CRHC20-23.pdf

REQUEST FOR QUOTATIONS

(THIS IS NOT AN ORDER)

THIS RFQ IS NOT A SMALL BUSINESS SET.ASIDE

PACE OF PAGES

1of 2

I REQUEST NO,

cRHC-20-23

2, DATE ISSUED

5119t2020

3, REQUISITION/PURCHASE REQUEST NO 4, CERT FOR NAT. DEF

UNDER BDSA REG,2

AND/OR DMS REG I

RATINC

5A ISSUED BY

Eagle Butte Indian Health Service, Cheyenne River Service Unit 24276 166tfi St, PO Box 1012, Easle Butte, SD 57625

6 DELIVERBY (Date)

See Schedule.

5b FOR INFORMATION CALL (NO COLLECTCALLS) 7 DELIVERY OTHER

X nos oesrtNer toN af 6ee schedute)

NAME

Stephanie Red Elk-Charger stephanie.redelk@ihs.sov

MBER 9 DESTINATION

AREA CODE

NUMBER

964-0507

a. NAME OF CONSIGNEE

Cheyenne River Service Unit

t. To: b STREET ADDRESS

24276 166th St . PO Box 1012 a NAME b. COMPANY c CITY

Eagle Butte c STREET ADDRESS d CITY e STAI-E I ZIP CODE d STATE

SD

e ZIP CODE

57625

IO, PLEASE FURNISH QUOTATIONS TO

THE ISSUING OFFICE IN BLOCK

5a ON OR BY lr00 PM MST ON (Dale,/

June 10,2020

IMPORTANT: This is a request for information, and quotadons fumished are not offiers Ifyou are unable toquote, please so indicate on lhis form and retum it to the address in Block 5a. Thisrequestdoes notcommitthe Govemment topay any costs incufted in the prepamtion ofthe submission ofthis quolatron or to contract for supplies or services Supplies are of domestic origin unless otherwise indoated by quoter. Any representatrons and/or certifications attached to this Request for Ouotalrons must be comDleled bv th€ ouoter

I l. SCHEDULE t?zclude applicable Federal, Stale and locol laxes)

ITEM NO,

{a)

SUPPLIES/SERVICES

(b)

QUANTITY

(c)

UNIT

(d)

LINIT PRICE

(e, AMOUNT

0) l)

3)

4)

Firm Fixed-Price, Blanket Purchase

Agreement (BPA) for Strep A2 Alere Test Kits, for the Cheyenne River Health Center, located in Eagle Butte, SD. The award resulting from this solicitation will not obligate funds; funds must be obligated prior to stading performance though the issuance of a BPA Call No.

Estimated 20 kits per month(24 tests per kit) x l2 months = 240 kits Base Year

Option Year I

Option Year 2

Option Year 3

Option Year 4

Kits

Kits

Kits

Kits

Kits s s

S

I2. DISCOUNT FOR PROMPT

PAYMENT

a, o/o

IO CALENDAR DAYS b20

CALENDAR

DAYS%

c.30 CALENDAR DAYS d CALENDAR DAYS

NUMBER PERCENTAGE

NarTF Addirional nro!isims and reDresenlalons are Ll are not attach iFnve nno aoonsss oF QUoTER I5 SICNATURE OF PERSON AUTHORIZED TO

SIGN QUOTATION

15 DAI'E OF

QUOTATIONa NAME OF QUOTER b STREETADDRESS c COUNTT I6, SICNER a NAME (TWe ofpint) D ,EPHONE

AREA CODE

d. CITY e STATE f. ZIP CODE c TITLE (type or Pritlt) NUMBER

-HORIZED FOR LOCAL .)nl laTIl edition not usable Prescribed by CSA-FAR (48 CFR, 5l-215- l(a)

ITEM

NO.

{a)

SUPPLIES/SERVICES

(b)

QUANTITY

(c)

UNIT

(d)

UNIT PRICE

(e)

AMOUNT

(f)

The "Unit Price" is an all-inclusive cost. "All-inclusive cost" is defined to include all costs pertinent to the performance of this blanket purchase agreement (i.e., shipping, freight, travel, lodging, insurances, benefits, etc... )

Defivery Address:24276 1661h St. Airport Rd, Eagle Bufte, SD 57625.

Basis for award: Lowest Price Technically Acceptable (LPTA)

Period of Performance will be a Base Year (BY) plus 4 additional/Option Years (OY), as follows:

BY: 7||12020 - 613012021

OY 1 : 7 I | /2021 - 6/30/2022

OYZ: 7 / | 12022 - 613012023

OY 3 : 1 I 1 /2023 - 6130/2024

OY 4 : 7 I | /2024 - 6130/2025

Attachments:

- sow -Provisions/Clauses, incorporated by full text and by reference.

DUNS & Bradstreet Number:

(The Duns & Bradstreet number is required. Provided you do not have it, you may call 866-705-571I and obtain one.) &4

The quoter is hereby notified that they must be registered in the System for Award Management (SAM) before the Government will issue an award. You may do this by going to www.sam.gov to register and you are required to update this registration every year prior to the expiration date.

No contract award shall be made to a vendor listed on the OIG Exclusion List ( h np://ex lusions.o is,. hhs. s,ov) throughout the duration of the contract.

Federal Tax ID Number:

Email Address:

Net Terms:

This Blanket Purchase Agreement (BPA) is established to provide Lab Supplies and consumables, on as needed basis, for the Cheyenne River Health Center, Eagle Butte, South Dakota. All orders placed against this BPA will be subject to the terms and condltions attached.

The "Unit Price" is an all-inclusive cost. All "inclusive cost" is defined to include travel, lodging, per diem, fringe benefits, shipping, freight, insurance(s), social security, etc..., plus all other cost pertinent to the

Derforma nce of this BPA.

This BPA does not obligate any funds. Funds will be obligated monthly as individual orders are placed hereunder. Also referred to as BPA Call Slips/Numbers.

