Attachment_6_-_Proposal_Submission_Package.pdf

Muir Woods National Monument

Solicitation: 140P623R0002 Salmon Habitat Enhancement, Phase 2

GOGA 312237

REQUEST FOR PROPOSAL

(RFP)

Proposal Submission Package

NATIONAL PARK SERVICE

GOLDEN GATE MABO

Solicitation No. 140P8623R0002, Proposal Submission Package

READ CAREFULLY: Many Government-provided forms mentioned in Section L of the Solicitation (Instructions for the Submission of Offers and Other Information) have been collected and provided in this Adobe Portable Document Format (PDF) portfolio format for the offeror’s convenience. However, the offeror is cautioned that that some criteria set forth in Section L of the Solicitation requires submission of documents for which no form or format is provided.

The offeror should carefully review the proposal preparation instructions provided in Section L of the Solicitation when formulating their proposal.

TABLE OF CONTENTS

For Technical Volume I:

1. Relevant Experience Questionnaire

2. Past Performance Questionnaire

For Business & Price Volume II:

1. Contract Bid Schedule

2. SF 24 Bid Bond

3. Copy of Provision 52.209-7

4. Copy of Provision 52.209-13

5. General References form

6. Subcontracting Percentage Worksheet (Limitations on Subcontracting Report)

Project Experience Questionnaire Solicitation: 140P8623R0002

Submit responses to the questions below that demonstrate your relevant experience successfully completing projects of a similar nature and scope as this requirement per the instructions provided in Section L of the Solicitation. Limit submittals to the quantity of projects and timeframes required in the solicitation. Expand the response sections shown below as needed to adequately address each question (this questionnaire may be expanded to multiple pages if needed).

Offeror Company Name

REFERENCED PROJECT INFORMATION

Project Title Title Project Location City, State Brief Project Description Description

Project Owner Company Name POC: First & Last Name Phone: (XXX) XXX-XXXX

CONTRACTOR LIST

List Contractor(s) whose experience on the referenced project is being submitted for evaluation on this proposed project. If more than one contractor is listed (i.e. prime and subcontractors), provide information specific to that contractor.

Contractor Name

Role on Referenced

Project (Prime or Sub)

Trade

Price (list for each contractor’s specific work)

Performance Period

(calendar days) (list for each contractor’s specific work) Original Final Original Final

Sparky’s Electrical Company Prime Prime $XXX,XXX $X,XXX,XXX XX XX

ABC Plumbing & Heating, Co Subcontractor Plumbing & Mechanical $X,XXX,XXX $X,XXX,XXX XXX XXX

Subcontractor

PROJECT EXPERIENCE QUESTIONS

1. Describe the project work performed by all contractors listed above.

Response

2. Identify which Project Experience elements listed in section L of the solicitation each contractor’s work addresses.

Response

3. Describe & provide reasons for any changes to the original price for the work described in question 2 above.

Response

4. Describe and provide reasons for any changes to the original schedule for the work described in question 2 above.

Response

5. Describe problems, associated with the work described in question 2 above, which were encountered and how they were resolved. Describe how the offeror’s proposal accounts for similar issues.

Response

6. Describe the means and methods, associated with the work described in question 2 above, which were successful. Would you implement the same means and methods on the proposed project? Why or why not?

Response

7. Provide any other additional project information you believe should be presented.

Response

Solicitation: 140P8623R0002 Offeror Company Name: _________________________________

PAST PERFORMANCE QUESTIONNAIRE

INSTRUCTIONS: Offeror to complete Sections A and B and transmit questionnaire to reference.

Reference to complete Sections C and D and transmit back to Contracting Officer listed in section E.

Notice to Contractor

Information provided in this questionnaire is intended for use as source selection information and as such is deemed Source Selection Sensitive. Statements or comments provided in the questionnaire do not signify an express or implied endorsement of any product, supply, service, or enterprise.

This information shall not be construed as an endorsement by the Government or its employee(s) of the contractor for advertising purposes or in a manner that implies the contractor, its products, or services, are approved, endorsed, or considered by the

Government to be superior to other products or services.

The contractor shall not be permitted to use any information provided in this questionnaire to publicize, or otherwise circulate, promotional materials that state or imply Governmental, organizational, group, expert, or individual endorsement or consumer testimonial of a product, service, or position which the contractor represents.

