Government_Employees.docx

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Supply and deliver 46, 000 pounds of NUVO-CS-B Crack Sealer
Solicitation number
AG-04P5-S-16-0009
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Government Employee declaration

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AG-04P5-S-16-0009

NUVO-CS-B Crack Sealer

Government Employees, Former USDA Employees, and USDA Retirees

The offeror/quoter represents and certifies that --

A. It [ ] is, [ ] is not a current Federal Government employee.

B. It [ ] is, [ ] is not a former USDA employee.

C. It [ ] is, [ ] is not a retired USDA employee. If retired, give date of retirement:_________.

D. It [ ] is, [ ] is not related by blood or marriage to a current Forest Service employee on the ______ National Forest. If so, list employee's name and location:______________________________.

E. It [ ] is, [ ] is not substantially owned or controlled by a former USDA employee or retiree.

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