Attachment 4 - Business Worksheet.pdf

Source Selection Information – See FAR 2.101 and 3.104 (When filled-in, this Document becomes CUI//SP-SSEL)

HTC71126QE130

Attachment 4

Business Proposal Worksheet

Company Name of Offeror:

Offerors are required to complete all items on this worksheet. A text field is provided below each item requiring a response. For items that do not require a narrative response, a drop down menu is included to acknowledge the necessary attachments/documentation and provision fill-ins/certifications were provided. Please be aware that responses are limited to the text field provided.

**Restriction on disclosure and use of data applies per solicitation section III under Federal

Acquisition Regulation provision 52.212-1.

Subfactor A: Proposal Compliance

1. The Offeror shall complete the Standard Form (SF) 1449, blocks 12, 17a, and 30a, b, and c. Block

17a should include the Commercial and Government Entity (CAGE) code. Signature by the Offeror on the SF 1449 constitutes an offer, which the Government may accept, and acknowledgement by the

Offeror that they accede to the contract terms and conditions as written in the Request for Proposal

(RFP), with attachments. Block 17b of the SF 1449 shall be checked if the Offeror’s remittance address is different. The remittance address must be identified in the proposal and such address must be registered in the System for Award Management (SAM) database.

2. Any amendments to the solicitation will be provided via the SF 30. If applicable, the Offeror shall complete blocks 15a, b, and c on each SF 30.

3. FAR Provision 52.209-5, Certification Regarding Responsibility Matters (Feb 2026) (Deviation). The

Offeror shall complete paragraphs (A) through (D).

4. FAR Provision 52.209-7, Information Regarding Responsibility Matters (Feb 2026) (Deviation). The

Offeror shall complete paragraph (b).

Source Selection Information – See FAR 2.101 and 3.104 (When filled-in, this Document becomes CUI//SP-SSEL)

HTC71126QE130

Attachment 4

** Use or disclosure of data contained on this sheet is subject to the restriction on page 1 of the

Business Proposal Worksheet.

5. FAR Provision 52.219-4, Notice of Price Evaluation Preference for HUBZone Small Business

Concerns (Feb 2026) (Deviation). If applicable, the Offeror shall complete paragraph(b).

6. FAR Provision 52.222-56, Certification Regarding Trafficking in Persons Compliance Plan (Feb

2026). Provide a certification statement for compliance.

Offeror’s Response:

7. FAR Provision 52.229-11, Tax on Certain Foreign Procurements – Notice and Representation (Jun

2020). The Offeror shall complete paragraph (d).

8. DFARS Provision 252.204-7016, Covered Defense Telecommunications Equipment or Services-

Representation (Dec 2019). The Offeror shall complete paragraph (c).

9. DFARS Provision 252.204-7017, Prohibition on the Acquisition of Covered Defense

Telecommunications Equipment or Services, Representation (May 2021). The Offeror shall complete paragraph (d).

10. Names, titles, telephone numbers, and email addresses of the individual(s) authorized to negotiate, on the Offeror’s behalf, with the Government in connection with this solicitation.

Offeror’s Response:

Source Selection Information – See FAR 2.101 and 3.104 (When filled-in, this Document becomes CUI//SP-SSEL)

HTC71126QE130

Attachment 4

** Use or disclosure of data contained on this sheet is subject to the restriction on page 1 of the

Business Proposal Worksheet.

11. Name, title, and signature of the individual(s) authorized to sign the proposal and resultant contract.

Proposals signed by an agent shall be accompanied by evidence of agent’s authority, unless evidence has been previously furnished to the issuing office.

Offeror’s Response:

12. Standard Carrier Abbreviation Code (SCAC), Commercial And Government Entity (CAGE), and

Unique Entity Identifier (UEI).

Offeror’s Response:

13. Company website (if applicable).

Offeror’s Response:

14. As required by FAR 9.5, the Government will ensure no organizational conflicts of interest (OCI) are present. If any such conflict of interest is found to exist, the Contracting Officer may disqualify the

Offeror or determine that it is otherwise in the best interests of the United States to contract with the

Offeror and include the appropriate provisions to avoid, neutralize, mitigate, or waive such conflict in the contract awarded. The Offeror shall provide the Contracting Officer with complete information of any previous or ongoing work that is in any way associated with this acquisition, or related acquisitions. The Offeror shall submit a mitigation plan that addresses actual or perceived conflicts of interest related to the services required by this effort for Government review. The Government will conduct an independent assessment review of any submitted OCI Mitigation Plan to determine if any actual or perceived OCI exists and what further actions are necessary, if any. Additionally, the

Government will monitor contract performance for emerging areas of conflict of interest and take action considered necessary to avoid, neutralize, or mitigate conflicts. If the Offeror believes there is no OCI, a statement as such shall be included.