A. CONTRACTOR INFORMATION (check one) ☐company listed above ☐ proposed sub for company listed above

Company Name Company Street Address Address City City State State Zip Code XXXXX UEI Number XXXXXXX Point of Contact Name, Email, Phone

B. CONTRACT INFORMATION

Project Title Title Contract Number XXXXXXXXXX Contract Type Firm Fixed Price / Time & Materials / Cost Reimbursable / Other Awarded Contract Price $X,XXX,XXX Current / Final Price $X,XXX,XXX Contract Award Date XX/XX/XXXX Contract Completion Date XX/XX/XXXX Period of Performance XX/XX/XXX – XX/XX/XXX Project Location Park or Street address, City, State Client / Owner Company Brief description of the contract & work effort:

Scope of work description

C. REFERENCE:

Name First, Last Position / Title Title Organization Agency or Company Phone Number XXX-XXX-XXXX Email Address Email Signature Signature Date XX/XX/XXXX

Solicitation: 140P8623R0002 Offeror Company Name: _________________________________

D. EVALUATION

Rating Definition

Exceptional Performance met contractual requirements and exceeded many to the owner’s benefit. The element being assessed was accomplished with few minor problems for which corrective actions taken by the contractor were highly effective.

Very Good Performance met contractual requirements and exceeded some to the owner’s benefit. The element being assessed was accomplished with some minor problems for which corrective actions taken by the contractor were effective.

Satisfactory Performance met contractual requirements. The element being assessed contains some minor problems for which corrective actions taken by the contractor appear or were satisfactory.

Marginal Performance did not meet some contractual requirements. The element being assessed reflects a serious problem for which the contractor has not yet identified corrective actions.

Unsatisfactory Performance does not meet most contractual requirements and recovery is not likely in a timely manner. The element being assessed contains a serious problem(s) for which the contractor’s corrective actions appear or were ineffective.

Evaluation Area Rating Quality Quality of workmanship (including subcontractors)? Choose an item.

Quality of and adherence to quality control plan? Choose an item.

Quality of informational and technical submittals? Choose an item.

Overall Quality Rating Choose an item.

Comments (Please provide comments supporting the above ratings. Comments supporting ratings of excellent, marginal, & unsatisfactory are especially helpful.):

Schedule (& Time Management) Met project schedule milestones? Choose an item.

Responded to owner requests in a timely manner? Choose an item.

Informational and technical submittals submitted timely? Choose an item.

Promptly addressed scheduling issues? Choose an item.

Overall Schedule (& Time Management) Rating Choose an item.

Cost Control Addressed differing & unforeseen site conditions so as to minimize additional costs? Choose an item.

Provided fair and reasonable pricing for contract modifications? Choose an item.

Submitted accurate and complete invoices? Choose an item.

Promptly paid subcontractors and suppliers? Choose an item.

Overall Cost Control Rating Choose an item.

Comments (Please provide comments supporting the above ratings. Comments supporting ratings of excellent, marginal, & unsatisfactory are especially helpful.):

Solicitation: 140P8623R0002 Offeror Company Name: _________________________________

Management General oversight by project manager and superintendent? Choose an item.

Coordination with and control of subcontractors? Choose an item.

Avoidance of accidents & safety violations? Choose an item.

Addressed location factors (especially remote locations)? Choose an item.

Maintained good working relationship with owner representatives? Choose an item.

Demonstrated flexibility, innovativeness and cooperation in resolving potential problems? Choose an item.

Overall Management Rating Choose an item.

Small Business Subcontracting (& Labor Standards) Met regulatory and contractual labor standards? Choose an item.

Successfully contracted with small and socio-economically disadvantaged businesses? Choose an item.

Quality and adherence to applicable subcontracting plans? Choose an item.

Overall Small Business Subcontracting (& Labor Standards) Rating Choose an item.

Comments (Please provide comments supporting the above ratings. Comments supporting ratings of excellent, marginal, & unsatisfactory are especially helpful.):

Regulatory Compliance Met building and life safety codes? Choose an item.

Overall Regulatory Compliance Rating Choose an item.

Overall Recommendation:

Given what I know today about the contractor's ability to perform in accordance with the contract’s most significant requirements, I would recommend them for similar contracts: Choose an item.

