889 Representation Form Rev 1.pdf

Covered Telecommunications Equipment or Services-Representation Section 1 – References

1. FAR 52.204-24 through 26 , FAR 4.2105(a)

2. Policy Alert # 20-124 and Rev 1

Section 2 – Merchant Representation As prescribed in FAR 4.2105(a), the merchant completes the following representation in paragraph (c) below:

(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”. Telecommunications equipment produced by Huawei Technologies Company or ZTE Corporation, (or any subsidiary or affiliate of such entities); Video surveillance and telecommunications equipment produced by Hytera Communications Corporation, Hangzhou Hikvision Digital Technology Company, or Dahua Technology Company (or any subsidiary or affiliate of such entities) is strictly prohibited.

(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.

Merchant Name ________________________________________________________________________

Merchant’s Authorized Representative _______________________________________________________ (Typed Name)

Authorized Representative Signature and Date ________________________________________________

Section 3 - Instructions

A. Cardholder (CH) provides this representation document to the merchant to complete, sign, and return to the CH.

B. Merchant completes the following:

1. Merchant goes to the following FAR site:

https://www.acquisition.gov/content/part-52-solicitation-provisions-and-contract-clauses#id1989I600I4C

2. Merchant reads FAR Provision 52.204-24 and Clause 52.204-25.

3. Upon completion of Step 2, merchant fills out the Section 2 paragraph (c) of the form above and returns the form to the CH

C. If a merchant represents “does not,” the CH can rely on the representation and make the purchase.

D. If a merchant represents “does,” or the merchant declines to complete the Representation - the CH shall not make the purchase. Forward the requirement along with the representation to the supporting contracting office for action.

E. If it is determined that entering into a contract with the merchant does not violate the section 889 prohibitions, the supporting contracting office may provide written approval for the CH to make the purchase. The CH shall include a copy of this approval with the transaction supporting data.

F. The following GPC transactions are exempt as these transactions are payments, not purchases.

1. Contract Payment Official - use of the GPC as a payment method only

2. Inter/Intra-Governmental Payments - (ex. DLA Document Services, NSN items using FedMall, or GSA Global Supply.

3. SF-182 Training Payments

G. Retain all documentation that supports this representation and upload in AXOL.