Attachment_3_-_52_212-3.docx
DOCX document 31 KB Posted
- Attached to
- DOI Main Building Food Services RFQ
- Solicitation number
- 140E0126Q0001
About this file
This document is a Federal Acquisition Regulation (FAR) 52.212-3 Offeror Representations and Certifications form for a food concession services solicitation by the U.S. Department of the Interior. The form is designed for offerors without an active SAM.gov registration and requires vendors to provide key business information, including organizational details, small business status, and compliance certifications.
The associated solicitation (140E0126Q0001) is a Total Small Business Set-Aside competition for food concession services at the DOI Stewart Lee Udall Building. The contract has a base period of one year with four additional one-year option periods. Potential vendors must complete this form to demonstrate eligibility, with sections covering business type, small business classification, equal opportunity compliance, tax status, and product/service certifications. Interested businesses must carefully complete all applicable sections to be considered for the food services contract.
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Other files
| File | Type | Posted |
|---|---|---|
| Sol_140E0126Q0001_Amd_0003.pdf | ||
| AMD_0003_Attachment_1_-_T_C_-_16JAN2026_0003.pdf | ||
| AMD_0003_COMPLETE_RFQ_-_16JAN2026_0003.pdf | ||
| AMD_0003_Attachment_4_-_16JAN2026_0003.xlsx | XLSX spreadsheet | |
| Sol_140E0126Q0001_Amd_0002.pdf | ||
| Sol_140E0126Q0001_Amd_0001.pdf | ||
| RFQ_140E0126Q0001_Final_-_15DEC2025.pdf | ||
| Attachment_1_-_T_C.pdf | ||
| Attachment_2_-_DC_WageDetermination.txt | TXT text file | |
| References_1-4.pdf |
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Text version
If completed, this form does not apply to any page limitations set forth in the RFQ.
FAR 52.212-3 — Offeror Representations and Certifications (Attachment for Offerors Without an Active SAM.gov Record) This attachment is provided for offerors who do NOT have an active SAM.gov registration or an up to date SAM.gov registration. Quoters shall complete all applicable sections of this provision. The Government will use this completed form to determine the offeror’s eligibility for award.
(a) Offeror Information Offeror Name: ________________________________ Address: ______________________________________ City/State/ZIP: ________________________________ UEI (if available): _____________________________
TIN: __________________________________________
(b) Representation Regarding Responsibility The offeror certifies that it is □ / is not □ a responsible contractor.
(c) Taxpayer Identification Number (TIN)
TIN: __________________________________________
Type of Organization (check one):
□ Sole Proprietorship
□ Partnership
□ Corporate Entity (Not Tax-Exempt)
□ Corporate Entity (Tax-Exempt)
□ Government Entity
□ Other: ___________________________________
(d) Small Business Status Check all that apply:
□ Small Business
□ Small Disadvantaged Business
□ Women-Owned Small Business
□ HUBZone Small Business
□ Veteran-Owned Small Business
□ Service-Disabled Veteran-Owned Small Business
□ Not a Small Business
(e) Affirmative Action Compliance The offeror □ has / □ has not participated in previous contracts or subcontracts subject to Equal Opportunity requirements.
(f) Previous Contracts and Compliance Reports (FAR 52.222-22) The offeror □ has / □ has not filed required reports.
(g) Certification Regarding Payments to Influence Federal Transactions (FAR 52.203-11) The offeror certifies that it □ has / □ has not made any payments in violation of 31 U.S.C. 1352.
(h) Representations Regarding Felony Conviction or Tax Delinquency (FAR 52.209-11) The offeror certifies that it □ is / □ is not a corporation with any unpaid federal tax liability.
The offeror certifies that it □ is / □ is not a corporation with a felony conviction under Federal law.
(i) Product/Service Certification The offeror certifies that all products and/or services proposed comply with the solicitation.
Signature Name: _________________________________________ Title: __________________________________________ Phone: _________________________________________ Email: __________________________________________ Signature: ______________________________________ Date: ___________________________________________ Request for Quotation No. 140E0126Q0001 – Attachment 3 (52.212-3) U.S. Department of the Interior – Stewart Lee Udall Building Food Concession Services
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