CRHC20-44.pdf

REQUEST FOR QUOTATIONS

(THIS IS NOT AN ORDER)

THIS RFQ !S SMALL BUSINESS SE'T.ASII]E

PAGE OF PAGES

1of 2

I REQUEST NO

cRHC-20-44

2- DATE ISSUED

08101t2020

]. REQUISITION/PURCHASTJ REQUIJST NO

tHs1408420

4 CERT FOR NAT. DEF I RATINC

UNDER BDSA REG.2

I

AND/OR DMS REC I I

5A, ISSUED BY

Eagle Butte Indian Health Service, Cheyenne River Service Unit 24276 166th St, PO Box 1012, Eaqle Butte. SD 57625

6 DELMR BY (Date)

See schedule

5b FOR INFORMATION CALL (NO COLLECTCALLS) 7 DELIVERY OTHER fi roo oesrlNl.rloN (See Scheaute)

NAME

Stephanie Charger stephanie.redelk@ihs.eov

TELEPHONE NUMBER 9 DESTINATION

AREA CODE

ouc

NUMBER

964-0507 a NAME OF CONSIGNEE

Chevenne River Service Unit 8TO b, STREET ADDRESS

24276 1661h St . PO Box 101 2 a NAME b COMPANY c. CITY

Eagle Butte c STREET ADDRESS d CITY e STATE i ZIP CODE d STATE

SD

c ZIP CODE

57625

IO PLEASE FURNISH QUOTATIONS TO

THE ISSUINC OFFICE IN BLOCK

5a ON OR BY l:00 PM MST ON (ral4

August 14, 2020

IMPORTANT: Thts is a request for information, and quotations fumished are not offiers lfyou are urBble toquote. please so indicate on this form and retum it to rhe address in Block 5a This request does not commit the Govemnent to pa) any cosrs incu rred in the prepararion o f l he submiss ion of th is q uot tion or to con tracl for supplies or serv ices Suppiies are of domestic origin unless othenxis€ indicated by quoter Any repreentations and/or certifications attached to this Requcsl for Ouotations must be comDleted bv theouoter

I l. SCHEDULE Anclude applicrble Federal, Stste and local tuxes)

ITEM NO.

(a) SUPPLIESiSERVICES

(b)

QUANTITY

(c)

LNTT

(d)

LINIT PRICE

tel

AMOTJNT

(fl

I r'*BUY INDIAN SET-ASIDE** Firm Fixed Price Purchase Order for Two(2) 2020 Bobcat 5600 Toolcats and Three(3) 96" Hydraulic Angle Snow Blades, with trade-in allowances ofthree(3) 96" snow blades, for the Maintenance Department, Cheyenne River Health Center, Eagle Bune, SD.

Price is all inclusive. See Attached SDecification Sheet.

2020 Bobcat 5600 Toolcat

96" Hydraulic Angle Snow Blade

Trade-in Allowance 1)Serial#: 683800f88 - $ 2)Serial#: 683800f97 - $ 3)Serial#: 683E07118 - S ea ea

S

Total:

Minus trade-in total:

Aggregated Total:

s

S

12 DISCOT]NT FOR PROMPT

PAYMENT

a, IO CALENDAR DAYS b20

CALENDAR

DAYS%

c. 30 CALENDAR DAYS vo d CALENDAR DAYS

NUMBER PERCEN'tACE

NOTE Addi Drovrsims atd representations are are not attached

13 NAME AND ADDRESS OF ( UOTER I5 SIGNATURE OF PERSON AUTHORIZED TO

SIGN QUOTATION

I5. DATE OF

QUOTATIONa NAME OF QUOTER b STREET ADDRESS

c. COUNTY I6 SICNER

a. NAME (Type ofptint) , TELEPHONE

AREA CODE

d CITY e. STATE I ZIP CODE c TITLE (type ot p nt) NUMBER

STlnc FORM FOR pDC.rihFrl hw r;s A -FAP /r'1 aFQ\ <1-t | <- I rar

ITEM

NO.

(a)

SUPPLIES/SERVICES

(b)

QUANTITY

(c)

I.JNIT

(d)

LINIT PRICE

(e)

AMOUNT

(0

DUNS & Bradstreet Number:

(The Duns & Bradstreet number is required.

