A10. J7. Proposal Response Form 12970223R0010.docx

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GAOA - Sierra Vista Scenic Byway Beasore Road Repairs
Solicitation number
12970223R0010
Issued by

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This document contains a proposal response form for a federal contract solicitation from the Department of Agriculture Forest Service. The solicitation seeks proposals for repairs to Beasore Road in the Sierra Vista Scenic Byway. Offerors must provide details on their plan of work, equipment, progress schedule, safety plan, sustainable procurement practices, key personnel, and past performance experience. The form requires certification that the information provided is complete and true. The contract number is 12970223R0010 and proposals were due by the date listed on the form.

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SPECIALIZED PROJECT OPERATIONS CENTER, SOUTHWEST ZONE

PROPOSAL FORM

Solicitation No.: 12970223R0010 Project Title: GAOA - Sierra Vista Scenic Byway Beasore Road Repairs

SPECIALIZED PROJECT OPERATIONS CENTER, SOUTHWEST ZONE

PROPOSAL FORM

Contractor Name Overwrite Here Date

Proposal Form Instructions. The proposal form will be used to make an evaluation and arrive at a determination as to whether the proposal will meet the requirements of the Government. Therefore, the offeror information contained herein must present sufficient information to reflect a thorough understanding of the requirements and a detailed description of the techniques, procedures, and program for achieving the objectives of the Statement of Work (Or Section C for applicable solicitations), demonstrate the experience and provide the past performance in accordance with Section L of the solicitation terms and any additional information necessary for a sufficient responsive determination. Please complete the following areas and return in accordance with the instruction provided in the solicitation terms:

a. Plan of Work. In narrative format, compose a narrative detailing how this project will be performed, addressing major tasks, the average number of employees assigned, equipment used and how equipment cleaning requirements will be met. If a subcontractor will be used, identify what actions the subcontractor will perform and the percent of work. The technical proposal should correspond with and support the project schedule and pricing offer. The Government should be able to clearly identify how the offeror will perform the work requirements. Do not exceed the space provided.

☐ Offer does not include subcontracted work.

☐ Offer does include subcontracted work. The details for each subcontractor working on the project site has been provided on the FS 6300-11, Subcontractor approval form with the proposal package.

Type Here

Contractor Name

Date

a. Plan of Work Continuation Page.

Contractor Name

Date

b. Equipment. Using the space provided, furnish, a listing of specific equipment available for use under each pay item, to include the make and model, and year. State what is being rented and what is owned.

Equipment Name, Make, Model and Year

Equipment Name
Make & Model
Year
Owned
Rented

c. Progress Schedule. Complete the Government provided Progress Schedule contained herein. Prepare and provide a tentative but practicable schedule showing a timeline for the work being accomplished.

Item of Work
CONTRACT TIME

Compute Time Per Square as follows = ( ) days per square.

% Completion 0 10 20 30 40 50 60 70 80 90 100 Days Contract Time 0 ( ) ( ) ( ) ( ) ( )

INSTRUCTIONS

CONTRACTOR

1. Complete CONTRACT TIME block above to determine days per square.

2. Insert contract days in brackets at 20%, 40%, etc.

3. Show line through each square for work planned. Please do not block in solid.

4. Submit ONE Copy to the Contracting Officer (CO) Representative (COR) and CO.

COR

1. Approve schedule to submit to CO with comments.

2. Chart actual progress against proposed progress.

3. Advise CO when progress falls behind.

4. Distribute as follows: Original to CO; Copies to Contractor; COR; Forest

SUBMITTED BY:

Type Here

Contractor Name

REVIEWED AND APPROVED:

Steve Wood

COR Name/Signature Date

Representative Name Date

REVIEWED:

Klenise Wallace

Contracting Officer Date

Comments

Contractor Name

Date

d. Safety Plan. Provide a narrative explaining how Contractor’s plan of work supports the protection of the lives and health of employees (contractor, government and/or subcontracted) and visitors on the site both while preventing the damage of property, materials, supplies and equipment damage to avoid work interruptions.

