Appendix A - Affirmation of Business Status Certification.pdf

APPENDIX A

AFFIRMATION OF BUSINESS STATUS CERTIFICATION (ABSC)

Every significant participating entity shall complete the following table and provide a signature representing its certification.

*Legal Entity Name

Industry Size Standard for

NAICS

Large Small Socio Economic Status:

*SAM UEI No.

*CAGE Code

*Tax Identification No.

*Active SAM Registration Yes No Expiration Date:

Address 1

Address 2

City/State/Zip

POC Name/Title

POC Phone/e-mail

* This information is required for the entity serving as the Prime/Lead/Principal and as applicable for all other legal entities. Submit one (1) Form per entity.

The Entity named above represents that it is (check one of the following boxes):

A Nontraditional Defense Contractor (NDC) Defined in 10 U.S.C. 3014: Nontraditional Defense Contractor - means an entity that is not currently performing and has not performed, for at least the one-yearperiod preceding the solicitation of sources by the Department of Defense for the procurement or transaction, any contract or subcontract for the Department of Defense that is subject to full coverage under the cost accounting standards prescribed pursuant to section 1502 of title 41 and the regulations implementing such section. (see 10 U.S.C. 2302(9)).

A Nonprofit Research Institution (NRI) Defined in 15 U.S.C. 3703 Definitions - the term (3) "Nonprofit institution", means an organization owned and operated exclusively for scientific or educational purposes, no part of the net earnings of which inures to the benefit of any private shareholder or individual. It includes federally funded research and development centers, as identified by the National Scientific Foundation in accordance with the Government wide Federal Acquisition Regulation issued in accordance with section 1303(a)(1) of title 41 (or any successor regulation thereto).

A Traditional Defense Contractor A Traditional Defense Contractor is an entity that does not meet the definition of a Nontraditional Defense Contractor (NDC).

The undersigned hereby certifies that the representations made herein are accurate and true regarding the entity identified above. I authorize my electronic signature to carry the same weight and legal effect as my written signature.

Signature

Printed Name

Title

Date

Affirmation-Business-Status-Cert 1

In addition to submitting the Affirmation of Business Status for all entity participants, the Prime Offeror [or Sole Offeror] shall submit an explanation on how the Prime [or Sole Offeror] is satisfying the requirements under 10 USC 4022(b)(d) Appropriate Use of Authority.- (1) (conditions is met).

The Prime Offer [or Sole Offeror] explanation provided below (text box) contains language supporting one of the following three areas (check one of the following boxes):

At least one Nontraditional Defense Contractor (NDC) or Nonprofit Research Institution (NRI) is participating to a significant extent in the prototype project. If checked: Provide an explanation of the effort and the significance of the NDC or contribution that supports at least one of the following factors (Ref OTA Guide Glossary, "Significant Extent" page 37) in the box below:

a) Supplying a new key technology, product or process.

b) Supplying a novel application or approach to an existing technology, product or process.

c) Provides a material increase in the performance, efficiency, quality or versatility of a key technology, product or process.

d) Accomplishes a significant amount of the prototype project.

e) Causes a material reduction in the cost or schedule of the prototype project.

f) Provides for a material increase in performance of the prototype project.

g) Provides additional capability beyond those described above necessary for this effort.

Provide a total estimated cost and percentage of the NDC or NRI associated with the proposal. (Note: While cost is an indicator for the level of NDC or NRI participation, there is no specific cost threshold required.)

All significant participants in the transaction other than the Federal Government are small businesses (including small businesses participating in a program described under section 9 of the Small Business Act (15 U.S.C. 638)) or nontraditional defense contractors.

At least one third of the total cost of the prototype project is to be paid out of funds provided by sources other than other than the Federal Government. If selected, the Cost Share details shall be provided with the ROM/Cost/Price submission.

Prime Offeror - Explanation for 10 USC 4022(b)(d) participating to a significant extent:

Affirmation-Business-Status-Cert 2

[Replace Sample Text - XYZ Corp] has teamed with several Nontraditional Defense Contractors that collectively are contributing to a significant extent as summarized below:

Supplying a novel application or approach to an existing technology, product or process:

a) New key technology, product or process: [LMNO LLC will provide ...... ]

b) Supplying a novel application or process: [1234 Inc will provide. ...... ]

c) Material increase in the performance, efficiency, quality or versatility:

d) Accomplishes a significant amount of the prototype project:

e) Causes a material reduction in the cost or schedule of the prototype project:

f) Provides for a material increase in performance of the prototype project:

g) Provides additional capability beyond those described above necessary for this effort. [ABC will provide Cloud Services at scale ......... ] and [EFG LLC will provide software that will. ]

Total estimated cost and percentage of NDC contribution to the Prototype is [$XX,XXX] and [XX]%.