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Mount Rainier National Park

Solicitation: 140P8324Q0085

Environmental Compliance Services for SR410 White River Project

REQUEST FOR QUOTATION (RFQ)

Attachment 4 - Quote Submission

Package (QSP)

NATIONAL PARK SERVICE

OLYM MABO

August 2024

Solicitation No. 140P8324Q0085 Quote Submission Package

READ CAREFULLY: Many Government-provided forms mentioned in Attachment no. 1, Section 6 (Instructions to Quoters (What to Include in Quote)) have been collected and provided in this Adobe Portable Document Format (PDF) portfolio format for the Quoter’s convenience.

However, the Quoter is cautioned that that some criteria set forth in Section 6 of Solicitation

Attachment no. 1 requires submission of documents for which no form or format is provided.

The Quoter should carefully review the request for quotations preparation instructions provided in Section 6 in Attachment no. 1 of the Solicitation when formulating their quote.

TABLE OF CONTENTS

1. Experience and Past Performance Form

(applicable to technical evaluation factors 2 and 3)

2. Key Personnel Experience Form

(applicable to technical evaluation factor 2)

3. Limitations on Subcontracting

(applicable to clause 52.219-14, requiring Quoter/Contractor subcontract no more than 50% of the work of the project – refer to clause. This is only required to be submitted at end of contract as a post-award deliverable. It is included in solicitation for Quoters to be award of reporting requirement)

4. Optional Provision 52.219-28 Re-Represent NAICS

(use only if Quoter’s SAM.gov account does not include NAICS 541620 at time of submitting quote)

5. Price Schedule

6. Provision 52.222-22

7. Provision 52.204-24 and 52.204-26

Experience and Past Performance

READ CAREFULLY: The purpose of this form is for the Quoter to demonstrate their technical capability to complete the work by providing a list of jobs of similar nature/scope and their past performance by providing references to current or former customers who will attest to the quality of their product or service as described under the Instructions to Quoters (What to Include in Quote) in Attachment no. 1, Terms/Provisions/Clauses, Section 06.

Name of company/quoter:

RELEVANT EXPERIENCE AND PAST PERFORMANCE:

Contract Number:

Amount:

Project Title:

Dates Performed:

Agency/Owner:

Contact Person:

Phone Number:

Describe the project work performed:

Contract Number:

Amount:

Project Title:

Dates Performed:

Agency/Owner:

Contact Person:

Phone Number:

Describe the project work performed:

Contract Number:

Amount:

Project Title:

Dates Performed:

Agency/Owner:

Contact Person:

Phone Number:

Describe the project work performed:

RFQ NO. 140P8324Q0085 ATTACHMENT NO. 4 QSP Package

Experience and Past Performance Form

Key Personnel Qualifications

READ CAREFULLY: The purpose of this form is for the Quoter to list the qualifications of all key personnel as described under the Instructions to Quoters (What to Include in Quote) in Attachment no. 1, Terms/Provisions/Clauses, Section 06. Experience and qualifications include those jobrelated training courses; certificates and licenses; honors; performance awards; and specialty skills that are relevant to the proposed project. Provide dates, but do not send documents. If applicable, provide the state in which registration or license is held and the registration or license number. Fill in the information by typing or printing legibly.

Name of company/quoter:

Personnel Information:

Name:

Job Title:

Years of Experience with This Firm:

Years of Experience with Other Firms:

Education and Professional Registration:

Top Educational Level Obtained:

Year:

Area of Specialization:

Professional Registrations:

Area of Specialization:

Experience and Qualifications

RFQ NO. 140P8423Q0085 ATTACHMENT NO. 4 QSP Package

Key Personnel Experience Form

Template for Contracts

Solicitation (RFQ) 140P8324Q0085

FAR Clause 52.219-14 Limitations on Subcontracting (Oct 2022) is incorporated by reference in Section 6-Clauses, in Attachment no. 1 Terms/Provisions/Clauses (8/20/24). The clause in full text, is as follows: (e) Limitations on subcontracting. By submission of an offer and execution of a contract, the Contractor agrees that in performance of a contract assigned a North American Industry Classification System (NAICS) code for— (1) Services (except construction), it will not pay more than 50 percent of the amount paid by the Government for contract performance to subcontractors that are not similarly situated entities. Any work that a similarly situated entity further subcontracts will count towards the prime contractor's 50 percent subcontract amount that cannot be exceeded. When a contract includes both services and supplies, the 50 percent limitation shall apply only to the service portion of the contract; What this section of the clause means is the Quoter/Awardee shall be capabile of performing 50% of the work of the project with its own crew/staff/team, subcontracting no more than 50% of the work of the project.