Overall Comments:

E. RETURN:

Return by 2:00 p.m. Pacific Standard Time on Monday, March 27, 2023 Name Liset Gomez Title Contracting Officer Organization National Park Service – Golden Gate MABO Email liset_gomez@nps,gov

Contract Line Item Number

Contract Line Item (CLI) Title1 QUANTITY

UNIT OF

MEASURE

UNIT

PRICE

TOTAL PRICE

1 Mobilization and Demobilization 1 Each 2 Water Diversion and Dewatering Systems 1 LS 3 Selective Demolition, Earthwork and Rock Work 1 LS 4 Install Woody Debris Structures 1 LS

TOTAL PROPOSED PRICE (CONTRACT LINE ITEMS 1‐4)

BID OPTIONS

A Haul soils to a landfill instead of Conlon Stockpile Site2 1 CY B Haul RSP to Conlon Stockpile Site from Area 6 instead of burial in channel3

1 CY

C Salvage, store and replant 118 native plants in Area 5 1 LS D Salvage, store and replant 231 native plants in Area 6 1 LS E Salvage, store and replant 87 native plants in Area 7 1 LS F Prepare As-built Drawings 1 LS G Install Additional Log(s) in LWD Structure4 1 Per Log

NOTES:

1 This is a firm fixed price requirement. All costs associated to perform the work in accordance to the Statement of Work. The overall total price of line Items 1- 4 and Options A through G will be evaluated to determine price reasonableness. It is anticipated that lines 1-4 will be awarded at the time of contract award. The Government may select one or more Option lines to award within 90 days of contract award. Listing option lines in the price schedule is not a guarantee by the Government that optional lines are to be awarded during contract administration.

SOLICITATION NUMBER: 140P8623R0002

PARK ‐ PMIS: GOGA ‐ 312237

DEVELOPED AREA: Muir Woods National Monument (MUWO), Marin County, California PROJECT TITLE: Salmon Habitation Enhancement, Phase 2 Offerors are required to submit, at a minimum, an offer that conforms to the solicitation documents with pricing for all Base line items and all Option line items (if any). Failure to do so may render the proposal unacceptable. On lump‐sum (LS) line items, provide the total price only. On 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 and extended prices to whole dollars.

CONTRACT BID SCHEDULE

2 The quantity may range from zero (0) to 249 cubic yards.

3 The quantity may range from zero (0) to 188 cubic yards 4 The quantity will depend on whether trees fall near Work Zones after design preparation and are suitable for installation

BID BOND

(See instructions on reverse)

OMB Control Number: 9000-0045 Expiration Date: 8/31/2022

PRINCIPAL (Legal name and business address) TYPE OF ORGANIZATION ("X" one)

STATE OF INCORPORATION

SURETY(IES) (Name and business address)

PERCENT

OF BID

PRICE

PENAL SUM OF BOND

AMOUNT NOT TO EXCEED

MILLION(S) THOUSAND(S) HUNDRED(S) CENTS

BID IDENTIFICATION

BID DATE INVITATION NUMBER

PRINCIPAL

SIGNATURE(S)

NAME(S) &

TITLE(S)

(Typed)

1.

1. 2.

2.

3.

3.

(Seal) (Seal) (Seal) Corporate Seal

INDIVIDUAL SURETY(IES)

SIGNATURE(S)

NAME(S)

(Typed)

1.

1.

2.

2.

(Seal) (Seal)

CORPORATE SURETY(IES)

SU

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Y

A

NAME &

ADDRESS

STATE OF INCORPORATION LIABILITY LIMIT ($)

SIGNATURE(S)

NAME(S) &

TITLE(S)

(Typed)

1.

1.

2.

2. Corporate Seal

AUTHORIZED FOR LOCAL REPRODUCTION

Previous edition is NOT usable

STANDARD FORM 24 (REV. 8/2016)

Prescribed by GSA - FAR (48 CFR) 53.228(a)

FOR (Construction, Supplies or Services)

OBLIGATION:

We, the Principal and Surety(ies) are firmly bound to the United States of America (hereinafter called the Government) in the above penal sum. For payment of the penal sum, we bind ourselves, our heirs, executors, administrators, and successors, jointly and severally. However, where the Sureties are corporations acting as co-sureties, we, the Sureties, bind ourselves in such sum "jointly and severally" as well as "severally" only for the purpose of allowing a joint action or actions against any or all of us. For all other purposes, each Surety binds itself, jointly and severally with the Principal, for the payment of the sum shown opposite the name of the Surety. If no limit of liability is indicated, the limit of liability is the full amount of the penal sum.