Contact person(s) for Procurement: Danielle Chasing Hawk, Contracting Officer 605-964-0605

. Stephanie Charger, Purchasing Agent 605-964-0507

Ste-Bl!n]!)-re-dslk@j!!eo-y, or Paige Kerstiens, Purchasing Agent 605-964-1565, s.Rov contact person(s) for Property & supply Depa rtment: Jessica Haskell, Property & supply supervisor, 605-

964-0693, iessica.haskell@ihs.eov

The period of performance will be as follows:

Base Year: July 1, 2020 through June 30,2021, with four (4) option years

Option YearOne 1: July 1,2021 throughJune30,2022

Option Year Two 2: July t,2022 through June30,ZO23

Option Year Three 3: July 1, 2023 through June 30, 2024

Option Year Four 4: July 1, 2024 through June 30, 2025

The government will have the option to exercise each option year in accordance with FAR 52.217-9

Option to Extend the Term of the Contract. TheBPAwill be reviewed annually by the Contracting

Officer or the designated representative of the contracting officer'

Orders shall be place against this BPA by using BPA Call Slips, also referred to as BPA Call numbers, and may be submitted electronically, facsimile, or hard copy. Individual BPA Call Slips placed against this

BpA are limited to: Minimum: s5.00 & Maximum: s12,00.00, a month. The yearly limit is up to s145,000, the 5 year limit shall not exceed s725,000.00.

The Government is obligated only to the extent of authorized BPA Call Slips issued under this BPA by a

Contracting Officer.

AUTHORIZED employees who can order and pick up under the executed BPA Call Slips, issued by the

Contracting Officer a re:

Jessica Haskell, Purchasing Agent 605-964-0693

Lab Supervisory 605-964-0640

Lab chemistry Technician 605-964-0639

Stephanie charger, Purchasing Agent 605-964-0507

Paige Kerstiens, Purchasing ABent 605-964-1565

INVOICE SUBMISSION AND PAYMENT

The Contractor shall submit a signed and approved invoice to request payment on, at least, on a monthly basis.

(A) The Contractor shall submit an original invoice to:

Attn: Accounts Payable

Great Plains Area Indian Health Service

Division of Financial Management

115 4th Avenue Southeast

Room 309 Federal Building

Aberdeen, South Dakota 57401

Phone: (605) 226-7526

And, to:

Cheyenne River Health Center

Attn: Property & Supply

24276 766th Street, Airport Rd.

P.O. Box 1012

Eagle Butte, South Dakota 57625

Phone: 605-964-7724

(B) The Contractor shall include the following information on each invoice in accordance with the

Prompt Payment Act (5 CFR Part 1315.9(b):

1. Contractor's name;

2. lnvoice number and date;

3. Entire contract number and Order number (BPA Call number) for delivery of goods or services; These numbers can be found in block 2 and block 3(last 4 numbers) of your option form 347 Order For Supplies or Services. Example: 75H7O6AOOOOB17 5H70620F03004. "3004" if your Call number

4. Description (including dates of service), price, and quantity of Boods and services rendered;

5. Shipping and payment terms;

6. DUNS number and Taxpayer ldentifying Number (TlN); and

7. contact name (where practicable), title and telephone number'

Receiving is done by the Cheyenne River Health Center, Payment shall be made by the IHS/Great Plains

Area Financial Management Branch, 115 4th Avenue SE, Room 309 Federal Building, Aberdeen, South

Dakota 57401.

ATTACHMENTS:

Clauses Incorporated by Reference and FullText

The Government reserves the right to accept or reiect supply/service, if the level of work is unsatisfactory.

Maximum discounts will be applied and should be reflected on the invoice.

Request For Quote/ CRHC20-23

CLAUSES INCORPORATED BY REFERENCE

(Firm Fixed-Price Service-Commercial ltem)

FAR CITATION(S): 52.252-l: Solicitation Provision Incorporated by Reference. (Ff,B 1998) & 52.252-2 Clauses Incorporated by Reference (FEB 1998) This solicitation & contract incorporates one or more solicitation provisions & clauses by reference, with the same force and effect as ifthey were given in full text. Upon request, the Conhacting Officer will make theirfull text available. The offeror is cautioned that the listed provisions may include blocks that must be completed by the offeror and submitted with its quotation or offer. In lieu of submitting the full text ofthose provisions, the offeror may identii/ the provision by paragraph identifier and provide the appropriate information with its quotation or offer. Also, the full text ofa solicitation provision & clauses may be accessed electronically at this/these address(es): hftps://www.acquisition.qov/far

I.

No. FAR citation clause Title Clause Date

52.204-7 System for Award Management

52.204-9 Personal ldentityVerificationofContractorPersonnel

52.204-13 System for Award Management Maintenance

52.204-16 Commercial and Govemment Entity Code Reporting

52.204-18 Commercial and Government Entity Code Maintenance

52.204-19 Incorporation by Reference of Representations and Certifications

52.204-22 Altemative Line Item Proposal

52.211-6 Brand Name or Equal

52.21 l-17 Delivery of Excess Quantities

52.212-1 Instructions to Offerors - Commercial Items

52.212-4 Contract Terms and Conditions - Commercial Items

52.215-5 FacsimileProposals

52.211-5 Evaluation of Options

52.223-6 Drug-FreeWorkPlace

52.225-13 Restrictions on Certain Foreign Purchases

52.229-3 Federal, State, and Local Taxes

52.232-1 Payments

52.232-8 Discounts for Prompt Payment

52.232-18 AvailabilitY of Funds Pag€ I of22

Oct 201 8

Jan 201 I

Oct 201 8

Jul 2016

Jul 2016

Dec 2014

Ian20l7

Aug 1999

Sep 1989

Mar 2020

Oct 2018

Oct 1997

Jul 1990

May 2001

Jun 2008

Feb 2013

Apr 1984

Feb 2002

Apr 1984

20.

21.

22.

2J.

24.

25.

26.

27.

28.

29.

30.