Report on Limitations on Subcontracting

Contract Number (PIID) [Insert PIID]

Type of Set Aside [Insert Type of Set-Aside]

Total Contract Value [Insert Total Contract Value]

Performance Period for This Report [Insert Date] to [Insert Date]

Type of Service

Total Amount Paid by the Government to the Prime during the Performance Period

Similarly Situated Subcontractors (SSS) Total Amount Paid to [Insert First SSS Name]

Total Amount Paid to [Insert Second SSS Name]

Total Amount Paid to [Insert Third SSS Name]

Total Amount Paid to [Insert Fourth SSS Name]

Total Amount Paid to SSS $0

Non-Similarly Situated Subcontractors (NSS) Total Amount Paid to [Insert First NSS Name]

Total Amount Paid to [Insert Second NSS Name]

Total Amount Paid to [Insert Third NSS Name]

Total Amount Paid to [Insert Fourth NSS Name]

Total Amount Paid to NSS $0

Sheet2

Services (except construction)

General construction

Construction by special trade contractors

RFQ No. 140P8324Q0085

Quoter shall have their representations and certifications (“reps/certs”) filled out electronically in SAM.gov. Provision 52.212-3 is incorporated by reference, available by full text at https://www.acquisition.gov/far/part-52#FAR_52_204_7.

In accordance with the clause 52.219-28 incorporated by reference in Section 5 in Attachment no. 1 – Terms, Provisions, Clauses (listed within Clause 52.212-5, Listed as Item 28), only if Quoter DOES NOT have a representation in SAM for the NAICS code applicable to this solicitation, then Quoter IS required to complete the following rerepresentation and submit it with quote, as follows:

The Contractor represents that it □ is, □ is not a small business concern under NAICS Code 541620 (Environmental Compliance Services) with an associated small business size standard of $19 million.

Submitted by:

_______________________________________________________________ (signature)

_______________________________________________________________ (date)

_______________________________________________________________ (type name)

_______________________________________________________________ (company name)

_______________________________________________________________ (Unique Entity ID)

PRICE SCHEDULE - BASE & OPTION

QUOTER:

SOLICITATION PRICE SCHEDULE

SOLICITATION NUMBER: 140P8424Q0085

PROJECT TITLE: Environmental Compliance Services

DEVELOPED AREA: Mount Rainier National Park (SR410 corridor within MORA is within Pierce County, WA. Park HQ is Ashford, WA, aslo Peirce County).

Quoters are required to submit, at a minimum, a quote that conforms to the solicitation documents with pricing for all line items listed below. Failure to do so may render the quote unacceptable. For any lump-sum line items, provide the total price only. For any unit-priced line items, provide the unit price and the extended total price. If no specific line item exists for a portion of the work, include the costs in a related item. In case of error in calculation of extended prices, the unit price governs. In case of summation error, the total corrected amounts govern. Round totals & extended prices to whole dollars. NOTE: Quoters shall refer to Attachment 3, Statement of Work, Section G, Contractor Tasks, for ful description of all tasks and subtasks. The line items below include base project items and optional items. The optional line items will be retained in the awarded contract price schedule with the intent that the Government may award any of the options during performance of the contract if determined necessary and with available funds. The Contracting Officer's Representative (COR) and contractor shall agree prior to award of options, which options are necessary. Any options selected will be awarded by the Contracting Officer unilaterally. Refer to options clauses in Section I of Attachment 1.