CONDITIONS:

The Principal has submitted the bid identified above.

THEREFORE:

The above obligation is void if the Principal - (a) upon acceptance by the Government of the bid identified above, within the period specified therein for acceptance (sixty (60) days if no period is specified), executes the further contractual documents and gives the bond(s) required by the terms of the bid as accepted within the time specified (ten (10) days if no period is specified) after receipt of the forms by the principal; or (b) in the event of failure to execute such further contractual documents and give such bonds, pays the Government for any cost of procuring the work which exceeds the amount of the bid.

Each Surety executing this instrument agrees that its obligation is not impaired by any extension(s) of the time for acceptance of the bid that the Principal may grant to the Government.

Notice to the surety(ies) of extension(s) is waived. However, waiver of the notice applies only to extensions aggregating not more than sixty (60) calendar days in addition to the period originally allowed for acceptance of the bid.

WITNESS:

The Principal and Surety(ies) executed this bid bond and affixed their seals on the above date.

DATE BOND EXECUTED (Must not be later than bid opening date)

Paperwork Reduction Act Statement - This information collection meets the requirements of 44 USC § 3507, as amended by section 2 of the Paperwork Reduction Act of 1995. You do not need to answer these questions unless we display a valid Office of Management and Budget (OMB) control number. The OMB control number for this collection is 9000-0045. We estimate that it will take 1 hour to read the instructions, gather the facts, and answer the questions. Send only comments relating to our time estimate, including suggestions for reducing this burden, or any other aspects of this collection of information to: General Services Administration, Regulatory Secretariat Division (M1V1CB), 1800 F Street, NW, Washington, DC 20405.

JOINT VENTURE

OTHER (Specify)

PARTNERSHIPINDIVIDUAL

CORPORATION

INSTRUCTIONS

1. This form is authorized for use when a bid guaranty is required. Any deviation from this form will require the written approval of the Administrator of General Services.

2. Insert the full legal name and business address of the Principal in the space designated "Principal" on the face of the form. An authorized person shall sign the bond. Any person signing in a representative capacity (e.g., an attorney-in-fact) must furnish evidence of authority if that representative is not a member of the firm, partnership, or joint venture, or an officer of the corporation involved.

3. The bond may express penal sum as a percentage of the bid price. In these cases, the bond may state a maximum dollar limitation (e.g., 20% of the bid price but the amount not to exceed dollars).

4. (a) Corporations executing the bond as sureties must appear on the Department of the Treasury's list of approved sureties and must act within the limitations listed therein. The value put into the LIABILITY LIMIT block is the penal sum (i.e., the face value) of the bond, unless a co-surety arrangement is proposed.

(b) When multiple corporate sureties are involved, their names and addresses shall appear in the spaces (Surety A, Surety B, etc.) headed "CORPORATE SURETY(IES)." In the space designated "SURETY(IES)" on the face of the form, insert only the letter identifier corresponding to each of the sureties. Moreover, when co-surety arrangements exist, the parties may allocate their respective limitations of liability under the bond, provided that the sum total of their liability equals 100% of the bond penal sum.

(c) When individual sureties are involved, a completed Affidavit of Individual Surety (Standard Form 28) for each individual surety, shall accompany the bond.

The Government may require the surety to furnish additional substantiating information concerning its financial capability.

5. Corporations executing the bond shall affix their corporate seals. Individuals shall execute the bond opposite the word "Corporate Seal"; and shall affix an adhesive seal if executed in Maine, New Hampshire, or any other jurisdiction requiring adhesive seals.

6. Type the name and title of each person signing this bond in the space provided.

7. In its application to negotiated contracts, the terms "bid" and "bidder" shall include "proposal" and "offeror."

SU

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NAME &

ADDRESS

STATE OF INCORPORATION LIABILITY LIMIT ($)

SIGNATURE(S)

NAME(S) &

TITLE(S)

(Typed)

1.