52.232-33

52.232-39

52.232-40

52.233-l

52.243-l

52.244-6

52.246-2

52.246-t6

52.247-34

52.249-l

52.249-E

Payment by Electonic Funds Transfer - System for Award Mgtm

Unenforceability of Unauthorized Obligations

Providing Accelerated Payments to Small Business Subcontractors

Disputes

Changes-Fixed-Price

Subcontracts for Commercial ltems

Inspection of Supplies-Fixed Price

Responsibility for Supplies

F.o.b. Destination

Termination for Convenience of the Govemment

Default (Fixed-Price Supply and Sewice) (Fixed-Price)(Short Form)

Oct 201E

Jun 2013

Dec 2013

Mry 2014

Aug 1987

Aug 2019

Aug 1996

Apr '1984

Nov 1991

Apr l9E4

Apr l9E4

Jan l99lJl.

IL

52.253-l Computer Generated Forms

Federal Acquisition Regulations (FAR) (48 CFR Chapter 1) Clauses in Full Text l.

2.

J.

A

52.204-l

52.2lL-8

52.212-3

52.2r2-5

52.2r7-9

52.232-lE

Approval of Contract

Time of Delivery

Offeror Representation and Certifi cations

- Commercial Items

Contract Terms and Conditions Required to Implement Statutes or Executive Orders - Commercial Items

Option to Extend the Term ofthe Contract

Availability ofFunds

52.204-l -- Approval of Contract.

Dec 1989

Jun 1997

Mar 2020

Mar 2020

Mar 2000

Apr 1984

5.

6.

Pag.2 of22

This contract is subject to the written approval of the Contracting Officer and shall not be binding until so approved.

(End of Clause)

52.211-8 - Time of Delivery.

(a) The Govemment requires delivery to be made according to the following schedule:

REQUIRED DELIVERY SCHEDULE

lContracting Oficer insert specific detctilsl

ITEM NO. QUANTITY WITHIN DAYS AFTER

DATE OF CONTRACT

BPA Catl Slip BPA Call Slip BPA Call Slip

The Govemment will evaluate equally, as regards time ofdelivery. offers that propose delivery ofeach quantity within the applicable delivery period specified above. Offers that propose delivery that will not clearly fall within the applicable required delivery period specified above, will be considered nonresponsive and rejected.

The Govemment reserves the right to award under either the required delivery schedule or the proposed delivery schedule, when an offeror offers an earlier delivery schedule than required above. Ifthe offeror proposes no other delivery schedule, the required delivery schedule above will apply.

OFFEROR'S PROPOSED DELIVERY SCHEDULE

ITEM NO. QUANTITY WITHIN DAYS AFTER

] DATEOFCONTRACT

ft) Attention is directed io ttre Contract At"ard provision of the ;licitation ittui p.ouia"t inat a written award or acceptance ofoffer mailed, or otherwise fumished to the successful offeror, results in a binding contract. The

Govemment will mail or otherwise furnish to the offeror an award or notice of award not later than the day award is dated. Therefore, the offeror should compute the time available for performance beginling with the actual date ofaward, rather than the date the written notice of award is received from the Contracting Offrcer through the ordinary mails. However, the Govemment will evaluate an offer that proposes delivery based on the

Contractor's date ofreceipt ofthe contract or notice of award by adding

(1) five calendar days for delivery ofthe award through the ordinary mails, or i2) one working day if the solicitation states that the contract or notice of award will be transmitted electronically. (Th" t"r. "working day" excludes weekends and U.S. Federal holidays.) If, as so computed, the offered delivery daie is later than the required delivery date, the offer will be considered nonresponsive and rejected.

(End of Clause)

52.2|2-!_olferorRepresentationsandCedifications.Commerciallterns.

The Offeror shall complete only paragraph (b) of this provision if the Offeror has completed the annual representations and certification electronically in the iyit"- io, Awaid Management (SAM) accessed through https://www sam gov lf P^Pe 3 of22 the Offeror has not completed the annual representations and certifications electronically, the Offeror shall complete only paragraphs (c) through 1v)l of this provision.

(a) Definitions. As used in this provision- "Covered telecommunications equipment or services" has the meaning provided in the clause 52.204-25, Prohibition on Contracting for Certain Telecommunications and Video Surveillance Services or Equipment.

Economically disadvantaged women-owned small business (EDWOSB) concem means a small business concem that is at least 5 I percent directly and unconditionally owned by, and the management and daily business operations of which are controlled by, one or more women who are citizens ofthe United States and who are economically disadvantaged in accordance with l3 CFR part 127. It automatically qualifies as a women-owned small business eligible under the WOSB Program.

Forced or indentured child labor means allwork or service- ( I ) Exacted from any person under the age of 18 under the menace ofany penalty for its nonperformance and for which the worker does not offer himself voluntarily; or

(2) Performed by any person under the age of l8 pursuant to a contract the enforcement of which can be accomplished by process or penalties.

Highest-level owner means the entity that owns or controls an immediate owner ofthe offeror, or that owns or controls one or more entities that control an immediate owner ofthe offeror. No entity owns or exercises control ofthe highest level owner.

Immediate owner means an entity, other than the offeror, that has direct control ofthe offeror. Indicators of control include, but are not limited to, one or more of the following: ownership or interlocking management, identity of interests among family members, shared facilities and equipment, and the common use of employees.

lnverted domestic corporation, means a foreign incorporated entity that meets the definition of an inverted domestic corporation under 6 U.S.C. 395(b), applied in accordance with the rules and definitions of6 U.S.C. 395(c).

Manufactured end product means any end product in product and service codes (PSCs) 1000-9999, except-

(l) PSC 5510, Lumber and Related Basic Wood Materials;

(2) Product or Service Group (PSG) 87, Agricultural Supplies;

(3 ) PSG 88, Live Animals.