BASE PROJECT LINE ITEMS:

BASE PROJECT PRICE SCHEDULE LINE ITEM NUMBER PRICE SCHEDULE LINE ITEM TITLE Note: Line Ites below are in accordance with the Statement of Work, Section G, Contractor Tasks QUANTITY UNIT OF MEASURE TOTAL PRICE

SOW PART 1 - PRELIMINARY (PRE-NEPA) PROJECT PLANNING SERVICES

1 Task 1 - Preliminary Project Planning Kick-Off Call 1 LUMP SUM $ - 0

2 Tas 2 - Preliminary (Pre-NEPA) Project Planning Workshop. The lump sum price of this line item shall include subtasks as follows: 1 LUMP SUM $ - 0

●Subtask 2-A Workshop Preparation

●Subtask 2-B Workshop Attendance and Facilitation (Virtual or On-site)

●Subtask 2-C Workshop Notes

3 Task 3 - Follow-Up Calls to the Preliminary (Pre-NEPA) Project Planning Workshop 1 LUMP SUM $ - 0

4 Task 5 - Civic Engagement Comment Analysis. The lump sum price of this line item shall include the substasks, and note that the base project is up to 75 documents or unique pieces of correspondence per subtask. An additional group of 20 pieces is optional per each subtask, as listed separately below in the Optional Line Items section. Subtasks are as follows: 1 LUMP SUM $ - 0

● Subtask 5-A Entering Hard Copy Civic Engagement Correspondence into the NPS PEPC System.

● Subtask 5-B Prepare Civic Engagement Comment Coding Structure

● Subtask 5-C Review and Code Unique Civic Engangement Correspondence

● Subtask 5-D Develop Concern Statemetns for the Civic Engagement Comments

● Subtask 5-E Civic Engagement Comment Summary Report

5 Task 6 - Proposed Action and Preliminary Alternatives Reviews and Refinement Calls. 1 LUMP SUM $ - 0

SOW PART 2 - NEPA INITIATION AND DOCUMENT PREPARATION

6 Task 6 - Environmental Assessment Public Scoping. The lump sum price of this line item shall only include subtask 6-B Virtual Public Scoping Meeting Attendance/Support. Subtask 6-A is optional as listed separately below in the Optional Line Items section. 1 LUMP SUM $ - 0

7 Task 7 - Environmental Assessment Public Scoping Comment Analysis. The lump sum price of this line item shall include the substasks, and note that the base project is up to 75 documents or unique pieces of correspondence per subtask. An additional group of 20 pieces is optional per each subtask, as listed separately below in the Optional Line Items section. Subtasks are as follows:

● Subtask 7-A Entering Hard Copy Public Correspondence into the NPS PEPC System

● Subtask 7-B Prepare Coding Structure

● Subtask 7-C Review and Code Unique Correspondence

● Subtask 7-D Develop Concern Statements

● Subtask 7-E Public Scoping Comment Summary Report

8 Task 8 - Enviornmental Assessment Outline 1 LUMP SUM $ - 0

9 Task 9 - Preparation of First Internal Draft Administrative Environmental Assessment 1 LUMP SUM $ - 0

10 Task 10 - Internal Review Roundtable Calls 1 LUMP SUM $ - 0

11 Task 11 - Preparation of Second Internal Draft Administrative Environmental Assessment 1 LUMP SUM $ - 0

12 Task 12 - Camera-Ready EA 1 LUMP SUM $ - 0

13 Task 13 - Environmental Assessment Public Comment Meetings. The lump sum price of this line item shall only include subtask 13-B Virtual Public Meeting Ogranization adn Facilitation. Subtask 6-A is optional as listed separately below in the Optional Line Items section. 1 LUMP SUM $ - 0

14 Task 14 - Environmental Assessment Public Comment Analysis. The lump sum price of this line item shall include the substasks, and note that the base project is up to 50 documents or unique pieces of correspondence per subtask. An additional group of 20 pieces is optional per each subtask, as listed separately below in the Optional Line Items section. Subtasks are as follows: 1 LUMP SUM $ - 0

● Subtask 14-A Entering Public Review Correspondence into the NPS PEPC

● Subtask 14-B Prepare Coding Structure

● Subtask 14-C Review and Code Unique Correspondence

● Subtask 14-D Developing concern Statements

● Subtask 14-E Draft Comment Summary Report

15 Task 15 - Responses to Public Comment and Errata. The lump sum price for this line item shall include the following subtasks: 1 LUMP SUM $ - 0

● Subtask 15-A Teleconference to Discuss Comment Analysis Report and Assign Comment Responses

● Subtask 15-B Preparation of Draft Responses

● Subtask 15-C Teleconference to Discuss Preparation of Final Responses and Preparation of Draft Errata.