Contractor Name Overwrite Here Date

d. Safety Plan Continuation Page.

Contractor Safety Certification

· The Contractor shall have a Safety Plan in place.

· The Contractor shall provide a copy of their safety plan at the pre-work meeting. This copy of the Safety plan shall be kept in the contract folder for OSHA’s review.

· The Safety Plan should be available to all employees and subcontractors working on the contract.

· The Safety Plan should cover at a minimum:

a. Safety briefings covering the work area, equipment being used, and any special considerations for the work under the contract.

b. Personal Protective Equipment required for the work under the contract.

c. Identify appropriate OSHA requirements for the type of work under the contract.

d. Weather considerations for the time of year of the contract.

e. Communication issues and locations of the nearest medical facilities.

f. Name and point of contact information of supervisor responsible for enforcing Safety Plan.

g. Name, position title and point of contact information of company executive responsible for approving the Safety Plan.

h. Specific contingency plans for emergencies such as medical, fire, hazard material spills and any other contract assessed hazard prevention and abatement requirement needs that apply to this project.

Contractor Representative Overwrite

certifies that
Company Name

Overwrite has a safety plan in place and certifies that it will be strictly enforced.

Contractor Name

Date

e. Bio-based /Sustainable Procurement Program.

As required by the Farm Security and Rural Investment Act of 2002 and the Energy Policy Act of 2005 (7 U.S.C. 8102(c)(3)), this solicitation/contract requires the use of Biobased products to the extent that such products are reasonably available, meet agency or relevant industry performance standards are reasonably priced.

Biobased products, within categories of products listed by the United States Department of Agriculture in 7 CFR part 3201, subpart B) to be used or delivered in the performance of the contract. Any other than biobased products that are not purchased by the offeror as a direct result of this contract, will comply with the applicable specifications or other contractual requirements. Information about this requirement and these products are available at http://sftool.gov/green-products/1/construction-materials.

Sustainable Products Statement of Intent (Check Only One)

☐ There are no expectations or intent of utilizing biobased products for this requirement at this time. The contractor certifies that it understands that the government requires the use of Biobased products to the extent reasonably available. Should any product be required throughout the duration of this contract, the Contractor will provide the government an updated form listing the products used that are in compliance with the Farm Security and Rural Investment Act of 2002 and the Energy Policy Act of 2005. The contractor also certifies that failure to comply with the requirements should product be required may result in penalties.

☐ The Contractor proposes utilizing non-designated products. The following justification is provided for use of those items identified as non-designated products.

☐ The following biobased products will be utilized for this requirement. The listing below contains all recycled-content products, biobased products, environmentally preferable products and services, and non-ozone depleting substances to be acquired, used, and installed in the performance of this contract.

1.
4.
2.
5.
3.
6.

☐ By submitting this information with the proposal, I certify that the information provided above is true to the best of my knowledge.

(Initial)

Contractor Name

Date

f. Designation of Representatives/Key Personnel. This tells the Government who the Government contacts are authorized to speak to from the offerors company. Offeror may include additional personnel by overwriting the title of the 2 additional reserved sections. Include a little background that identifies their position within the company, years of experience and a summary of projects being worked.

Key Personnel

Contractor Representative Name
Phone
Email
Overwrite Here
Overwrite Here
Overwrite Here
Project Foreman/Woman Name
Phone
Email
Overwrite Here
Overwrite Here
Overwrite Here
Inspector Name
Phone
Email
Overwrite Here
Overwrite Here
Overwrite Here
Reserved
Phone
Email
Overwrite Here
Overwrite Here
Overwrite Here
Reserved
Phone
Email
Overwrite Here
Overwrite Here
Overwrite Here

Designated Representative This delegation extends authority to take any action necessary with respect to the execution of work, including acknowledging receipt of Notice to Proceed, Suspend and Resume Work Orders, and Notices of Noncompliance. The items check below indicates additional authority authorized by this delegation:

☐ Sign progress payment estimates and invoices.

