Attachment 004 - Barracks Maintenance - Affirmation of Business Status Certification.pdf
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- Attached to
- Barracks Maintenance OTA
- Solicitation number
- W9124826R0041
About this file
This is a federal contracting form requiring business status certification from all significant participating entities in a proposal or bid.
The form requires completion of entity information including legal name, proposed NAICS code, industry size standard designation (Small/Large/Foreign), UEI number, CAGE code, tax identification number, SAM registration status with expiration date, and complete address and point of contact details. Each entity must certify its business status by selecting one of five categories: Nontraditional Defense Contractor (NDC) as defined under 10 U.S.C. § 3014 for entities with no DoD contracts subject to cost accounting standards in the preceding year; Nonprofit Research Institution (NRI) as defined under 40 C.F.R. § 262.200 for organizations conducting research as their primary function and filing as 501(c)(3) nonprofits; Small Business Contractor (SB) as defined under 15 U.S.C. § 632 for independently owned and operated enterprises not dominant in their field; Traditional Defense Contractor (TDC) that does not meet NDC definition, subdivided into TDC–Small Business or TDC–Large Business; or Other with self-identification for entities not covered by the above categories. The form requires signature certification by an authorized representative affirming that all representations are accurate and true, with the signatory's name, title, and date. The document is effective May 5, 2026.
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ATTACHMENT 004: AFFIRMATION OF BUSINESS STATUS CERTIFICATION
May 5, 2026 Page 1 of 2
Every significant participating entity shall complete the following table and provide a signature representing its certification.
Legal Entity Name
Proposed NAICS Code
Industry Size Standard (Small/Large/Foreign)
UEI Number
CAGE Code
Tax Identification
Active SAM Registration ☐ Yes ☐ No Expiration Date:
Address 1
Address 2
City/State/Zip
POC Name/Title
POC Phone/e-mail
The Entity named above represents that it is (check one of the following boxes):
A Nontraditional Defense Contractor (NDC) – As defined in 10 U.S.C. § 3014, is an entity that is not currently performing and has not performed, for at least the one-year period preceding the solicitation of sources by DoD for the procurement or transaction, any contract or subcontract for the DoD 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.
A Nonprofit Research Institution (NRI) – As defined in 40 C.F.R. § 262.200, is an organization that conducts research as its primary function and files as a non-profit organization under the tax code of 26 U.S.C. 501(c)(3). Additionally, it 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; and includes federally funded research and development centers, as identified by the National Scientific Foundation.
ATTACHMENT 003: AFFIRMATION OF BUSINESS STATUS CERTIFICATION
May 5, 2026 Page 2 of 2
A Small Business Contractor (SB) – As defined in 15 U.S.C. § 632, small business concern is an enterprise that is deemed to be one that is independently owned and operated, and is not dominant in its field of operation based on the appropriate standards, utilizing the number of employees, dollar volume of business, net worth, net income, a combination thereof, or other appropriate factors.
A Traditional Defense Contractor (TDC) – A TDC is an entity that does not meet the definition of a NDC, as defined in 10 U.S.C. § 3014. (Check one of the following)
☐ TDC – Small Business
☐ TDC – Large Business
Other (Self-Identify) – For entities not covered above. Please specify.
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
Name
Title
Date
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