Appendix F - Reps and Certs Supplemental 12-8-2022.pdf

Form 48300.000 Procurement Revision 0, 12-8-2022 Page 1 of 6

REPRESENTATIONS AND CERTIFICATIONS SUPPLEMENTAL

Iowa State University (ISU) manages and operates Ames National Laboratory (referred to as the “Laboratory” or “Ames Laboratory”) for the Department of Energy (DOE) as a prime contractor under DOE Contract # DE-AC02-07CH11358 (Prime Contract), as amended. Therefore, all suppliers and subcontractors performing work or supplying goods to the Laboratory will be paid with government funds. To that end, ALL suppliers and subcontractors that desire to be considered for a purchase order or subcontract award valued at $10,000 or more are required to register their company in the Official U.S. Government System for Award Management (SAM) and complete annual representations and certifications electronically in SAM accessed through www.sam.gov.

INSTRUCTIONS

A. If proposed cost for work is less than $10,000, and your firm IS registered in SAM, then you are only required to provide the information in

SECTION I (a) Entity Information, below. If your firm is NOT registered in SAM, then you are required to complete both SECTIONS I (a) Entity Information and I (b) Business Size. HOWEVER, IF PROPOSED PRODUCTS ARE EXPORT CONTROLLED, THEN ALSO COMPLETE SECTION II (1).

B. If your proposed cost for work is $10,000 or more, your firm MUST be registered in SAM, and you are required to complete SECTION I(a) only, & ALL Parts of SECTION II.

C. SUBMIT your Representations and Certifications Supplemental to: Andrew Saxton via email at saxton@ameslab.gov.

AS USED HEREIN, THE TERM “CONTRACT” SHALL MEAN THE AMES NATIONAL LABORATORY AWARD “AGREEMENT” (ALSO REFERRED TO AS “PURCHASE ORDER” / “SUBCONTRACT”) RESULTING FROM THE OFFEROR’S PROPOSAL; “OFFER” INCLUDES “BID”, “PROPOSAL” AND “QUOTATION”;

AND “OFFEROR” INCLUDES “BIDDER”, “PROPOSER”, “QUOTER”, “SUPPLIER”, “SUBCONTRACTOR”, OR “VENDOR” AS MAY BE APPLICABLE.

SECTION I

1. (a) ENTITY INFORMATION (complete and check all that applies) 1. (b) BUSINESS SIZE Business Name: Click or tap here to enter text. In addition to 1(a), complete the section below if your proposed offer is less than $10,000 and your firm is NOT registered in SAM.

The North American Industry Classification System (NAICS) code that your firm falls under for this purchase is: (Offeror fills in) Click or tap here to enter text.

Your Firm’s Business Size (per FAR 52.219-1) (Select all that apply) ☐ Small Business (SB) ☐ Disadvantaged SB ☐ Women-Owned SB ☐ Veteran-Owned (VO) SB ☐ Service-Disabled VOSB ☐ Educational Institution ☐ Other Non-Profit ☐ HUBZone SB ☐ Foreign-Owned Business ☐ Large Business

Unique Entity ID: (from SAM) Click or tap here to enter text.

CAGE Code: (if known) Click or tap here to enter text.

Taxpayer Identification Number (TIN): Click or tap here to enter text.

(((( IMPORTANT ))))

NEW DOMESTIC OR FOREIGN SUPPLIERS MUST ATTACH A COPY OF YOUR CURRENT IRS FORM W-9, OR W-8 BEN, ACCORDINGLY, TO THIS REPRESENTATIONS & CERTIFICATIONS SUPPLMENTAL DOCUMENT.

FOR AN EXISTING SUPPLIER THAT HAS PREVIOUSLY SUBMITTED TO THE LABORATORY A W-9 OR W-8 BEN AND NOW ITS COMPANY NAME OR ADDRESS HAS CHANGED, YOU MUST PROVIDE SUCH NOTICES ON YOUR COMPANY LETTERHEAD. A CURRENT W-9 OR W-8 BEN IS REQUIRED FOR COMPANY NAME

CHANGES.