(4) PSG 89, Subsistence;

(5) PSC 9410, Crude Grades of Plant Materials;

(6) PSC 9430, Miscellaneous Crude Animal Products, Inedible;

(7) PSC 9440, Miscellaneous Crude Agricultural and Forestry Products;

(8) PSC 9610, Ores;

(9) PSC 9620, Minerals, Natural and Synthetic; and

(10) PSC 9630, Additive Metal Materials.

place of manufacture means the place where an end product is assembled out of components, or otherwise made or

Drocessed from raw materials into the finished product that is to be provided to the Covemment. Ifa product is disassembled and reassembled, the place of reassembly is not the place of manufacture.

predecessor means an entity that is replaced by a successor and includes any predecessors ofthe predecessor.

Restricted business operations means business operations in Sudan that include power production activities, mineral extraction activities, oil-related activities, or the production of military equipment, as those terms are defined in the Sudan

Accountability and Divestment Act of2007 (Pub. L. I 10- 174). Restricted business operations do not include business operations that the person (as that term is defined in Section 2 of the Sudan Accountability and Divestment Act of 2007) conducting the business can demonstrate- ( I )ire conducted under contract directly and exclusively with the regional govemment-of southern Sudan;

(2j Are conducted pursuant to specific authorization from the Office of Foreign Assets Control in the Department ofthe i.easury, or are expressly exempted under Federal law from the requirement to be conducted under such authorizationl

(3) Consist of providing goods or services to marginalized populations ofSudan;-

1+j Consist otproviding goods or services to an inte rationally recognized peacekeeping force or humanitarian organization;

(5) Consist ofproviding goods or services that are used only to promote health or education; or

(6) Have been voluntarily suspended "Sensitive technology"- Pase 4 of 22

Sensitive technology-

(1) Means hardware, software, telecommunications equipment, or any other technology that is to be used specifically-

(i) To restrict the free flow ofunbiased information in Iran; or

(ii) To disrupt, monitor, or otherwise restrict speech ofthe people of [ran; and

(2) Does not include information or informational materials the export of which the President does not have the authority to regulate or prohibit pursuant to section 203(bX3)ofthe International Emergency Economic Powers Act (50 u.s c. 1702(bx3).

Service-disabled veteran-owned small business concem-

(l) Means a small business concem-

(i) Not less than 5 I percent of which is owned by one or more service-disabled veterans or, in the case of any publicly owned business, not less than 51 percent ofthe stock of which is owned by one or more service-disabled veterans; and

(ii) The management and daily business operations of which are controlled by one or more service-disabled veteransor, in the case ofa service-disabled veteran with permanent and severe disabiliry, the spouse or permanent caregiver of such veteran.

(2) Service-disabled veteran means a veteran, as defined in 38 U.S.C. 101(2), with a disability that is service connected. as defined in 38 U.S.C. l0l(16).

Small business concem means a concem, including its affiliates, that is independently owned and operated, not dominant in the field of operation in which it is bidding on Government contracts, and qualified as a small business under the criteria in I 3 CFR Part 'l2l and size standards in this solicitation Small disadvantaged business concem, consistent vvith l3 CFR 124.1002, means a small business concem under the size standard applicable to the acquisition, that- ( I ) Is at least 5 I percent unconditionally and directly owned (as defined at l3 CFR 124' 105) by-

(i) One or more socially disadvantaged (as defined at13 CFR 124.103) and economically disadvantaged (as defined at l3 CFR 124.104) individuals who are citizens of the United States; and

(ii) Each individual claiming economic disadvantage has a net worth not exceeding $750,000 after taking into account the applicable exclusions set forth at I 3 CFRI24.l04(c)(2); and

(2) The management and daily business operations of which are controlled (as defined at I3 CFR 124'106)by individuals, who meet the criteria in paragraphs (lXi) and (ii) of this definition.

Subsidiary means an entity in which more than 50 percent ofthe entity is owned-

(l) Directly by a parent corporation; or

(2) Through another subsidiary of a parent corporation

Succersor.Jans an entity that has replaced a predecessor by acquiring the assets and carrying out the affairs ofthe predecessor under a new name (often through acquisition or merger). The term "successor" does not include new offices/divisions ofthe same company or aiompany that only changes its name. The extent ofthe responsibility ofthe successor for the liabilities ofthe predecessor may vary, depending on State law and specific circumstances

Veteran-owned small business concern means a small business concem- ( I ) Not less than 5l percent of which is owned by one or more veterans (as defined at 38 U.S.C. l0l(2)) or' in the

"ur.

oiuny publicly ownedbusiness, not less than 5l percent of the stock of which is owned by one or more veterans; and

(2)'Tire management and daily business operations of which are controlled by one or more veterans.

Women-owned s-mall business IWOSS; coniern eligible under the WOSB Program (in accordance with l3 CFR part

127), means a small business concem that is at least 5 I percent directly and unconditionally owned by' and the management and daily business operations of which are controlted by' one or more women who are citizens ofthe United

States.

Women-owned small business concern means a small business concem-

(l) That is at least 51 percent owned by one or more vlr'omen; or, in the case ofany publicly owned business, at least5l percent ofthe stock of which is owned by one or more women; and

(2)whosemanagementanddailybusinessoperationsarecontrolledbyoneormorewomen' (b)

( f ) ,innual Representations and Certifications. Any changes provided by the Offeror in paragraph (bX2) of this provision do not automaiically change the representations and certifications in SAM

(2) The offeror has completed the annual representations and certifications electronically in SAM accessed through http://www.sam.gov. After reviewing SAM information, the Offeror verifies by submission of this offer that the representations and certifications currently posted electronically at FAR 52.212-3, Offeror Representations and Certifications-Commercial ltems, have been entered or updated in the last 12 months, are current, accurate, complete, and applicable to this solicitation (including the business size standard(s) applicable to the NAICS code(s) referenced for this solicitation), at the time this offer is submitted and are incorporated in this offer by reference (see FAR 4.1201 ), except for paragraphs

[Offeror to identiry the applicable paragraphs at (c) through (v) ofthis provision that the offeror has completed for the purposes ofthis solicitation only, ifany.