● Subtask 15-D Final Comment Analysis Report & errata

16 Task 16 - Finding of No Significant Impact and Non-Impairment Determination. The lump sum price of this line item shall include the following subtasks: 1 LUMP SUM $ - 0

● Subtask 16-A Preparation of Draft and Final FONSI and appendices

● Subtask 16-B Preparation of Draft and Final Non-Impairment Determination

PART 3 - COMPLIANCE WITH SECTION 7 OF THE ENDANGERED SPECIES ACT

17 Task 18 - Prepare Biological Assessment (BA) 1 LUMP SUM $ - 0

18 Task 19 - Prepare Essential Fish Habitat Assessment (EFH) 1 LUMP SUM $ - 0

PART 4 - COMPLIANCE WITH CLEAN WATER ACT

19 Task 20 - Wetland Delineation 1 LUMP SUM $ - 0

PART 5 - PREPARATION OF A FLOODPLAIN STATEMENT OF FINDINGS NOTE: Only task is Task 22 which is optional, as listed separately below.

PART 6 - COMPLIANCE WITH THE WILD AND SCENIC RIVERS ACT NOTE: Only task is Task 23 which is optional, as listed separately below.

PART 7 - (NO TITLE)

20 Task 24 - Project Status Calls, Notes, Schedules, and Deliverables Status Tracking 1 LUMP SUM $ - 0

21 Task 25 - Decision File 1 LUMP SUM $ - 0

OTHER ITEMS:

22* Travel & Per Diem Total Estimate (also fill in price breakdown rates as requested below) 1 LUMP SUM $ - 0

23 Materials/Supplies Estimate 1 LUMP SUM $ - 0

TOTAL PRICE - BASE PROJECT (Line Item Numbers 1 through 23):

*Travel & Per Diem Breakdown Estimate

Total number of people ____________ Per Diem - Lodging @ estimated $____________ per night = $____________

Total number of people ____________ Per Diem - Meals & Incidentals @ estimated $____________ per day = $____________

Total number of people ____________ Travel - Transportation (airfare, rental car, tolls, parking fees, etc. @ estimated $____________ per person = $____________

As stated in Section B in Terms/Provisions/Clauses Attachment no. 1: While anticipated travel and per diem expenses shall be factored into quoted price, the awarded contractor will be paid for actual travel at limits established in the Federal Travel Regulations in place at time of travel. The General Services Administration (GSA) publishes travel and per diem rates at this site: https://www.gsa.gov/travel/plan-book/per-diem-rates. GSA. Project work at Mount Rainier National Park will be in Pierce County, WA. 2024 rate for lodging in Pierce County is $132/night, and meals and incidentals (M&IE) is $69/day.

OPTIONAL LINE ITEMS:

OPTIONAL PRICE SCHEDULE LINE ITEM NUMBER PRICE SCHEDULE LINE ITEM TITLE Note: Line Ites below are in accordance with the Statement of Work, Section G, Contractor Tasks QUANTITY UNIT OF MEASURE TOTAL PRICE

SOW PART 1 - PREILINARY (PRE-NEPA) PPROJECT PLANNING SERVICES:

A Task 4 - Civic Engagement Media Products 1 LUMP SUM $ - 0

B Task 5 - Civic Engagement Comment Analysis. Optional quantity for this line item shall be priced as a single group of 20 additional documents or unique pieces of correspondence. NOTE: The price per group of 20 will remain firm-fixed in the awarded contract such that the price per group of 20 may be applied to each subtask 5-A through 5-E if it becomes necessary. 1 LUMP SUM for single group of 20 documents or additional pices of correspondence $ - 0