Physical Address: Click or tap here to enter text.

Mailing Address: Click or tap here to enter text.

(If different from physical address) Identify below the Place of Performance (principal plant or place of business where the items will be produced, supplied from stock, or where the service will be performed):

Zip+4: Click or tap here to enter text. Country: Click or tap here to enter text.

# of employees (if known & not a government entity):

Click or tap here to enter text.

Company Point of Contact:

Click or tap here to enter text.

Email: Click or tap here to enter text.

http://www.sam.gov/

REPRESENTATIONS AND CERTIFICATIONS SUPPLEMENTAL

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SECTION II

1. COMPLIANCE WITH EXPORT CONTROL LAWS AND REGULATIONS (Per DEAR 970.5225-1)(NOV 2015)

(a) Offeror’s Export Compliance Point of Contact Information:

Name Email Phone Click or tap here to enter text. Click or tap here to enter text. Click or tap here to enter text.

(b) The Offeror represents that items furnished under any resultant award agreement are ☐, are not ☐, items that are specially designed, fabricated, and configured for military or space applications as listed on the United States Munitions List (22 CFR 120-130).

(c) The Offeror represents that items furnished under any resultant award agreement are ☐, are not ☐, items that are dual-use military or space items listed on the Commerce Control List 15 CFR 730-774 (CCL) as 500 or 600 series items.

(d) The Offeror represents that items furnished under any resultant award agreement are ☐, are not ☐, items that are listed on the CCL, other than 500 or 600 series items. If the items are listed on the CCL, provide the following information:

Manufacturer’s Name

Description Export Classification Control Number (ECCN) or

EAR99

Harmonized Tariff Schedule (HTS) / Schedule B Number, if applicable

Click or tap here to enter text.

Click or tap here to enter text. Click or tap here to enter text.

Click or tap here to enter text.

[List as necessary]

2. BUY AMERICAN-SUPPLIES CERTIFICATE (Per FAR 52.225-2)(OCT 2022)

(a) Definitions, see FAR 52.225-1(a).

(b) (1) The Offeror certifies that each end product, except those listed in paragraph (b) of this provision, is a domestic end product and that each domestic end product listed in paragraph (c) of this provision contains a critical component.

(2) The Offeror shall list as foreign end products those end products manufactured in the United States that do not qualify as domestic end products. For those foreign end products that do not consist wholly or predominantly of iron or steel or a combination of both, the Offeror shall also indicate whether these foreign end products exceed 55 percent domestic content, except for those that are COTS items. If the percentage of the domestic content is unknown, select “no”.

(3) The Offeror shall separately list the line item numbers of domestic end products that contain a critical component (see

FAR 25.105).

(c) Foreign End Products: [List as necessary] Line Item No.

Country of Origin

Exceeds 55% domestic content

(yes/no) Click or tap here to enter text. ☐ Yes ☐ No Click or tap here to enter text. ☐ Yes ☐ No Click or tap here to enter text. ☐ Yes ☐ No

(d) Domestic end products containing a critical component:

Line Item No. Click or tap here to enter text.

[List as necessary]

(e) The Laboratory will evaluate offers in accordance with the policies and procedures of FAR 25.

3. BUY AMERICAN-CONSTRUCTION MATERIALS CERTIFICATE (Per FAR 52.225-2)(OCT 2022)

(Applicable for construction services that are performed in the United States)

(a) Definitions, see FAR 52.225-9(a).

(b) Domestic preference.

(1) This clause implements 41 U.S.C. Chapter 83, Buy American, by providing a preference for domestic construction material.

In accordance with 41 U.S.C. 1907, the domestic content test of the Buy American statute is waived for construction material that is a COTS item, except that for construction material that consists wholly or predominantly of iron or steel or a combination of both, the domestic content test is applied only to the iron and steel content of the construction materials, excluding COTS fasteners. (See FAR 12.505(a)(2)). The Contractor shall use only domestic construction material in performing this contract, except as provided in paragraphs (b)(2) and (b)(3) of this clause.