1.

2.

2. Corporate Seal

Corporate Seal

LIABILITY LIMIT ($)STATE OF INCORPORATION

2.

2.

1.

1.NAME(S) &

TITLE(S)

(Typed)

SIGNATURE(S)

NAME &

ADDRESS

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Corporate Seal

LIABILITY LIMIT ($)

2.

2.

STATE OF INCORPORATION

1.

1.

NAME(S) &

TITLE(S)

(Typed)

SIGNATURE(S)

NAME &

ADDRESS

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Corporate Seal

LIABILITY LIMIT ($)

2.

2.

STATE OF INCORPORATION

1.

1.

NAME(S) &

TITLE(S)

(Typed)

SIGNATURE(S)

NAME &

ADDRESS

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Corporate Seal

LIABILITY LIMIT ($)

2.

2.

STATE OF INCORPORATION

1.

1.

NAME(S) &

TITLE(S)

(Typed)

SIGNATURE(S)

NAME &

ADDRESS

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Corporate Seal

LIABILITY LIMIT ($)

2.

2.

STATE OF INCORPORATION

1.

1.

NAME(S) &

TITLE(S)

(Typed)

SIGNATURE(S)

NAME &

ADDRESS

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STANDARD FORM 24 (REV. 8/2016) BACK

RFP No. 140P8623R0002, 52.209-7 Certification Company Name: _________________________________

52.209-7 INFORMATION REGARDING RESPONSIBILITY MATTERS (OCT 2018)

(a) Definitions. As used in this provision—

Administrative proceeding means a non-judicial process that is adjudicatory in nature in order to make a determination of fault or liability (e.g., Securities and Exchange Commission

Administrative Proceedings, Civilian Board of Contract Appeals Proceedings, and Armed Services

Board of Contract Appeals Proceedings). This includes administrative proceedings at the Federal and State level but only in connection with performance of a Federal contract or grant. It does not include agency actions such as contract audits, site visits, corrective plans, or inspection of deliverables.

Federal contracts and grants with total value greater than $10,000,000 means—

(1) The total value of all current, active contracts and grants, including all priced options;

and

(2) The total value of all current, active orders including all priced options under indefinite-delivery, indefinite-quantity, 8(a), or requirements contracts (including task and delivery and multiple-award Schedules).

Principal means an officer, director, owner, partner, or a person having primary management or supervisory responsibilities within a business entity (e.g., general manager; plant manager; head of a division or business segment; and similar positions).

(b) The offeror ☐ has ☐ does not have current active Federal contracts and grants with total value greater than $10,000,000 .

(c) If the offeror checked "has" in paragraph (b) of this provision, the offeror represents, by submission of this offer, that the information it has entered in the Federal Awardee Performance and Integrity Information System (FAPIIS) is current, accurate, and complete as of the date of submission of this offer with regard to the following information :

(1) Whether the offeror, and/or any of its principals, has or has not, within the last five years, in connection with the award to or performance by the offeror of a Federal contract or grant, been the subject of a proceeding, at the Federal or State level that resulted in any of the following dispositions:

(i) In a criminal proceeding, a conviction.

(ii) In a civil proceeding, a finding of fault and liability that results in the payment of a monetary fine, penalty, reimbursement, restitution, or damages of $5,000 or more.

(iii) In an administrative proceeding, a finding of fault and liability that results in–

(A) The payment of a monetary fine or penalty of $5,000 or more; or

RFP No. 140P8623R0002, 52.209-7 Certification Company Name: _________________________________

(B) The payment of a reimbursement, restitution, or damages in excess of $100,000.

(iv) In a criminal, civil, or administrative proceeding, a disposition of the matter by consent or compromise with an acknowledgment of fault by the Contractor if the proceeding could have led to any of the outcomes specified in paragraphs (c)(1)(i), (c)(1)(ii), or (c)(1)(iii) of this provision.

(2) If the offeror has been involved in the last five years in any of the occurrences listed in

(c)(1) of this provision, whether the offeror has provided the requested information with regard to each occurrence.

(d) The offeror shall post the information in paragraphs (c)(1)(i) through (c)(1)(iv) of this provision in FAPIIS as required through maintaining an active registration in the System for Award

Management, which can be accessed via https://www.sam.gov (see 52.204-7).

