Attachment No. 4 - RFP No. 748396_REPS & CERTS - Foreign.pdf

Request for Proposal Number: 748396

FOREIGN CERTIFICATIONS

For the Pacific Northwest National Laboratory

Operated by Battelle Memorial Institute

Battelle Memorial Institute has executed and is engaged in the performance of Prime Contract DE-AC05- 76RL01830 with the United States Department of Energy (DOE), for the management, operation, and maintenance of the Pacific Northwest National Laboratory (PNNL) in Richland, Washington. The following certifications must be completed, and this form must be signed and returned with the Offeror's proposal.

----------------------The following must be completed for proposals exceeding $10,000----------------------

Individual/Company Name_____________________________________________________________

Representation Regarding Certain Telecommunications and Video Surveillance Services or Equipment (cl. 424 - July 2021)

A. The Offeror represents that it will , will not provide covered telecommunications equipment or services to the Government or Pacific Northwest National Laboratory in the performance of any of contract, subcontract or other contractual instrument resulting from this solicitation.

B. If the answer to (A) above is "will", the Offeror shall provide the following information as part of its offer:

1. All covered telecommunication equipment and services offered (include brand; model number, such as original equipment manufacturer (OEM) number, manufacturer part number, or wholesaler number; and item description as appliable:

Explanation of the proposed use of covered telecommunications services and any factors relevant to determining if such use would be permissible under paragraph (b) of FAR 52.204- 24:

For services, the entity providing the covered telecommunication services (include entity name, unique identifier, and Commercial and Government Entity (CAGE) code, if known:

For equipment, the entity that produced the covered telecommunications equipment (include entity name, unique entity identifier, and Commercial and Government Entity (CAGE) code, and whether the entity was the OEM or a distributor, if known):

NOTE: The term "Covered telecommunications equipment or services" and "Covered foreign country" are defined in FAR 52.204-25 as follows:

Covered telecommunications equipment or services means (1) Telecommunications equipment produced by Huawei Technologies Company or ZTE Corporation (or any subsidiary or affiliate of such entities); (2) For the purpose of public safety, security of Government facilities, physical security surveillance of critical infrastructure, and other national security purposes, video surveillance and telecommunications equipment produced by Hytera Communications Corporation, Hangzhou Hikvision Digital Technology Company, or Dahua Technology Company (or any subsidiary or affiliate of such entities); (3) Telecommunications or video surveillance services provided by such entities or using such equipment; or (4) Telecommunications or video surveillance equipment or services produced or provided by an entity that the Secretary of Defense, in consultation with the Director of National Intelligence or the Director of the Federal

Request for Proposal Number: 748396

Bureau of Investigation, reasonably believes to be an entity owned or controlled by, or otherwise connected to, the government of a covered foreign country.

Covered foreign country means The People's Republic of China.

-In addition to the preceding sections, the following must be completed for proposals exceeding $35,000- Certification Regarding Responsibility Matters (F-419 - July 2017) A. The Offeror certifies, to the best of its knowledge and belief that the Offeror and/or any of its Principals are are not presently debarred, suspended, proposed for debarment, or declared ineligible for the award of contracts by any U.S. Federal agency.

"Principal", for the purposes of this certification, means an officer, director, owner, partner, or a person having primary management or supervisory responsibilities within a business entity.

B. The Offeror shall provide immediate written notice to the Battelle Contracts Specialist if, at any time prior to contract award, the Offeror learns that its certification was erroneous when submitted or has become erroneous by reason of changed circumstances.

C. The certification in paragraph A will not necessarily result in withholding of an award under this solicitation. However, the certification will be considered in connection with a determination of the Offeror's responsibility. Failure of the Offeror to furnish a certification or provide such additional information as requested by the Battelle Contracts Specialist may render the Offeror nonresponsible.

D. This certification is a material representation of fact upon which reliance was placed when making award. If it is later determined that the Offeror knowingly rendered an erroneous certification, in addition to other remedies available to Battelle, the Battelle Contracts Specialist may terminate the contract resulting from this Request for Proposal for default.

SIGNATURE

Note: A person authorized to make legally binding commitments on behalf of the Offeror must sign below. Signature constitutes a representation that reasonable and prudent inquiry has been made to ascertain the true and accurate basis of all statements. Signature further constitutes Offeror's compliance with the requirements of DOE ORDER (O) 486.1A, Foreign Government Sponsored or Affiliated Activities, which prohibits any employees of government contractors and subcontractors from participating in certain covered programs sponsored by countries of risk and establishes a structured system for reporting possible participating such activities. Statements which a person knows or has reason to know are false, fictitious, or fraudulent may result in criminal or civil penalties, as prescribed in 18 USC 1001 and 31 USC 3802(a)(2). The Offeror shall notify Battelle of any changes that occur in any of the representations or certifications during any resulting contract period.

Authorized Signature _____________________________________________

Signer's Name (Printed) _____________________________________________ Title _____________________________________________

Date _____________________________________________