☐ Sign contract modifications.

☐ Sign final payment estimate and invoice and contract release.

☐ Execute contract termination settlement agreement.

☐ Full authority in all contractual matters.

Name
Title
Overwrite Here
Overwrite Here

Contractor Name

Date

g. Past Performance and Experience. Document experience in accordance with solicitation requirements using the data below.

List below, a maximum of five (5) projects your firm has completed relating to this solicitation within the last three (3) years:

PROJECT DETAILS
PROJECT SUMMARY

Project Title:

Project Total Value (in Dollars):

Project Role: ☐ Prime ☐ Sub-contractor Company/Government Entity Name Contracted by:

Address:

POC Name:

POC Phone:

POC Email:

Project Title:

Project Total Value (in Dollars):

Project Role: ☐ Prime ☐ Sub-contractor Company/Government Entity Name Contracted by:

Address:

POC Name:

Project Title:

Project Role: ☐ Prime ☐ Sub-contractor Company/Government Entity Name Contracted by:

Address:

POC Name:

Project Title:

Project Role: ☐ Prime ☐ Sub-contractor Company/Government Entity Name Contracted by:

Address:

POC Name:

Project Title:

Project Role: ☐ Prime ☐ Sub-contractor Company/Government Entity Name Contracted by:

Address:

POC Name:

Contractor Name

Date

h. Representations and Certifications.

52.204-8 Annual Representations and Certifications (MAR 2023) (DEVIATION DEC 2022)

(a) (1) The North American Industry Classification System (NAICS) code for this acquisition is 237310.

(2) The small business size standard is $45M.

(3) The small business size standard for a concern that submits an offer, other than on a construction or service acquisition, but proposes to furnish an end item that it did not itself manufacture, process, or produce is 500 employees, or 150 employees for information technology value-added resellers under NAICS code 541519 if the acquisition -

(i) Is set aside for small business and has a value above the simplified acquisition threshold;

(ii) Uses the HUBZone price evaluation preference regardless of dollar value, unless the offeror waives the price evaluation preference; or

(iii) Is an 8(a), HUBZone, service-disabled veteran-owned, economically disadvantaged women-owned, or women-owned small business set-aside or sole-source award regardless of dollar value.

(b) (1) If the provision at 52.204-7, System for Award Management, is included in this solicitation, paragraph (d) of this provision applies.

(2) If the provision at 52.204-7, System for Award Management, is not included in this solicitation, and the Offeror has an active registration in the System for Award Management (SAM), the Offeror may choose to use paragraph (d) of this provision instead of completing the corresponding individual representations and certifications in the solicitation. The Offeror shall indicate which option applies by checking one of the following boxes:

(i) ☐ Paragraph (d) applies.

(ii) ☐ Paragraph (d) does not apply and the offeror has completed the individual representations and certifications in the solicitation.

(c) (1) The following representations or certifications in SAM are applicable to this solicitation as indicated:

(i) 52.203-2, Certificate of Independent Price Determination. This provision applies to solicitations when a firm-fixed-price contract or fixed-price contract with economic price adjustment is contemplated, unless–

(A) The acquisition is to be made under the simplified acquisition procedures in part 13;

(B) The solicitation is a request for technical proposals under two-step sealed bidding procedures; or

(C) The solicitation is for utility services for which rates are set by law or regulation.

(ii) 52.203-11, Certification and Disclosure Regarding Payments to Influence Certain Federal Transactions. This provision applies to solicitations expected to exceed $150,000.

(iii) 52.203-18, Prohibition on Contracting with Entities that Require Certain Internal Confidentiality Agreements or Statements-Representation. This provision applies to all solicitations.

