Attachment 3 - Local Non-FAR Representations and Certifications.pdf

ATTACHMENT 3

AIR FORCE RESEARCH LABORATORY

DIRECTED ENERGY AND SPACE VEHICLES DIRECTORATES

CERTIFICATIONS FOR APPLICATIONS FOR FEDERAL ASSISTANCE

(GRANTS AND COOPERATIVE AGREEMENTS)

(Current as of 27 Aug 2007)

2 CFR §180.335 – Debarment and Suspension

(1) The prospective primary participant certifies to the best of its knowledge and belief, that it and its principals:

(a) Are Are not presently excluded or disqualified;

(b) Have Have not been convicted within the preceding three years of any offenses listed in §180.800(a) or had a civil judgment rendered against you for one of those offenses within that time period;

(c) Are Are not presently indicted for or otherwise criminally or civilly charged by a governmental entity (Federal, State or local) with commission of any of the offenses listed in §180.800(a); or

(d) Have Have not had one or more public transactions (Federal, State or local) terminated within the preceding three years for cause or default.

32 CFR Part 26 – Drug-Free Workplace

§26.300 (Recipients Other Than Individuals)

As a condition of receiving a DoD Component award, the recipient agrees that—

(a) First, you must make a good faith effort, on a continuing basis, to maintain a drug-free workplace. You must agree to do so as a condition for receiving any award covered by this part.

The specific measures that you must take in this regard are described in more detail in subsequent sections of this subpart. Briefly, those measures are to–

(1) Publish a drug-free workplace statement and establish a drug-free awareness program for your employees (see §§26.205 through 26.220); and

(2) Take actions concerning employees who are convicted of violating drug statutes in the workplace (see §26.225).

(b) Second, you must identify all known workplaces under your Federal awards (see §26.230).

Place of Performance (Street address, city, county, State, zip code)

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Check if there are workplaces on file that are not identified here.

§26.300 (Recipients Who Are Individuals)

As a condition of receiving a DoD Component award, the recipient agrees that--

(a) He or she will not engage in the unlawful manufacture, distribution, dispensing, possession, or use of a controlled substance in conducting any activity with the grant; and

(b) If convicted of a criminal drug offense resulting from a violation occurring during the conduct of any award activity, he or she will report the conviction:

(1) In writing.

(2) Within 10 calendar days of the conviction.

(3) To the DoD Component awarding official or other designee, for to every grant office or other designee, for each award that you currently have, unless §26.301 or the award document designates a central point for the receipt of the notices. When notice is made to a central point, it must include the identification number(s) of each affected award.

32 CFR Part 28 Appendix A – Lobbying

The undersigned certifies, to the best of his or her knowledge and belief, that:

(1) No Federal appropriated funds have been paid or will be paid, by or on behalf of the undersigned, to any person for influencing or attempting to influence an officer or employee of an agency, a Member of Congress, an officer or employee of Congress, or an employee of a Member of Congress in connection with the awarding of any Federal contract, the making of any Federal grant, the making of any Federal loan, the entering into of any cooperative agreement, and the extension, continuation, renewal, amendment, or modification of any Federal contract, grant, loan, or cooperative agreement.

(2) If any funds other than Federal appropriated funds have been paid or will be paid to any person for influencing or attempting to influence an officer or employee of any agency, a Member of Congress, an officer or employee of Congress, or an employee of a Member of Congress in connection with this Federal contract, grant, loan, or cooperative agreement, the undersigned shall complete and submit Standard Form-LLL, ``Disclosure Form to Report Lobbying,'' in accordance with its instructions.

(3) The undersigned shall require that the language of this certification be included in the award documents for all subawards at all tiers (including subcontracts, subgrants, and contracts under grants, loans, and cooperative agreements) and that all subrecipients shall certify and disclose accordingly.

This certification is a material representation of fact upon which reliance was placed when this transaction was made or entered into. Submission of this certification is a prerequisite for making or entering into this transaction imposed by section 1352, title 31, U.S. Code. Any person who fails to file the required certification shall be subject to a civil penalty of not less than $10,000 and not more than $100,000 for each such failure.

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Sections 8114 and 8113 of Division C and sections 514 and 515 of Division E of the Consolidated and Further Continuing Appropriations Act, 2013, (Pub. L. 113-6)

(a) In accordance with sections 8114 and 8113 of Division C and sections 514 and 515 of Division E of the Consolidated and Further Continuing Appropriations Act, 2013, (Pub. L. 113-6), none of the funds made available by that Act for DoD (including Military Construction funds) may be used to enter into an agreement with any entity that--

(1) Has any unpaid Federal tax liability that has been assessed, for which all judicial and administrative remedies have been exhausted or have lapsed, and that is not being paid in a timely manner pursuant to an agreement with the authority responsible for collecting the tax liability, where the awarding agency is aware of the unpaid tax liability, unless the agency has considered suspension or debarment of the corporation and made a determination that this further action is not necessary to protect the interests of the Government; or

(2) Was convicted of a felony criminal violation under any Federal law within the preceding 24 months, where the awarding agency is aware of the conviction, unless the agency has considered suspension or debarment of the corporation and made a determination that this action is not necessary to protect the interests of the Government.

(b) The prospective participant represents that--

(1) It is is not an entity that has any unpaid Federal tax liability that has been assessed, for which all judicial and administrative remedies have been exhausted or have lapsed, and that is not being paid in a timely manner pursuant to an agreement with the authority responsible for collecting the tax liability,

(2) It is is not an entity that was convicted of a felony criminal violation under a Federal law within the preceding 24 months.

As an authorized representative, I hereby make the above certifications on behalf of the offeror.

(Signature) Date

Name of Authorized Company Official

Offeror's Taxpayer Identification Number (TIN): _________________________

Offeror's Data Universal Numbering System (DUNS) Number: _________________________

Offeror's applicable Commercial and Government Entity (CAGE) Code: __________

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