Provided you do not have it, you may call 866705- 571 I and obtain one.) You will need a DUNS & Bradstreet NUMBER lo be awarded the parchase order and rcsislered t'ilh lhe Svstem for At'ard

The quoter is bereby 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 (htto://exlusions.oig.hhs.gov) throughout the duration of the contract.

Federal Tax ID Number:

Email Address:

Net Terms:

NOTTCE TO QUOTERS

REOUEST FOR OUOTES RFO): CRHC20-41

QUOTE DUE DATE: Quotes are due August 11,2(120 @ l:00 PM MST

RETURN RFO TO: Cheyenne River Service Unit Attn: Stephanie Charger PO Box 1012 Eagle Butte, SD 57625 Telephone: 605-964-7724 Ext. 0507 Fax: 605-964-1140

GENERAL DESCRIPTION;

Firm Fixed Price, Purchase Order, fbr Two(2) 2020 Bobcat 5600 Toolcats and Three(3) 96" Hydraulic Angle Snow Blades, with trade-in allowances ofthree(3) 96" snow blades, for the Maintenance Department, at the Cheyenne River Health Center located in Eagle Butte, SD. The Delivery: 60 days after ARO. The quoted "unit price" shall be an all inclusive price. There are three(3) 96" snow blade trade-in's the vendor will allow for a trade-in allowance on them and must be listed separate on quote submitted.

This RFQ is issued as a 100% Indian Small Business Economic Enterprise Set Aside and the associated NAICS code is 333 120 with a small business size standard of 1 ,250 employees.

BASIS FOR AWARD:

Lowest Price Technically Acceptable (LPTA). LPTA factors in determining the successful contractor:

L Provide Brand Name or Equal Items listed in the Specification Sheet/Price Schedule

2. Trade-ln Allowance

3. Complete/Submit Indian Health Service Buy Indian Act Indian Firm Representation Form

4. Meet the Delivery Schedule.

Contractor must be registered with the System for Award Management. The website to register is at:

www.sam.gov

INSTRUCTION TO QUOTERS:

To be considered an acceptable quote, the following items 4qgg! be completed and retumed by the due date stated above.

l. Complete and sign SF- l8 - Request for Quotation (Signature required)

2. Complete Taxpayer Identification Form (FAR Part 52.204-3 - Taxpayer Identification)

3. Complete Annual Representations & Certifications form (FAR 52.212-5)

4. Indian Health Service Buy Indian Act lndian Firm Representation Form

ATTACHMENTS:

l. SF-I8 Request for Quotations

2. Notice to Quoters

3. Specification Sheet

4. Trade-lnAttachments

5. Clauses incorporated by reference

6. Clauses incorporated in full text

7. Representations and Certifications

8. Indian Health Service Buy Indian Act Indian Firm Representation Form

NO CONTRACT AWARD SHALL BE MADE TO ANY VENDOR OR PROVIDER LISTED ON THE

OIG EXLUSION LIST http://exlLrsions.oig.hhs.gov THROUGHOUT THE DURATION OF THE

CONTRACT. IT SHALL BE THE RESPONSIBILITY OF THE CONTRACTOR TO NOTIFY THE

ACQUISITION OFFICIAL IF THERE IS A CHANGE IN I'IiOVIDER.

SECURITY CLEARANCE

Performance of this contract will require routine access by employees of the Contractor or its subcontractors to facilities or systems controlled by the Indian Health Service (l.H.S.). Before starting work requiring routine access to l.H.S. facilities or systems each person must complete a FBI National Criminal History Check (Fingerprint Check) adjudicated by an l.H.S. employee using the Office of Personnel Management Personnel Investigations Processing System. Contractors shall allow five business days for l.H.S. processing of fingerprints taken electronically at an l.H.S. site and thirty business days for non-electronic processing of fingerprints using FBI Form FD-258. A list of l.H.S. sites with electronic fingerprint capability is available from the Conhacting Officer.

Quotation must set forth full, accurate, and complete information as required by this Request for Quotation (RFQ), and be retumed no later than the date referenced in Block #10 ofthe Request for Quotation form SF-18.

All required information must be submitted in order to be considered responsive and eligible for award.