(iv) 52.204-3, Taxpayer Identification. This provision applies to solicitations that do not include the provision at 52.204-7, System for Award Management.

(v) 52.204-5, Women-Owned Business (Other Than Small Business). This provision applies to solicitations that-

(A) Are not set aside for small business concerns;

(B) Exceed the simplified acquisition threshold; and

(C) Are for contracts that will be performed in the United States or its outlying areas.

(vi) 52.204-26, Covered Telecommunications Equipment or Services-Representation. This provision applies to all solicitations.

(vii) 52.209-2, Prohibition on Contracting with Inverted Domestic Corporations-Representation.

(viii) 52.209-5, Certification Regarding Responsibility Matters. This provision applies to solicitations where the contract value is expected to exceed the simplified acquisition threshold.

(ix) 52.209-11, Representation by Corporations Regarding Delinquent Tax Liability or a Felony Conviction under any Federal Law. This provision applies to all solicitations.

(x) 52.214-14, Place of Performance-Sealed Bidding. This provision applies to invitations for bids except those in which the place of performance is specified by the Government.

(xi) 52.215-6, Place of Performance. This provision applies to solicitations unless the place of performance is specified by the Government.

(xii) 52.219-1, Small Business Program Representations (Basic, Alternates I, and II). (DEVIATION DEC 2022) This provision applies to solicitations when the contract is for supplies to be delivered or services to be performed in the United States or its outlying areas, or when the contracting officer has applied Part 19 in accordance with 19.000(b)(1)(ii).

(A) The basic provision applies when the solicitations are issued by other than DoD, NASA, and the Coast Guard.

(B) The provision with its Alternate I applies to solicitations issued by DoD, NASA, or the Coast Guard.

(C) The provision with its Alternate II applies to solicitations that will result in a multiple-award contract with more than one NAICS code assigned.

(xiii) 52.219-2, Equal Low Bids. This provision applies to solicitations when contracting by sealed bidding and the contract is for supplies to be delivered or services to be performed in the United States or its outlying areas, or when the contracting officer has applied Part 19 in accordance with 19.000(b)(1)(ii).

(xiv) 52.222-22, Previous Contracts and Compliance Reports. This provision applies to solicitations that include the clause at 52.222-26, Equal Opportunity.

(xv) 52.222-25, Affirmative Action Compliance. This provision applies to solicitations, other than those for construction, when the solicitation includes the clause at 52.222-26, Equal Opportunity.

(xvi) 52.222-38, Compliance with Veterans’ Employment Reporting Requirements. This provision applies to solicitations when it is anticipated the contract award will exceed the simplified acquisition threshold and the contract is not for acquisition of commercial products or commercial services.

(xvii) 52.223-1, Biobased Product Certification. This provision applies to solicitations that require the delivery or specify the use of USDA–designated items; or include the clause at 52.223-2, Affirmative Procurement of Biobased Products Under Service and Construction Contracts.

(xviii) 52.223-4, Recovered Material Certification. This provision applies to solicitations that are for, or specify the use of, EPA–designated items.

(xix) 52.223-22, Public Disclosure of Greenhouse Gas Emissions and Reduction Goals-Representation. This provision applies to solicitations that include the clause at 52.204-7.)

(xx) 52.225-2, Buy American Certificate. This provision applies to solicitations containing the clause at 52.225-1.

(xxi) 52.225-4, Buy American-Free Trade Agreements-Israeli Trade Act Certificate. (Basic, Alternates II and III.) This provision applies to solicitations containing the clause at 52.225-3.

(A) If the acquisition value is less than $50,000, the basic provision applies.

(B) If the acquisition value is $50,000 or more but is less than $92,319, the provision with its Alternate II applies.

(C) If the acquisition value is $92,319 or more but is less than $100,000, the provision with its Alternate III applies.

(xxii) 52.225-6, Trade Agreements Certificate. This provision applies to solicitations containing the clause at 52.225-5.