SOW PART 2 - NEPA INITIATION AND DOCUMENT PREPARATION:

C Subtask 6-A, Public Scoping Meeting Materials 1 LUMP SUM $ - 0

D Subtasks 7-A through 7-E: Optional quantity for this line item shall be priced as a single group of 20 additional doucments or unique pieces of correspondence. NOTE: The price per group of 20 will rmain firm-fixed in the awarded contract such that the price per group of 20 may be applied to each subtask 7-A through 7-E if it becomes necessary. 1 LUMP SUM for single group of 20 documents or additional pices of correspondence $ - 0

E Subtask 13-A, Public Meeting Materials 1 LUMP SUM $ - 0

F Subtasks 14-A through 14-E: Optional quantity for this line item shall be priced as a single group of 20 additional doucments or unique pieces of correspondence. NOTE: The price per group of 20 will rmain firm-fixed in the awarded contract such that the price per group of 20 may be applied to each subtask 14-A through 14-E if it becomes necessary. 1 LUMP SUM for single group of 20 documents or additional pices of correspondence $ - 0

SOW PART 3 - COMPLIANCE WITH SECTION 7 OF THE ENDANGERED SPECIES ACT:

G Task 17 - Botanical Surveys 1 LUMP SUM $ - 0

SOW PART 4 - COMPLIANCE WITH CLEAN WATER ACT OF 1972:

H Task 21 - Preparation of a Wetlands Statement of Findings (WSOF). The lump sum price of this line includes the following subtasks: 1 LUMP SUM $ - 0

● Subtask 21-A WOSF Outline

● Subtask 21-B WSOF 1st Draft (NPS Review)

● Subtask 21-C WSOF 2ndt Draft (Regional and/or Water Resources Division Review)

● Subtask 21-D WSOF 3rd Draft and Final for Public Revciew

SOW PART 5 - PREPARATION OF A FLOODPLAIN STATEMENT OF FINDINGS:

I Task 22 - Preparation of a Floodplain Statement of Findings (FSOF). The lump sum price of this line includes the following subtasks: 1 LUMP SUM $ - 0

● Subtask 22-A Floodplain Desktop Survey

● Subtask 22-B Floodplain FSOF Outline

● Subtask 22-C FSOF 1st Draft (NPS Review)

● Subtask 22-D FSOF 2nd Draft (Regional and/or Water Resources Division Review)

● Subtask 22-E FSOF 3rd Draft and Final for Public Review

SOW PART 6 - COMPLIANCE WITH THE WILD AND SCENIC RIVERS ACT:

J SOW Task 23 - Preparation of a Wild and Scenic Rivers Act (WSRA) Section 7 Report. The lump sum price of this line includes the following subtasks: 1 LUMP SUM $ - 0

● Subtask 23-A WSRA Section 7 Outline

● Subtask 23-B WSRA Section 7 Report

RFQ No. 140P8324Q0085

Quoter shall have their representations and certifications (“reps/certs”) filled out electronically in SAM.gov. Provision 52.212-3 is incorporated by reference, available by full text at https://www.acquisition.gov/far/part-52#FAR_52_204_7.

If Quoter does not have NAICS 541620 listed in their SAM.gov Reps/Certs at time quote is submitted, then the Quoter shall fill the re-representation below for NAICS 541620. In other words, this provision is optional because it’s not necessary to be filled in and submitted if Quoter does have NAICS 541620 in their SAM.gov Reps/Certs.

Re-Representation:

The Contractor represents that it □ is, □ is not a small business concern under NAICS Code 541620 (Environmental Compliance Services) with an associated small business size standard for of $19 million assigned to Solicitation 140P8324Q0085.

_______________________________________________________________ (type name)

RFQ No. 140P8324Q0085, 52.204-24 and 52.204-26 Certifications

52.204-24 Representation Regarding Certain Telecommunications and Video Surveillance Services or Equipment (NOV 2021)

This section requires Offeror to fill in and submit with proposal unless the offeror has already responded “does not” in Paragraphs (c)(1) and (c)(2) of 52.204–26, Covered Telecommunications Equipment or Services—Representation (OCT 2020) in SAM.