These amended representation(s) and/or certification(s) are also incorporated in this offer and are current, accurate, and complete as of the date ofthis offer.

Any changes provided by the offeror are applicable to this solicitation only, and do not result in an update to the representations and cetlifications posted electronically on SAM.]

(c) Offerors must complete the following representations when the resulting contract will be performed in the United

States or its outlying areas. Check all that apply.

(l ) Small business concem. The offeror represents as part of its offer that it tr is, n is not a small business concem.

(2) Veteran-owned small business concern. [Complete only if the offeror represented itselfas a small business concem in paragraph (c)( I ) of this provision.] The offeror represents as part of its offer that it ! is, - is not a veteran-o*'ned small business concern.

(3) Service-disabled veteran-owned small business concern. [Complete only ifthe offeror represented itselfas a veteran-owned small business concern in paragraph (c)(2) of this provision.] The offeror represents as part of its offer that it . is, o is not a service-disabled veteran-owned small business concem.

(4) Small disadvantaged business concem. [Complete only if the offeror represented itself as a small business concem in paragraph (c)(l) ofthis provision.] The offeror represents, that it n is, o is not a small disadvantaged business concem as defined in l3 CFRI24.1002.

(5) Women-owned small business concem. [Complete only if the offeror represented itself as a small business concern in paragraph (c)(l) ofthis provision.] The offeror represents that it E is, o is not a women-owned small business concem.

(6) WOSB concem eligible under the WOSB Program. [Complete only if the offeror represented itself as a women-owned small business concem in paragraph (c)(5) of this provision.] The offeror represents that-

(i) It I is, o is not a WOSB concem eligible under the WOSB Program, has provided all the required documents to the WOSB Repository, and no change in circumstances or adverse decisions have been issued that affects its eligibility;

ano

(ii) It o is, n is not ajoint venture that complies with the requirements of l3 CFR part 127, and the representation in paragraph (c)(6)(i) of this provision is accurate for each WOSB concern eligible under the WOSB program panicipiting in ihejoint venture. [The offeror shall enter the name or names ofthe WOSB concern eligible under tne WOSb Program and other small businesses that are participating in the joint venture: .l Each WOSB concem eligible under the WOSB Program participating in thejoint venture shall submit a separate signed copy of the

WOSB representation.

(7) Economicatly disadvantaged women-owned small business (EDWOSB) concem. [Complete only if the offeror represenied itselfas a WOSB concern eligible under the WOSB Program in (c)(6) of this provision l The offeror represents that-

(i) It - is, tr is not an EDWOSB concem, has provided all the required documents to the WOSB Repository, and no change in circumstances or adverse decisions have been issued that affects its eligibility; and

(ii) It a is, o is not ajoint venture that complies with the requirements of 13 CFR part 127 , and the representation in paragraph (c)i7)(i) ofthis provision is accurate for each EDWOSB concem participating in thejoint venture. [The offeror ihail enter the name or names ofthe EDWOSB concem and other small businesses that are participaiing in thejoint venture: .] Each EDWOSB concem participating in thejoint venture shall submit a separate signed copy ofthe EDWOSB representation.' liote: Complete paragraphs (c)i8) and (c)(9) only ifthis solicitation is expected to exceed the simplified acouisition threshold.

Page 6 ot 22

(8) Women-owned business concern (other than small business concem). [Complete only if the offeror is a women-owned business concern and did not represent itselfas a small business concern in paragraph (c)(l) ofthis provision.] The offeror represents that it o is a women-owned business concern.

(9) Tie bid priority for labor surplus area concerns. lf this is an invitation for bid, small business offerors may identify the labor surplus areas in which costs to be incurred on account of manufacturing or production (by offeror or first-tier subcontractors) amount to more than 50 percent ofthe contract price:

(10) tIUBZone small business concern. [Complete only ifthe offeror represented itselfas a small business concern in paragraph (c)(l) ofthis provision.] The offeror represents, as part of its offer, that-

(i) It I is, tr is not a F{UBZone small business concern listed, on the date ofthis repres€ntation, on the List of Qualified HUBZone Small Business Concems maintained by the Small Business Administmtion, and no material changes in ownership and control, principal office, or HUBZone employee percentage have occurred since it was certified in accordance with l3 CFR Part 126; and

(ii) lt I is, I is not a HUBZonejoint venture that complies with the requirements of l3 CFR Part 126, and the representation in paragraph (c)( I 0)(i) of this provision is accurate for each HUBZone small business concern participating in the HUBZonejoint venture. [The offeror shall enter the names ofeach ofthe HUBZone small business concerns participating in the F{UBZonejoint venture: .l Each HUBZone small business concem participating in the

HUBZone joint venture shall submit a separate signed copy of the HUBZone representation.

(d) Representations required to implement provisions ofExecutive Orderl1246-

( I ) Previous contracts and compliance. The offeror represents that-

(i) It I has, o has not pafticipated in a previous contract or subcontract subject to the Equal Opportunity clause of this solicitation: and

(ii) lt r has, n has not filed all required compliance reports.

(2) Affirmative Action Compliance. The offeror represents that-

(i) It o has developed and has on file, n has not developed and does not have on file, at each establishment, affirmative action programs required by rules and regulations ofthe Secretary of Labor (41 CFR parts 60-l and 60-2), or

(ii) It o has not previously had contracts subject to the written affirmative action programs requirement of the rules and regulations of the Secretary of Labor.

(e) Certification Regarding Payments to Influence Federal Transactions (31 http://uscode.house.gov/ U.S .C. 1352).