(End of provision)

Submitted by:

_______________________________________________________________ (signature) __________________________ (date)

_______________________________________________________________ (type name)

_______________________________________________________________ (company name)

_______________________________________________________________ (Unique Entity ID) https://www.sam.gov/ https://www.acquisition.gov/far/part-52#FAR_52_204_7

RFP No. 140P8623R0002, 52.209-13 Certification Company Name: _________________________________

52.209-13, VIOLATION OF ARMS CONTROL TREATIES OR AGREEMENTS-CERTIFICATION (NOV 2021)

(a) This provision does not apply to acquisitions at or below the simplified acquisition threshold or to acquisitions of commercial products and commercial services as defined in Federal Acquisition Regulation 2.101.

(b) Certification. [Offeror shall check either (1) or (2).] ☐ (1) The Offeror certifies that–

(i) It does not engage and has not engaged in any activity that contributed to or was a significant factor in the President's or Secretary of State 's determination that a foreign country is in violation of its obligations undertaken in any arms control, nonproliferation, or disarmament agreement to which the United States is a party, or is not adhering to its arms control, nonproliferation, or disarmament commitments in which the United States is a participating state .

The determinations are described in the most recent unclassified annual report provided to Congress pursuant to section 403 of the Arms Control and Disarmament Act ( 22 U.S.C. 2593a). The report is available at https://www.state.gov/bureaus-offices/under-secretary-for-arms-control-and-international-security-affairs/bureau-of-arms-control-verification-and-compliance/; and

(ii) No entity owned or controlled by the Offeror has engaged in any activity that contributed to or was a significant factor in the President's or Secretary of State 's determination that a foreign country is in violation of its obligations undertaken in any arms control, nonproliferation, or disarmament agreement to which the United States is a party, or is not adhering to its arms control, nonproliferation, or disarmament commitments in which the United States is a participating state . The determinations are described in the most recent unclassified annual report provided to Congress pursuant to section 403 of the Arms Control and Disarmament Act ( 22 U.S.C. 2593a). The report is available at https://www.state.gov/bureaus-offices/under-secretary-for-arms-control-and-international-security-affairs/bureau-of-arms-control-verification-and-compliance/; or

☐ (2) The Offeror is providing separate information with its offer in accordance with paragraph (d)(2) of this provision.

(c) Procedures for reviewing the annual unclassified report (see paragraph (b)(1) of this provision). For clarity, references to the report in this section refer to the entirety of the annual unclassified report, including any separate reports that are incorporated by reference into the annual unclassified report.

(1) Check the table of contents of the annual unclassified report and the country section headings of the reports incorporated by reference to identify the foreign countries listed there.

Determine whether the Offeror or any person owned or controlled by the Offeror may have engaged in any activity related to one or more of such foreign countries.

(2) If there may have been such activity, review all findings in the report associated with those foreign countries to determine whether or not each such foreign country was determined to be in violation of its obligations undertaken in an arms control, nonproliferation, or disarmament agreement to which the United States is a party, or to be not adhering to its arms control, nonproliferation, or disarmament commitments in which the United States is a participating state .

For clarity, in the annual report an explicit certification of non-compliance is equivalent to a determination of violation. However, the following statements in the annual report are not equivalent to a determination of violation:

(i) An inability to certify compliance.

(ii) An inability to conclude compliance.

(iii) A statement about compliance concerns.

(3) If so, determine whether the Offeror or any person owned or controlled by the Offeror has engaged in any activity that contributed to or is a significant factor in the determination in the https://www.acquisition.gov/far/part-2#FAR_2_101 http://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title22-section2593a&num=0&edition=prelim https://www.state.gov/bureaus-offices/under-secretary-for-arms-control-and-international-security-affairs/bureau-of-arms-control-verification-and-compliance/ https://www.state.gov/bureaus-offices/under-secretary-for-arms-control-and-international-security-affairs/bureau-of-arms-control-verification-and-compliance/ http://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title22-section2593a&num=0&edition=prelim https://www.state.gov/bureaus-offices/under-secretary-for-arms-control-and-international-security-affairs/bureau-of-arms-control-verification-and-compliance/ https://www.state.gov/bureaus-offices/under-secretary-for-arms-control-and-international-security-affairs/bureau-of-arms-control-verification-and-compliance/ https://www.state.gov/bureaus-offices/under-secretary-for-arms-control-and-international-security-affairs/bureau-of-arms-control-verification-and-compliance/