The Offeror shall not complete the representation at paragraph (d)(1) of this provision if the Offeror has represented that it "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" in paragraph (c)(1) in the provision at 52.204-26, Covered Telecommunications Equipment or Services—Representation, or in paragraph (v)(2)(i) of the provision at 52.212-3, Offeror Representations and Certifications-Commercial Products or Commercial Services. The Offeror shall not complete the representation in paragraph (d)(2) of this provision if the Offeror has represented that it "does not use covered telecommunications equipment or services, or any equipment, system, or service that uses covered telecommunications equipment or services" in paragraph (c)(2) of the provision at 52.204-26, or in paragraph (v)(2)(ii) of the provision at 52.212-3.

(a) Definitions. As used in this provision—

Backhaul, covered telecommunications equipment or services, critical technology, interconnection arrangements, reasonable inquiry, roaming, and substantial or essential component have the meanings provided in the clause 52.204-25, Prohibition on Contracting for Certain Telecommunications and Video Surveillance Services or Equipment.

(b) Prohibition.

(1) Section 889(a)(1)(A) of the John S. McCain National Defense Authorization Act for Fiscal Year 2019 (Pub. L. 115-232) prohibits the head of an executive agency on or after August 13, 2019, from procuring or obtaining, or extending or renewing a contract to procure or obtain, any equipment, system, or service that uses covered telecommunications equipment or services as a substantial or essential component of any system, or as critical technology as part of any system. 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.

(2) Section 889(a)(1)(B) of the John S. McCain National Defense Authorization Act for Fiscal Year 2019 (Pub. L. 115-232) prohibits the head of an executive agency on or after August 13, 2020, from entering into a contract or extending or renewing a contract with an entity that uses any equipment, system, or service that uses covered telecommunications equipment or services as a substantial or essential component of any system, or as critical technology as part of any system. This prohibition applies to the use of covered telecommunications equipment or 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—

(1) 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 Offeror 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 Offeror has responded "will" in the representation in paragraph (d)(1) of this provision, the Offeror shall provide the following information as part of the offer:

(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

(C) Explanation of the proposed use of covered telecommunications equipment and any factors relevant to determining if such use would be permissible under the prohibition in paragraph (b)(1) of this provision.

(ii) For covered services—

(A) If the service is related to item maintenance: A description of all covered telecommunications services offered (include on the item being maintained: Brand; model number, such as OEM number, manufacturer part number, or wholesaler number; and item description, as applicable); or

(B) If not associated with maintenance, the Product Service Code (PSC) of the service being provided; and explanation of the proposed use of covered telecommunications services and any factors relevant to determining if such use would be permissible under the prohibition in paragraph (b)(1) of this provision.

(2) Disclosure for the representation in paragraph (d)(2) of this provision. If the Offeror has responded "does" in the representation in paragraph (d)(2) of this provision, the Offeror shall provide the following information as part of the offer:

(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 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

(C) Explanation of the proposed use of covered telecommunications equipment and any factors relevant to determining if such use would be permissible under the prohibition in paragraph (b)(2) of this provision.

(ii) For covered services—

(A) If the service is related to item maintenance: A description of all covered telecommunications services offered (include on the item being maintained: Brand; model number, such as OEM number, manufacturer part number, or wholesaler number; and item description, as applicable); or

(B) If not associated with maintenance, the PSC of the service being provided; and explanation of the proposed use of covered telecommunications services and any factors relevant to determining if such use would be permissible under the prohibition in paragraph (b)(2) of this provision.

52.204-26 COVERED TELECOMMUNICATIONS EQUIPMENT OR SERVICES-REPRESENTATION (OCT 2020)

(a) Definitions. As used in this provision, “covered telecommunications equipment or services” and “reasonable inquiry” have 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.

(1) 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.

(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 any equipment, system, or service that uses covered telecommunications equipment or services.

_______________________________________________________________ (type name)