successor” does not include new offices/divisions of the same company or a company that only changes its name. The extent of the responsibility of the successor for the liabilities of the predecessor may vary, depending on State law and specific circumstances.

Veteran‐owned small business concern means a small business concern—

(1) Not less than 51 percent of which is owned by one or more veterans (as defined at 38 U.S.C. 101(2)) or, in the case of any publicly owned business, not less than 51 percent of the stock of which is owned by one or more veterans;

and

(2) The management and daily business operations of which are controlled by one or more veterans.

Women‐owned small business (WOSB) concern eligible under the WOSB Program (in accordance with 13 CFR part 127), means a small business concern that is at least 51 percent directly and unconditionally owned by, and the management and daily business operations of which are controlled by, one or more women who are citizens of the United States.

Women‐owned small business concern means a small business concern—

(1) That is at least 51 percent owned by one or more women; or, in the case of any publicly owned business, at least51 percent of the stock of which is owned by one or more women; and

(2) Whose management and daily business operations are controlled by one or more women.

(b)

(1) Annual Representations and Certifications. Any changes provided by the Offeror in paragraph (b)(2) of this provision do not automatically change the representations and certifications in SAM

(2) The offeror has completed the annual representations and certifications electronically in SAM accessed through http://www.sam.gov. After reviewing SAM information, the Offeror verifies by submission of this offer that the representations and certifications currently posted electronically at FAR 52.212‐3, Offeror Representations and Certifications‐Commercial Items, have been entered or updated in the last 12 months, are current, accurate, complete, and applicable to this solicitation (including the business size standard(s) applicable to the NAICS code(s) referenced for this solicitation), at the time this offer is submitted and are incorporated in this offer by reference (see FAR 4.1201), except for paragraphs ______________.

[Offeror to identify the applicable paragraphs at (c) through (v) of this provision that the offeror has completed for the purposes of this solicitation only, if any.

These amended representation(s) and/or certification(s) are also incorporated in this offer and are current, accurate, and complete as of the date of this offer.

Any changes provided by the offeror are applicable to this solicitation only, and do not result in an update to the representations and certifications posted electronically on SAM.]

(c) Offerors must complete the following representations when the resulting contract will be performed in the United States or its outlying areas. Check all that apply.

(1) Small business concern. The offeror represents as part of its offer that it □ is, □ is not a small business concern.

(2) Veteran‐owned small business concern. [Complete only if the offeror represented itself as a small business concern in paragraph (c)(1) of this provision.] The offeror represents as part of its offer that it □ is, □ is not a veteran‐ owned small business concern.

(3) Service‐disabled veteran‐owned small business concern. [Complete only if the offeror represented itself as a veteran‐owned small business concern in paragraph (c)(2) of this provision.] The offeror represents as part of its offer that it □ is, □ is not a service‐disabled veteran‐owned small business concern.

(4) Small disadvantaged business concern. [Complete only if the offeror represented itself as a small business concern in paragraph (c)(1) of this provision.] The offeror represents, that it □ is, □ is not a small disadvantaged business concern as defined in 13 CFR124.1002.

(5) Women‐owned small business concern. [Complete only if the offeror represented itself as a small business concern in paragraph (c)(1) of this provision.] The offeror represents that it □ is, □ is not a women‐owned small business concern.

(6) WOSB concern eligible under the WOSB Program. [Complete only if the offeror represented itself as a women‐ owned small business concern…