(2) This requirement does not apply to information technology that is a commercial product or to the construction materials or components listed by the Government as follows: NONE.

(3) The Contracting Officer may add other foreign construction material to the list in paragraph ©(2) of this clause of the Government determines that—

(i) The cost of domestic material would be unreasonable.

https://www.acquisition.gov/far/part-25#FAR_25_105 http://uscode.house.gov/browse.xhtml;jsessionid=114A3287C7B3359E597506A31FC855B3 http://uscode.house.gov/browse.xhtml;jsessionid=114A3287C7B3359E597506A31FC855B3 https://www.acquisition.gov/far/part-12#FAR_12_505

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(A) For domestic construction material that is not a critical item or does not contain critical components.

(1) The cost of a particular domestic construction material subject to the requirements of the Buy

American statute is unreasonable when the cost of such material exceeds the cost of foreign material by more than 20 percent;

(2) For construction material that is not a COTS item and does not consist wholly or predominantly of iron or steel or a combination of both, if the cost of a particular domestic construction material is determined to be unreasonable or there is no domestic offer received, and the low offer is for foreign construction material that is manufactured in the United States and does not exceed 55 percent domestic content, the Contracting Officer will treat the lowest offer of foreign construction material that exceeds 55 percent domestic content as a domestic offer and determine whether the cost of that offer is unreasonable by applying the evaluation factor listed in paragraph (b)(3)(i)(A)(1) of this clause.

(3) The procedures in paragraph (b)(3)(i)(B)(2) of this clause will no longer apply as of January 1, 2030.

(ii) The application of the restriction of the Buy American statute to a particular construction material would be impracticable or inconsistent with the public interest; or

(iii) The construction material is not mined, produced, or manufactured in the United States in sufficient and reasonably available commercial quantities of a satisfactory quality.

(c) Request for determination of inapplicability of the Buy American statute.

(1) (i) Any Contractor request to use foreign construction material in accordance with paragraph

(b)(3) of this clause shall include adequate information for Government evaluation of the request, including—

(A) A description of the foreign and domestic construction materials;

(B) Unit of measure;

(C) Quantity;

(D) Price;

(E) Time of delivery or availability;

(F) Location of the construction project;

(G) Name and address of the proposed supplier; and

(H) A detailed justification of the reason for use of foreign construction materials cited in accordance with paragraph (b)(3) of this clause.

(ii) A request based on unreasonable cost shall include a reasonable survey of the market and a completed price comparison table in the format in paragraph (d) of this clause.

(iii) The price of construction material shall include all delivery costs to the construction site and any applicable duty

(whether or not a duty-free certificate may be issued).

(iv) Any Contractor request for a determination submitted after contract award shall explain why the Contractor could not reasonably foresee the need for such determination and could not have requested the determination before contract award. If the Contractor does not submit a satisfactory explanation, the Contracting Officer need not make a determination.

(2) If the Government determines after contract award that an exception to the Buy American statute applies and the Contracting Officer and the Contractor negotiate adequate consideration, the Contracting Officer will modify the contract to allow use of the foreign construction material. However, when the basis for the exception is the unreasonable price of a domestic construction material, adequate consideration is not less than the differential established in paragraph (b)(3)(i) of this clause.

(3) Unless the Government determines that an exception to the Buy American statute applies, use of foreign construction material is noncompliant with the Buy American statute.

(d) Data. To permit evaluation of requests under paragraph (c) of this clause based on unreasonable cost, the Contractor shall include the following information and any applicable supporting data based on the survey of suppliers:

Construction Material Description

Unit of Measure

Quantity Price (dollars)*

Item 1 Foreign Click or tap here to enter text. $

Domestic Click or tap here to enter text. $ Item 2

Foreign Click or tap here to enter text. $ Domestic Click or tap here to enter text. $

[* Include all delivery costs to the construction site and any applicable duty (whether or not a duty-free entry certificate is issued)].