(Applies only ifthe contract is expected to exceed $150,000.) By submission of its offer, the offeror certifies to the best of its'knowledge and beliefthat no Federal appropriated funds have been paid or will be paid to any person for influencing or attempting to influence an officer or employee ofany agency, a Member ofCongress, an officer or employee ofCongress

o. an Lmp-ioy"e ofa Member ofCongress on his or her behalfin connection with the award ofany resultant contract. If uny regist antt under the Lobbying Disclosure Act of 1995 have made a lobbying contact on behalf of the offeror with reipeci to this contract, the offeror shall complete and submit, with its offer, OMB Standard Form LLL, Disclosure of Lo|bying Activities, to provide the name of the registrants. The offeror need not report regularly employed officers or employees ofthe offeror to whom payments ofreasonable compensation were made'

(f) Buy American Certificate. (Applies only if the clause at Federal Acquisition Regulation (FAR\ 52.225-l ' Buy

American-Supplies, is included in this solicitation.)

(l) Thi offeror certifies that each end product, except those listed in paragraph (0(2) ofthis provision. is a domestlc'end product and that for other than bOTS items, the offeror has considered components of unknown origin to have been mined, produced, or manufactured outside the United States. The offeror shall list as foreign end products those end products ma;;factured in the United States that do not qualiry as domestic end products,i.e.,.an end product that is not a COTS item and does not meet the component test in paragraph (2) ofthe definition of "domestic end product." The terms ..commercially available off-the-shelf (COTS) itim" "component," "domestic end product," "end product," "foreign end product,,' and ,.iJnited States" are defined in the clause ofthis solicitation entitled "Buy American-Supplies."

(2) Foreign End Products:

Line ltem No. Country of Origin

Page l ot22

[List as necessary]

(3) The Govemment will evaluate offers in accordance with the policies and procedures ofFAR part 25.

(c)

(l) Buy Arnerican-Free Trade Agreements-lsraeli Trade Act Certificate. (Applies only if the clause at FAF.52.225-3,Buy American-Free Trade Agreements-lsraeli Trade Act, is included in this solicitation.)

(i) The offeror certifies that each end product, except those listed in paragraph (g)(lXii) or (g)(l)(iii) ofthis provision, is a domestic end product and that for other than COTS items, the offeror has considered components of unknown origin to have been mined, produced, or manufactured outside the United States. The terms "Bahrainian, Moroccan, Omani, Panamanian, or Peruvian end product," "commercially available off{he-shelf (COTS) item," "component," "domestic end product," "end product," "foreign end product," "Free Trade Agreement country," "Free Trade Agreement country end product," "lsraeli end product," and "United States" are defined in the clause of this solicitation entitled "Buy American-Free Trade Agreements-lsraeli Trade Act."

(ii) The offeror certifies that the following supplies are Free Trade Agreement country end products (other than

Bahrainian, Moroccan, Omani, Panamanian, or Peruvian end products) or lsraeli end products as defined in the clause of this solicitation entitled "Buy American-Free Trade Agreements-lsraeli Trade Act":

Free Trade Agreement Country End Products (Other than Bahrainian, Moroccan, Omani, Panamanian, or Peruvian End Products) or Israeli End Products:

Line Item No. Country of Origin

IList as necessary]

(iii) The offeror shall list those supplies that are foreign end products (other than those listed in paragraph

(gXlXii) of this provision) as defined in the clause ofthis solicitation entitled "Buy American-Free Trade Agreements-

Israeli Trade Act." The offeror shall list as other foreign end products those end products manufactured in the United

States that do not qualifu as domestic end products, i.e., an end product that is not a COTS item and does not meet the component test in paragraph (2) ofthe definition of"domestic end product."

Other Foreign End Products:

Line Item No. Counlry of Origin

[List as necessary]

(iv) The Government willevaluate offers in accordance with the policies and procedures of FAR pad 25.

(2) Buy American-Free Trade Agreements-lsraeli Trade Act Certificate, Altemate L lf Altemate I to the clause at

F AR 52.i25-3 is included in this solicitation, substitute the following paragraph (g)(tXii) for paragraph (g)(l)(ii) ofthe basic provision:

(g)(lXii) The offeror certifies that the following supplies are Canadian end products as defined in the clause ofthis solicitation entitled "Buy American-Free Trade Agreements-Israeli Trade Act":

Canadian End Products:

Line Item No.

[List as necessary] (:) gry ,Ame.ican-Free Trade Agreements-Israeli Trade Act certificate, Alternate II. lf Altemate ll to the clause at

FARi.i25-i is included in this solicitlation, substitute the following paragraph (g)(tXii) for paragraph (gXl)(ii) of the basic provision:

P^Ee 8 of 22

(g)(lXii) The offeror certifies that the following supplies are Canadian end products or Israeli end products as defined in the clause of this solicitation entitled "Buy American-Free Trade Agreements-lsraeli Trade Act":

Canadian or Israeli End Products:

Line Item No. Country of Origin

[List as necessary]

(4) Buy American-Free Trade Agreements-Israeli Trade Act Certificate, Altemate IIl. If Alternate lll to the clause at 52.225-3 is included in this solicitation, substitute the following paragraph (gXl)(ii) for paragraph (gXl)(ii) ofthe basic provision:

(g)( l)(ii) The offeror certifies that the following supplies are Free Trade Agreement country end products (other than Bahrainian, Korean, Moroccan, Omani, Panamanian, or Peruvian end products) or Israeli end products as defined in the clause ofthis solicitation entitled "Buy American-Free Trade Agreements-lsraeli Trade Act":

Free Trade Agreement Country End Products (Other than Bahrainian, Korean, Moroccan, Omani, Panamanian, or Peruvian End Products) or Israeli End Products:

Line ltem No. Country of Origin

[List as necessary]

(5) Trade Agreements Certificate. (Applies only if the clause at F AR 52.225-5, Trade Agreements, is included in this solicitation.)

(i) The offeror certifies that each end product, except those listed in paragraph (g)(5)(ii) ofthis provision, is a

U.S.-made or designated country end product, as defined in the clause ofthis solicitation entitled "Trade Agreements."

(ii) The offeror shall list as other end products those end products that are not U.S.-made or designated country end oroducts.