S COPE OF WORIVSPE CIFICATIONS

2020 Bobcat 5600

Item#1 lAdjustable Vinyl Seats All-Wheel Steer

Quantity - 2 ea. ] Automatically Activated Glow Plugs Auxiliary Hydraulics Variable Flow with dual direction detent Beverage Holders Bob-Tach Boom Float Cargo Box Support Cruise Control Deluxe Operator Canopy includes:

Front Window, Rear Window Front Wipers, and Electrical Power Port Lower Engine Guard Limited Slip Transaxle Engine and Hydraulic Monitor with Shutdown Front Work Lights Full-time Four-Wheel Drive Horsepower Management Roll Over Protective Structure (ROPS). Meets Requirements of SAE-J1040 &amp; ISO 347f Falling Object Protective Structure (FOPS). Meets Requirements of SAE-J1043 &amp; ISO3449, Level I Dome Light Hydraulic Dump Box Instrumentation: Hour meter, Job Hours, Speedometer, Tachometer, Fuel Gauge' Engine Temperature Gauge and Warning Lights Joystick, Manually Controlled with Lift Arm Float Lift Arm Support Parking Brake, automatic Power Steering with Tilt Steering Wheel Radiator Screen Rear Receiver Hitch Seat Belts. Shoulder Harness Spark Arrestor Muffler Suspension, 4-wheel independent Tires: 27 x 10.6-15 (8 ply)' Lug Tread Toolcat Interlock Control System (TICS) Two-Speed Transmission

Item #2

Quantity - 2 ea.

Deluxe Road Packaqe:

Backup Alarm Turn Sigrrals Flashers Tail Lights Brake Lights Rear View Mirror Side Mirrors Horn Lower Engine Guard Rear Work Lights Headliehts

Item #14

Rear Window Guard

Item #13

Trade-in #1:

Melroe Ingersoll-Rand 96" Hydraulic Angle Snow Blade Serial:683800188

Trade-in #2:

Melroe Ingersoll-Rand

Serial:683800197

Trade-in #3:

201 I Bobcat

Serial: 6838071 18

DEPARTMENT OF HEALTH & HUMAN SERVICES

Division of Acquisition Polic) (DAP) 5600 Fishers Lanc

Rockville, MD 20857

INDIAN HEALTH SERVICE

BUY INDIAN ACT

INDIAN FIR.IVI REPRESENTATION FORM

SOLICIATION IIUMBER:

PROJECT TITLE:

DATE:

In accordance with 25 U.S.C. 47 the Buy lndian Act, the signature below constitutes self-certification that the Offeror meets the definition of an "lndian Firm" (HHSAR 326.602) with "lndian Ownership" (HHSAR 326.603), in response to this solicitation and resultant contract.

The enterp se must meet the definition of "lndian Firm" throughout the following time periods:

(l) At the time an offer is made in response to this solicitation;

(2) At the time of contract award; and

(l) During the full term of the contract performance period. At any point during these periods, ifthe Contractor no longer meets the eligibility requirements, the contractor must provide immediate wriften notification to the Contracting Officer.

Individual Contracting Officers may require documentation ofeligibility before awarding a set-aside or sole source contracts under the Buy Indian Act and awards may be subject to protest if the eligibility ofthe successful Offeror is in question. In addition to the self-certification requirements, successful Offerors rnust also be registered with DUN and

Bradstreet (D&B) and the System of Award Management (SAM).

Any false or misleading information submitted by an enterprise when submining an offer in consideration ofan award set-aside under the aurhority of the Buy Indian Act is a violation of the law and punishable under l8 U.S.C. l00l .

False claims submitted as part of contract performance are subject to the penalties enumerated in 3 I U.S.C. 3729 to

3731 and l8 U.S.C. 287.

REPRESENTATION

The Offeror represents as part of its offer that it does does not with "lndian Ownership" under the authority of the Buy Indian Act

Business Name meet the definition ofan "lndian Firm"

Certilying Signature

DUNS Number Print Name

CLAUSES INCORPORATED BY REFERENCE

(Firm Fixed-Price -Commercial Items)

FAR CITATION: 52.252-lz Solicitation Provision Incorporated by Reference. (FEB 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 lorce and effect as ifthey were given in full text. Upon request, the Contracting Officer will maketheirfull 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. ln lieu of submitting the full text ofthose provisions, the offeror may identi! 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): hnps://www.acquisition.gov/far

I.