[List name, address, telephone number, and contact for suppliers surveyed. Attach copy of response; if oral, attach summary.] [Include other applicable supporting information.]

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4. RIGHTS TO PROPOSAL DATA (Technical) (Applicable when Offeror’s technical proposal is being considered as part of the award decision.)

☐ Not Applicable Or, the data contained in pages Click or tap here to enter text. of this proposal have been submitted in confidence and contain trade secrets or proprietary information, and such data shall be used or disclosed only for evaluation purposes; provided that if a contract is awarded to the offeror as a result of or in connection with the submission of this proposal, the Government and the Laboratory shall have the right to use or disclose the data herein to the extent provided in the contract. This restriction does not limit the Government's or the Laboratory's right to use or disclose data obtained without restriction from any source, including the offeror.

Reference to this notice on the cover sheet should be placed on each page to which the notice applies. Data or abstracts of data, marked with this notice will be retained in confidence and used by the Laboratory, DOE or its designated representative(s), including Laboratory or Government contractors and consultants, solely for the purpose of evaluating the proposal. The data so marked will not otherwise be disclosed or used without the offeror's prior written permission except to the extent provided in any resulting contract, or to the extent required by law. The restriction contained in the notice does not limit the Laboratory's nor the Government's right to use or disclose any data contained in the proposal if it is obtainable from any source, including the offeror, without restriction. Although it is our policy to treat all proposals as confidential, neither the Laboratory nor the Government assumes any liability for disclosure or use of unmarked data and both may use or disclose such data for any purpose.

5. RIGHTS IN DATA-GENERAL

(Generally, does not apply to Commercial Items or Commercial Services. However, applies when a technical proposal is being considered as part of the award decision (data will be produced, furnished or acquired.)

It is Laboratory policy for a contract award based on a proposal that, in consideration of the award, the Government shall obtain unlimited rights in the technical data (data which are of a scientific or technical nature) contained in the proposal unless the contractor marks those portions of the technical information which he asserts as "proprietary data" or specifies those portions of such technical data which are not directly related to or will not be utilized in the work to be funded under the contract. Accordingly, please indicate:

☐ No restriction on Government rights in the proposal technical data; or ☐ The following identified technical data is proprietary or is not directly related to or will not be utilized in the work to be funded under the contract: DATA: Click or tap here to enter text.

☐ Not Applicable

6. REPRESENTATION OF LIMITED RIGHTS DATA AND RESTRICTED COMPUTER SOFTWARE

(NOTE: “Limited rights data” & “Restricted computer software” are defined in the contract clause “Rights in Data – General.” (48 CFR 52.227-14).)

(a) This solicitation sets forth the work to be performed if a contract award results, and the Government's and the Laboratory's known delivery requirements for data (as defined in 48 CFR 52.227-14). Any resulting contract may also provide the Government and the Laboratory the option to order additional data under the Additional Data Requirements clause at 48 CFR 52.227-16 of the FAR, if included in the contract. Any data delivered under the resulting contract will be subject to the Rights in Data--General clause at 48 CFR 52.227-14 that is to be included in this contract. Under the latter clause, a Contractor may withhold from delivery data that qualify as limited rights data or restricted computer software, and deliver form, fit, and function data in lieu thereof. The latter clause also may be used with it Alternates II and/or III to obtain delivery of limited rights or restricted computer software, marked with limited rights or restricted rights notices, as appropriate. In addition, use of Alternate V with this latter clause provides the Government the right to inspect such data at the Contractor's facility.

(b) As an aid in determining the Government's and the Laboratory's need to include any of the aforementioned Alternates in the clause at 48 CFR 52.227-14, Rights in Data--General, the offeror's response to this solicitation shall, to the extent feasible, complete the representation in paragraph (b) of this provision to either state that none of the data qualify as limited rights data or restricted computer software, or identify which of the data qualifies as limited rights data or restricted computer software. Any identification of limited rights data or restricted computer software in the offeror's response is not determinative of the status of such data should a contract be awarded to the offeror.