Other End Products:

Line ltem No. Country of Origin

IList as necessary]

(iii) The Govemment will evaluate offers in accordance with the policies and procedures of FAR part 25. For line items covered by the WTO GPA, the Government will evaluate offers of U.S.-made or designated country end products without regard to the restrictions ofthe Buy American statute. The Govemment will consider for award only offers of U.S.-made or designated country end products unless the Contracting Officer determines that there are no offers for such products or that the offers for such products are insufficient to fi-rlfill the requirements of the solicitation.

(h) CLrtification Regarding Responsibitity Matters (Executive Order 12689). (Applies only if the contract value is expecied to exceed the iimptified aiquisition threshold.) The offeror certifies, to the best of its knowledge and belief, that the offeror and/or any of its principals-

(l) I Are, o are not presenily debarred, suspended, proposed for debarmen! or declared ineligible for the award of contracts by any Federal agencY;

(Z) o Have, I have not, within a three-year period preceding this offer, been convicted ofor had a civiljudgment rendered against them for: commission offraud or a criminal offense in connection with obtaining, attempting to obtain, or perform nt confact or subcontract; violation ofFederal or state antitrust statutes relating to on ofembezzlement, theft, forgery, bribery, falsification or destruction of recoros, m olating Federal criminal ta,r laws, or receiving stolen property;

P.€eg of22

(3) c Are, ! are not presently indicted for, or otherwise criminally or civilly charged by a Govemment entity with, commission ofany ofthese offenses enumerated in paragraph (h)(2) ofthis clause; and

(4) o Have, tr have not, within a three-year period preceding this offer, been notified of any delinquent Federal taxes in an amount that exceeds $3,500 for which the liability remains unsatisfied.

(i) Taxes are considered delinquent if both ofthe following criteria apply:

(A) The tax liability is finally determined. The liability is finally determined if it has been assessed. A liability is not finally determined ifthere is a pending administrative orjudicial challenge. In the case ofajudicial challenge to the liability, the liability is not finally determined until alljudicial appeal rights have been exhausted.

(B) The taxpayer is delinquent in making payment. A taxpayer is delinquent ifthe taxpayer has failed to pay the tax liability when full payment was due and required. A taxpayer is not delinquent in cases where enforced collection action is precluded.

(ii) Examples.

(A) The taxpayer has received a statutory notice ofdeficiency, under I.R.C. $6212, which entitles the taxpayer to seek Tax Court review of a proposed tax deficiency. This is not a delinquent tax because it is not a final tax liability. Should the taxpayer seek Tax Court review, this will not be a final tax liability until the taxpayer has exercised alljudicial appeal rights.

(B) The IRS has filed a notice of Federal tax lien with respect to an assessed tax liability, and the taxpayer has been issued a notice under I.R.C. $6320 entitling the taxpayer to request a hearing with the IRS Office ofAppeals contesting the lien filing, and to further appeal to the Tax Court if the IRS determines to sustain the lien filing. ln the course ofthe hearing, the taxpayer is entitled to contest the underlying tax liability because the taxpayer has had no prior opportunity to contest the liability. This is not a delinquent tax because it is not a final tax liability. Should the taxpayer seek tax court review, this will not be a final tax liability until the taxpayer has exercised all judicial appeal rights.

(C) The taxpayer has entered into an installment agreement pursuant to I.R.C. $61 59. The taxpayer is making timely payments and is in full compliance with the agreement terms. The taxpayer is not delinquent because the taxpayer is not cunently required to make full payment.

(D) The taxpayer has filed for bankruptcy protection. The ta-rpayer is not delinquent because enforced collection action is stayed under ll U.S.C. $362 (the Bankruptcy Code).

(i) Certification Regarding Knowledge of Child Labor for Listed End Products (Executive Order 13126). [The Contracting Officer must list in paragraph (i)(l) any end products being acquired under this solieitation that are included in the List of Products Requiring Contractor Certification as to Forced or Indentured Child Labor, unless excluded at

22.1 s03(b).1

(l) Listed end products.

Listed End Product Listed Countries ofOrigin

(2) Certification. [lfthe Contracting Offrcer has identified end products and countries oforigin in paragraph (i)(l) ofthis provision, then the offeror must certiry to either (iX2Xi) or (i)(2)(ii) by checking the appropriate block.l

(i) The offeror will not supply any end product listed in paragraph (i)(l) ofthis provision that was mined, produced, or manufactured in the corresponding country as' (ii) The offeror may supply an end product listed s provision that was mined, produced, or manufactured in the corresponding country as listed for th certifies that it has made a good faith effort to determine whether forced or indentured child labor was used to mine, produce, or manufacture any such end product furnished under this contract. On the basis ofthose efforts, the offeror certifies that it is not aware ofany such use of child labor.

itation is predominantly for the acquisition of manufactured indicate whether the place of manufacture ofthe end

;::if,:,ilXty*"rrered end products manuractured in the

United States exceeds the total anticipated price of offered end products manufactured outside the United States); or

(2) o Outside the United States.

Page 10 of22

(k) Certificates regarding exemptions liom the application ofthe Service Contract Labor Standards (Certification by the offeror as to its compliance with respect to the contract also constitutes its certification as to compliance by its subcontractor if it subcontracts out the exempt services.) [The contracting officer is to check a box to indicate if paragraph (kX l) or (k)(2) applies.l

( 1) Maintenance, calibration, or repair of certain equipment as described in FAR 22. 1003-4(c)( I ). The offeror a does r does not certiry that-

(i) The items ofequipment to be serviced under this contract are used regularly for other than Governmental purposes and are sold or traded by the offeror (or subcontractor in the case of an exempt subcontract) in substantial quantities to the general public in the course of normal business operations;

(ii) The services will be furnished at prices which are, or are based on, established catalog or market prices (see

FAR 22. 1003-4(c)(2)(ii)) for the maintenance, calibration, or repair of such equipment; and

(iii) The compensation (wage and fringe benefits) plan for all service employees performing work under the contract will be the same as that used for these employees and equivalent employees servicing the same equipment of commercial customers.