No. FAR Citation Clause Title Clause l)ate

52.204-7 System for Award Management (P)

52,204-13 System for Award Management Maintenance

52.204-16 Commercial and Government Entity Code Reporting

52.204-lE Commercial and Govemment Entity Code Maintenance

52.204-19 lncorporation by Reference of Representations and Certifications

52.2ll-6 Brand Name or Equal

52.21l-17 Delivery of Excess Quantities

52.212-l Instructions to Offerors - Commercial ltems

52.212-4 Contract Terms and Conditions - Commercial Items

52.215-5 FacsimileProPosals

52.232-l Payments

52.232-E Discounts for Prompt Payment

52.232-11 Extras

52.232-39 Unenforceability of Unauthorized Obligations

52.232-40 Providing Accelerated Payments to Small Business subcontractors

52.233-l DisPutes

52.243-l Changes-Fixed-Price

52.244-6 Subcontracts for Commercial ltems

52.246-16 ResponsibilityforSupplies

Oct 201E

Oct 2018

Jul 2016

Jul 2016

Dec 2014

Aug 1999

Sep 1989

Mar 2020

Oct 201 8

Oct 1997

Apr 1984

Feb 2002

Apr l9E4

JUN ZU IJ

Dec 2013

May 20l,4

Aug 1987

Aug 2019

Apr 1984

Page I of2l

20.

21.

22.

II.

52.247-34

52.249-l

52.249-8

52.253-l

F.o.b. - Destination

Termination for Convenience of the Govemment (Fixed-Price)(Short Form)

Default (Fixed-Price Supply and Service)

Computer Generated Forms

Nov 1991

Apr 1984

Apr 1984

Jan 1991

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

No. FAR Citation Clause Title Clause I)ate

A

2.

3.

l. 52.204-l

52.204-3

52.2t2-3

52.212-5

Approval of Contract

Taxpayer Identifi cation (P)

Offeror Representation and Certifi cations

- Commercial Items

Contract Terms and Condition Required to lmplement Statutes or Executive Orders - Commercial Items

Dec 1989

Oct 1998

Mar 2020

Mar 2020

52.204-l Approval of Contract This contract is subject to the written approval of Contracting Officer and shall not be finding until so approved.

52.204-3 Tax payer Identifi cation

TAXPAYER IDENTIFICATION (OCT I 998)

(a) Definitions.

"Common parent," as used in this position, means that corporate entity that owns or controls an affiliated group of corporations that files its Federal income tax retums on a consolidated basis, and of which the offeror is a member.

"Taxpayer Identification Number (TlN)," as used in this provision, means the number required by the Internal

Revenue Service (lRS) to be used by the offeror in reporting income tax and other returns. The TIN may be either a

Social Security Number or an Employer ldentifrcation Number.

(b) All offerors must submit the information required in paragraphs (d) through (f) of this 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. 6041, 405 I A' and 6050M, and implementing regulations issued by the IRS. lfthe resulting contract is subject to the payment reporting requirements described in Federal Acquisition Regulation (FAR) 4.904, the failure or refusal by the ofieror to fumish the information may result in a 3 I percent reduction of payments otherwise due under the contract.

(c) The TIN may be used by the Govemment to collect and report on any delinquent amounts arising out ofthe offeror's relitionship with the Govemment (31 U.S.C, 7701@(3)). lf the 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 verifu the accuracy ofthe offeror's TIN.

(d) Ta.xpayer Identification Number (TIN)

! rrN:

N TIN

! rrN has been applied for.

is not required because:

Page 2 of2l f] 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.

(e) Type of organization.

n Sole proprietorship;

n Partnership;

n Corporate entity (not tax-exempt);

! Corporate entiry (tax-exempt);

n Government entity (Federal, State, or local);

n Foreign govemment;

! Intemational organization per 26 CFR |.6049-4 n other

(f1 Common parent.

n Offeror is not owned or controlled by a common par€nt as defined in paragraph (a) ofthis provision.