REPRESENTATION CONCERNING DATA RIGHTS

Offeror has reviewed the requirements for the delivery of data or software and states (offeror must check appropriate block)— ☐ None of the data proposed for fulfilling such requirements qualifies as limited rights data or restricted computer software.

☐ Data proposed for fulfilling such requirements qualify as limited rights data or restricted computer software and are identified as follows: Click or tap here to enter text.

☐ Not Applicable

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7. CERTIFICATION AS TO SMALL BUSINESS OR NONPROFIT STATUS UNDER PUBLIC LAW 96-517, AS AMENDED BY PUBLIC LAW 98-620

PATENT TERMS AND NOTICE OF RIGHT TO REQUEST PATENT WAIVER

(a) Under the provisions of Public Law 96-517 as amended by Public Law 68-620, the patent terms required for contracts with offerors in certain categories are as set forth in DOE Acquisition Regulations. In order to determine the Patent Provisions applicable to this contract, please check the applicable box. Offeror is:

☐ A small business firm as defined at Section 3 of Public Law 85-536 (15 U.S.C. 632) and implementing regulations of the

Administrator of Small Business Administration.

☐ A university or other institution of higher education or an organization of the type described in Section 501(c)(3) of the Internal

Revenue Code of 1954 (26 U.S.C. 501(c)) and exempt from taxation under Section 501(a) of the Internal Revenue Code (26 U.S.C.

501(a)); or

☐ A nonprofit scientific or educational organization qualified under a State nonprofit organization statute. Name of the statute:

Click or tap here to enter text.

☐ None of the above.

(b) Offerors who fall within any of the above categories have the right to request in advance of or within thirty (30) days after execution of the contract, in accordance with applicable statutes and DOE Patent Waiver Regulation 10 CFR 784, a waiver of all or any part of the rights of the United States in subject inventions. If the offeror intends to request a waiver to such invention rights pursuant to DOE Patent Waiver Regulation 10 CFR 784, please indicate:

☐ I intend to request an advance waiver in accordance with DOE Patent Waiver Regulation 10 CFR 784.

☐ I do not intend to request an advance waiver.

This is submitted with the intention that the Department of Energy rely on my representation that the offeror is a member of the category indicated.

8. COVENANT AGAINST CONTINGENT FEES (Per FAR 52.203-5)(MAY 2014)

(Applicable if offer exceeds Simplified Acquisition Threshold (SAT). Does not apply if requirements are for commercial products or commercial services.)

By submission of this Representations and Certifications Supplemental—

(a) The Contractor warrants that no person or agency has been employed or retained to solicit or obtain this contract upon an agreement or understanding for a contingent fee, except a bona fide employee or agency. For breach or violation of this warranty, the Government shall have the right to annul this contract without liability or, to deduct from the contract price or consideration, or otherwise recover, the full amount of the contingent fee.

(b) "Bona fide agency," as used in this clause, means an established commercial or selling agency, maintained by a contractor for the purpose of securing business, that neither exerts nor proposes to exert improper influence to solicit or obtain Government contracts nor holds itself out as being able to obtain any Government contract or contracts through improper influence.

Bona fide employee, as used in this clause, means a person, employed by a contractor and subject to the contractor’s supervision and control as to time, place, and manner of performance, who neither exerts nor proposes to exert improper influence to solicit or obtain Government contracts nor holds out as being able to obtain any Government contract or contracts through improper influence.

Contingent fee, as used in this clause, means any commission, percentage, brokerage, or other fee that is contingent upon the success that a person or concern has in securing a Government contract.

Improper influence, as used in this clause, means any influence that induces or tends to induce a Government employee or officer to give consideration or to act regarding a Government contract on any basis other than the merits of the matter.

