Attachment 2 889 Representation Form with Provisions 8 March 2021.pdf

Covered Telecommunications Equipment or Services-Representation

Section 1 - References

1. FAR 52.204-24 through 26, FAR 4.2105(a)

2. Policy Alert# 20-124 and Rev 1

Section 2 - Merchant Representation

As prescribed in FAR 4.2105(a), the merchant completes the following representation in paragraph (c) below:

(a) Definitions. As used in this provision, "covered telecommunications equipment or services" has the meaning provided in the clause 52.204-25, Prohibition on Contracting for Certain Telecommunications and Video Surveillance Services or Equipment.

(b) 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".

(c) Representation. The Offeror represents that it does, 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.

Merchant Name

Merchant's Authorized Representative

(Typed Name)

Authorized Representative Signature and Date

Section 3 - Instructions

A. Card holder (CH) provides this representation document to the merchant to complete, sign, and return to the CH.

B. Merchant completes the following:

1. Merchant goes to the following FAR site:

https :/ /www. acq u is itio n .gov/ content/pa rt-52-so I ic itatio n-p rovis ions-a nd-contract-c I au ses#i d 1989 I 60014C

2. Merchant reads FAR Provision 52.204-24 and Clause 52.204-25.

3. Upon completion of Step 2, merchant fills out the Section 2 paragraph (c) of the form above and returns the form to the CH

C. If a merchant represents "does not," the CH can rely on the representation and make the purchase.

D. If a merchant represents "does," or the merchant declines to complete the Representation - the CH shall not make the purchase. Forward the requirement along with the representation to the supporting contracting office for action.

E. If it is determined that entering into a contract with the merchant does not violate the section 889 prohibitions, the supporting contracting office may provide written approval for the CH to make the purchase. The CH shall include a copy of this approval with the transaction supporting data.

F. The following GPC transactions are exempt as these transactions are payments, not purchases.

1. Contract Payment Official - use of the GPC as a payment method only

2. Inter/Intra-Governmental Payments - (ex. DLA Document Services, NSN items using FedMall, or GSA Global Supply.

3. SF-182 Training Payments

G. Retain all documentation that supports this representation and upload in AXOL.

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-

( I )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 Off eror 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 Off eror has responded "will" in the representation in paragraph (d)(l) of this provision, the Offeror shall provide the following information as part of the off er:

(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