(2) Certain services as described in FAR 22.1003 -4(d)( l). The offeror o does n does not certify that-

(i) The services under the contract are offered and sold regularly to non-Govemmental customers, and are provided by the offeror (or subcontractor in the case ofan exempt subcontract) to the general public in substantial quantities in the course of normal business operations;

(ii) The contract services will be fumished at prices that are, or are based on, established catalog or market prices (see FAR 22.1003-4(d)(2)(iii));

(iii) Each service employee who will perform the services under the contract will spend only a small portion of his or her time (a monthly average of less than 20 percent of the available hours on an annualized basis, or less than 20 percent ofavailable hours during the contract period ifthe contract period is less than a month) servicing the Govemment contract; and

(iv) The compensation (wage and fringe benefits) plan for all service employees performing work under the contract is the same as that used for these employees and equivalent employees servicing commercial customers.

(3) If paragraph (kX l) or (kX2) of this clause applies

(i) Ifthe offeror does not certify to the conditions in paragraph (kXl) or (k)(2) and the Contracting Officer did not attach a Service Contract Labor Standards wage determination to the solicitation, the offeror shall notify the

Contracting Officer as soon as possible; and

1ii; The Contracting Officer muy not make an award to the offeror if the offeror fails to execute the certification in paragraph (k)(l) or (kX2) of this clause or to contact the Contracting Officer as required in paragraph (k)(3)(i) ofthis ctause.

(l) Taxpayer ldentification Number (TIN) ( 26 U.S.C. 6109, 3l U.S.C. 7701). (Not applicable if the offeror is required to provide this information to the SAM to be eligible for award.)

6) All offerors must submit the information required in paragraphs (l)(3) through (l)(5) ofthis provision to comply with debt collection requirements of 3 I U.S.C. 7701 (c) and 3325(d), reporting requirements of 26 U S.C. 604 I

604 I A, and 6050M, and implementing regulations issued by the Intemal Revenue Service (lRS)'

(2) The TIN may be usid by the Govemment to collect and report on any delinquent amounts arising out ofthe offeroris relationship with the Government (31 U.S.C. 7701(c)(3)). Ifthe resulting contract is subject to the payment reporting requirements described in FAR 4.904, the TIN provided hereunder may be matched with IRS records to veriry the accuracy ofthe offeror's TlN.

(3) Taxpayer ldentification Number (TIN)

TIN:

TIN has been apPlied for.

TIN is not required because:

Offeror is a nonresident alien, foreign corporation, or foreign partnership that does not have income effectively connected with the conduct of a trade or business in the United States and does not have an office or place of business or a fiscal paying agent in the United States;

Offeror is an agency or instrumentality of a foreign government;

Offeror is an agency or instrumentality ofthe Federal Govemment

(4) Type of organization.

Paee I I of22

Sole proprietorship;

Partnership;

Corporate entity (not ta-\-exempt);

Corporate entity (tax-exem pt);

Government entity (Federal, State, or local);

Foreign government;

lntemational organization per 26 CFRl.6049-4;

Other

(5) Common parent.

Offeror is not owned or controlled by a common pareng

Name and TIN of common parent:

Name

TIN

(m) Restricted business operations in Sudan. By submission of its offer, the offeror ceftifies that the offeror does not gonduct any restricted business operations in Sudan.

(n) Prohibition on Contracting with Inverted Domestic Corporations.

(1) Government agencies are not permifted to use appropriated (or otherwise made available) funds for contracts with either an inverted domestic corporation, or a subsidiary of an inverted domestic corporation, unless the exception at 9. 108-

2(b) applies orthe requirement is waived in accordance with the procedures at 9.108-4.

(2) Representation. The Offeror represents that-

(i) It r is, - is not an inverted domestic corporation; ani

(ii) It r is, o is not a subsidiary of an inverted domestic corporation.

(o) Prohibition on contracting with entities engaging in certain activities or transactions relating to Iran.

( I ) The offeror shall e-mail questions concerning sensitive technology to the Department ofState at

CISADAI06@state.gov.

(2) Representation and Certifications. Unless a waiver is granted or an exception applies as provided in paragraph

(o)(3) ofthis provision, by submission of its offer, the offeror-

(i) Represents, to the best of its knowledge and belief, that the offeror does not export any sensitive technology to the govemment of lran the govemment oflran;

or any entities or individuals owned or controlled by, or acting on behalf or at the direction of,

(ii) Certifies that the offeror, or any person owned or controlled by the offeror, for which sanctions may be imposed under section 5 of the Iran Sanctions Act; and does not engage in any activities

( iii) Certifies that the offeror, and any person owned or controlled by the offeror, does not knowingly engage in any transaction that exceeds $3,500 with Iran's Revolutionary Guard Corps or any of its officials, agents, or affiliates, the property and interests in property of which are blocked pursuant to the Intemational Emergency Economic Powers Act (et ieq.) (see OFAC's Specially Designated Nationals and Blocked Persons List at https://www.treasury.gov/resource-center/sanctions/S DN-Li st/Pages/default.aspx).

(3) The representation and certification requirements of paragraph (o)(2) ofthis provision do not apply if-

(i) This solicitation includes a trade agreements certification (e.g., 52.212-3(9) or a comparable agency provision); and

(ii) The offeror has certified that all the offered products to be supplied are designated country end products.

(p) Ownership or Control ofOfferor. (Applies in all solicitations when there is a requirement to be registered in SAM or a requirement to have a unique entity identifier in the solicitation).

(l; Thr Off"rot t"presents that it n has or n does not have an immediate owner. Ifthe Offeror has more than one immediute owner (such ai ajoint venture), then the Offeror shall respond to paragraph (2) and ifapplicable, paragraph (3) of this provision for each participant in the joint venture.

iZ) ttt6. Offeror indicates "has" in paragraph (p)(l) ofthis provision, enter the following information:

Immediate owner CAGE code:

Immediate owner leqal name:

(Do not use a "doing business as" name)

Is the immediate owner owned or controlled by another entity: I Yes or o No'

Page l2 of22

(3)…