(xxiii) 52.225-20, Prohibition on Conducting Restricted Business Operations in Sudan-Certification. This provision applies to all solicitations.

(xxiv) 52.225-25, Prohibition on Contracting with Entities Engaging in Certain Activities or Transactions Relating to Iran-Representation and Certifications. This provision applies to all solicitations.

(xxv) 52.226-2, Historically Black College or University and Minority Institution Representation. This provision applies to solicitations for research, studies, supplies, or services of the type normally acquired from higher educational institutions.

(2) The following representations or certifications are applicable as indicated by the Contracting Officer:

[Contracting Officer check as appropriate.] ☒ (i) 52.204-17, Ownership or Control of Offeror.

☒ (ii) 52.204-20, Predecessor of Offeror.

☐ (iii) 52.222-18, Certification Regarding Knowledge of Child Labor for Listed End Products.

☐ (iv) 52.222-48, Exemption from Application of the Service Contract Labor Standards to Contracts for Maintenance, Calibration, or Repair of Certain Equipment- Certification.

☐ (v) 52.222-52, Exemption from Application of the Service Contract Labor Standards to Contracts for Certain Services-Certification.

☐ (vi) 52.223-9, with its Alternate I, Estimate of Percentage of Recovered Material Content for EPA–Designated Products (Alternate I only).

☐ (vii) 52.227-6, Royalty Information.

☐ (A) Basic.

☐ (B) Alternate I.

☐ (viii) 52.227-15, Representation of Limited Rights Data and Restricted Computer Software.

(d) The offeror has completed the annual representations and certifications electronically in SAM website accessed through https://www.sam.gov. After reviewing the SAM information, the offeror verifies by submission of the offer that the representations and certifications currently posted electronically that apply to this solicitation as indicated in paragraph (c) of this provision have been entered or updated within the last 12 months, are current, accurate, complete, and applicable to this solicitation (including the business size standard applicable to the NAICS code referenced for this solicitation), as of the date of this offer and are incorporated in this offer by reference (see FAR 4.1201); except for the changes identified below [offeror to insert changes, identifying change by clause number, title, date]. 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.

FAR Clause #
Title & Date
Change

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

DEVIATION NOV 2022] Offerors that are representing as Small Business Joint Venture or Service Disabled Veteran Owned Small Business Joint Venture should submit their socio-economic status in the space provided above until such time that SAM.gov has been updated to include the joint venture representations contained within provision 52.219-1 paragraph (c).

52.204-24 Representation Regarding Certain Telecommunications and Video Surveillance Services or Equipment (OCT 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 paragraph (c)(1) in the provision at 52.204-26, Covered Telecommunications Equipment or Services—Representation, or in paragraph (v)(2)(i) of the provision at 52.212-3, Offeror Representations and Certifications-Commercial Items. The Offeror shall not complete the representation in paragraph (d)(2) of this provision if the Offeror has represented that it "does not use covered telecommunications equipment or services, or any equipment, system, or service that uses covered telecommunications equipment or services" in paragraph (c)(2) of the provision at 52.204-26, or in paragraph (v)(2)(ii) of the provision at 52.212-3.

(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.

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 active 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 via https://www.sam.gov (see 52.204-7).

g. Certification. The items contained herein have been completed and are submitted in response to solicitation 12970223R0010. By signing this certification, I certify that the information provided within this Technical Proposal Form for solicitation 12970223R0010 is complete and true to the best of my knowledge.

Company Name:
Overwrite Here
Representative’s Name:
Overwrite Here
Representative’s Phone:
Overwrite Here
Representative’s Email:
Overwrite Here

Overwrite Here

Representative’s Signature
Date

Solicitation No. 12970223R0010 | GAOA - Sierra Vista Scenic Byway Beasore Road Repairs | Page 2 of 2 image1.png image2.png

File details come from the government source that posted it. Updated .