9. CERTIFICATION OF NONSEGREGATED FACILITIES

By submission of this Representations and Certifications Supplemental—

(a) “Segregated facilities,” as used in this provision, means any waiting rooms, work areas, rest rooms and wash rooms, restaurants and other eating areas, time clocks, locker rooms and other storage or dress areas, parking lots, drinking fountains, recreation or entertainment areas, transportation, and housing facilities provided for employees, that are segregated by explicit directive or are in fact segregated on the basis of race, color, religion, or national origin because of habit, local custom, or otherwise.

(b) By the submission of this offer, the offeror certifies that it does not and will not maintain or provide for its employees any segregated facilities at any of its establishments, and that it does not and will not permit its employees to perform their services at any location under its control where segregated facilities are maintained. The offeror agrees that a breach of this certification is a violation of the Equal Opportunity clause in the contract.

(c) The offeror further agrees that (except where it has obtained identical certifications from proposed subcontractors for specific time periods) it will –

(1) Obtain identical certifications from proposed subcontractors before the award of subcontracts under which the subcontractor

Revision 0, 12-8-2022 Page 6 of 6 will be subject to the Equal Opportunity clause;

(2) Retain the certifications in the files; and

(3) Forward the following notice to the proposed subcontractors (except if the proposed subcontractors have submitted identical certifications for specific time periods):

NOTICE TO PROSPECTIVE SUBCONTRACTORS OF REQUIREMENT FOR CERTIFICATIONS OF NON SEGREGATED FACILITIES

A Certification of Nonsegregated Facilities must be submitted before the ward of a subcontract under which the subcontractor will be subject to the Equal Opportunity clause. The certification may be submitted either for each subcontract or for all subcontracts during a period (i.e., quarterly, semiannually, or annually).

NOTE: The penalty for making false statements in offers is prescribed in 18 U.S.C. 1001.

10. RADIOACTIVE MATERIALS

For purposes of this question, “radiation” includes particles with energies in the range of KeV or higher. It does not include laser, IR, UV or microwave radiation.

(a) Is there any planned or potential use of radioactive material under the proposed subcontract?

☐ YES ☐ NO

(b) Is there any planned or potential use of a radiation-producing device, e.g., accelerator, reactor, x-ray machine, fusion device?

☐ YES ☐ NO

If a. or b. above is answered “YES”, then provide the following information:

Principal Investigator Name: Click or tap here to enter text.

Phone No.: Click or tap here to enter text.

Email: Click or tap here to enter text.

Health Physicist/Radiation Safety Officer Name: Click or tap here to enter text.

Phone No.: Click or tap here to enter text.

Email: Click or tap here to enter text.

(c) Will subcontractor’s personnel perform any part of the work at Ames National Laboratory? ☐ YES ☐ NO

11. SUSPECT/COUNTERFEIT PARTS CERTIFICATION

Suspect/counterfeit parts shall not be used in the performance of any work resulting from this offer, whether on or off the Laboratory site, nor shall suspect/counterfeit parts be included in any supplies furnished as a result of this offer.

12. AMES NATIONAL LABORTORY TERMS AND CONDITIONS

By submission of its offer, the offeror represents that, unless otherwise noted in the offeror’s proposal, the Laboratory’s terms and conditions (included in the Laboratory’s solicitation) will be included in and govern any subsequent subcontract.

CERTIFICATION

A PERSON AUTHORIZED TO MAKE LEGALLY BINDING COMMITMENTS ON BEHALF OF THE OFFEROR MUST SIGN BELOW. BY SIGNING BELOW, THE OFFEROR CERTIFIES, UNDER PERJURY OF LAW, THAT THESE REPRESENTATIONS AND CERTIFICATIONS SUPPLEMENTAL ARE

ACCURATE, CURRENT, AND COMPLETE.

Company/Organization Name: Click or tap here to enter text.

Signature:

Signer’s Name (Printed): Click or tap here to enter text.

Title: Click or tap here to enter text.

Date: Click or tap to enter a date.

Telephone Number: Click or tap here to enter text.

Email Address: Click or tap here to enter text.