RFP No. 140P8623R0002, 52.209-13 Certification Company Name: _________________________________ report that one or more of these foreign countries is in violation of its obligations undertaken in an arms control, nonproliferation, or disarmament agreement to which the United States is a party, or is not adhering to its arms control, nonproliferation, or disarmament commitments in which the United States is a participating state . Review the narrative for any such findings reflecting a determination of violation or non-adherence related to those foreign countries in the report, including the finding itself, and to the extent necessary, the conduct giving rise to the compliance or adherence concerns, the analysis of compliance or adherence concerns, and efforts to resolve compliance or adherence concerns.

(4) The Offeror may submit any questions with regard to this report by email to NDAA1290Cert@state.gov. To the extent feasible, the Department of State will respond to such email inquiries within 3 business days.

(d) Do not submit an offer unless—

(1) A certification is provided in paragraph (b)(1) of this provision and submitted with the offer; or

(2) In accordance with paragraph (b)(2) of this provision, the Offeror provides with its offer information that the President of the United States has

(i) Waived application under 22 U.S.C. 2593e(d) or (e); or

(ii) Determined under 22 U.S.C. 2593e(g)(2) that the entity has ceased all activities for which measures were imposed under 22 U.S.C. 2593e(b).

(e) Remedies. The certification in paragraph (b)(1) of this provision is a material representation of fact upon which reliance was placed when making award. If it is later determined that the Offeror knowingly submitted a false certification, in addition to other remedies available to the Government, such as suspension or debarment, the Contracting Officer may terminate any contract resulting from the false certification.

(End of provision)

Submitted by:

_______________________________________________________________ (signature) __________________________ (date)

_______________________________________________________________ (type name)

_______________________________________________________________ (company name)

_______________________________________________________________ (Unique Entity ID) mailto:NDAA1290Cert@state.gov http://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title22-section2593e&num=0&edition=prelim http://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title22-section2593e&num=0&edition=prelim http://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title22-section2593e&num=0&edition=prelim

Solicitation No. 140P8422R0007 Page 1 of 2

General References READ CAREFULLY: The purpose of this form is for the offeror to provide the Government with general references in the spaces provided as described in the Instructions, Conditions, and Notices to Offerors (Section L of the Solicitation). Include Area Codes with all telephone numbers. Fill in the information by typing or printing legibly.

It is especially important that the offeror disclose instances in which their relationships with the references may be considered less than fully satisfactory. The offeror should tell their side of the story and describe remedial corrective action that has been taken or will be taken to correct the deficiency. Failure to do so may result in a determination that an offeror has been less than candid with the Government, which could result in an unfavorable assessment of the offeror’s past performance record. Provide explanations on separate sheets as necessary.

NAME OF CONTRACTOR/OFFEROR:

SURETY

Name of Surety:

Address of Surety:

Name of Agent:

Telephone Number:

CORPORATE BANK

Name of Bank:

Address of Bank:

Name of Agent:

Telephone Number:

Types and Numbers of Accounts:

CORPORATE BANK

Name of Bank:

Address of Bank:

Name of Agent:

Telephone Number:

Types and Numbers of Accounts:

INSURANCE COMPANY

Name:

Address:

Name of Agent:

Types of Policies:

Solicitation No. 140P8422R0007 Page 2 of 2

SUBCONTRACTOR

Name:

Address:

Name of Contact:

Area of Specialized Work:

Address:

Name of Contact:

Address:

Name of Contact:

MATERIAL SUPPLIER

Address:

Name of Contact:

Telephone Number:

Types of Material:

MATERIAL SUPPLIER

Name:

Address:

Name of Contact:

Telephone Number:

Types of Material:

MATERIAL SUPPLIER

Name:

Address:

Name of Contact:

Types of Material:

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

Limitation on Subcontracting Percentage (Total Amount Paid to the Prime - Total Amount Total Amount Paid to NSS / Total Amount Paid to the Prime)

#DIV/0!

Report on Limitations on Subcontracting