! Name and TIN of common parent:

Name

TIN

(End of provision)

52.212-3 -- Offeror Representations and Certifications -- Commercial Items'

The Offeror shall complete only paragraph (b) ofthis provision if the Offeror has completed the annual representations and certification electronically inthe Syitem for Award Management (SAM) accessed through https://www.sam.gov. lf the Offeror has not completed the annual representations and certifications electronically, the Offeror shall complete only paragraphs (c) through (v)) 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.

Economicallylisadvantaged women-owned small business (EDWOSB) concem means a small business concem that n "t t"uu 5l iercent direJtly and unconditionally owned by, and the management and daily business operations of which are controlled by, oni or more women who are citizens of the United States and who are economically disadvantaged in accoidance 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 all work or service- ( I ) Exacted from any person under the age of l8 under the menace ofany penalty for its nonperformance and for which the worker does not offer himself voluntarily; or

Page I ol 2l

(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.

Highestlevel 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 entiry owns or exercises control of the highest level owner.

Immediate owner means an entity, other than the offeror, that has direct control ofthe offeror. Indicators ofcontrol 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.

Inverted domestic corporation, means a foreign incorporated entity that meets the definition ofan 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 ofPlant 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 ofmanufacture means the place where an end product is assembled out ofcomponents, or otherwise made or processed from raw materials into the finished product that is to be provided to the Government. If a 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 of the oredecessor.

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 of 2007 (Pub. L. I l0- I 74).

Restricted business operations do not include business operations that the person (as that term is defined in

Section 2 ofthe Sudan Accountability and Divestment Act of2007) conducting the business can demonstrate- ( I ) Are conducted under contract directly and exclusively with the regional govemment of southem Sudan;

(2) Are conducted pursuant to specific authorization from the Office of Foreign Assets Control in the Department ofthe Treasury, or are expressly exempted under Federal law from the requirement to be conducted under such authorization;

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

(4) Consist ofproviding goods or services to an intemationally recognized peacekeeping force or humanitarian organization;

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

(6) Have been voluntarily suspended."Sensitive technology"-

Sensitive technology- ( I ) Means hardwari, software, telecommunications equipment, or any other technology that is to be used specifically-

(i) To restrict the free flow of unbiased information in Iran; or iiil fo alsrupt, monitor, or otherwise restrict speech ofthe people oflran; and

(2) Ooes not include information or informational materials the export of which the President_does not have the auihority to regulate or prohibit pursuant to section 203(b)(3)of the Intemational Emergency Economic Powers

Act (s0 U.S.C. 1702(bX3).

Service-disabted veteran-owned small business concem-

( I ) Means a small business concern-

(l) Not less than 5 I percent of which is owned by one or more service-disabled veterans or, in the case of any puUt;"ty o*nra business, not less than 5l percent ofthe stock of which is owned by one or more service-d isabled veterans; ano (ii)Themanagementanddailybusinessoperationsofwhicharecontrolledbyoneormoreservlce.

Page 4 of2l disabled veteransor, in the case of a service-disabled veteran with perrnanent and severe disability, the spouse or permanent caregiver of such veteran.

(2) Service-disabled veteran means a veteran, as defined in 38 U.S.C. I 0l (2), with a d isability that is service connected, as defined in 38 U.S.C. l0l ( l6).

Small business concem means a concern, including its affiliates, that is independently owned and operated, not dominant in the field of operation in which it is bidding on Govemment contracts, and qualified as a small business under the criteria in l3 CFR Part l2l and size standards in this solicitation.

Small disadvantaged business concern, consistent withl3 CFR 124.1002, means a small business concem under the size standard applicable to the acquisition, tha

(l ) Is at least 5l percent unconditionally and directly owned (as defined at l3 CFR 124.105) by-

(i) One or more socially disadvantaged (as defined atl3 CFR 124.103) and economically disadvantaged (as defined at l3 CFR 124.104) individuals who are citizens ofthe 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 CFR 124.104(c)(2); and

(2) The management and daily business operations of which are controlled (as defined at I 3.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- ( I ) Directly by a parent corporation; or

(2) Through another subsidiary of a parent corporation

Successor means an entity that has replaced a predecessor by acquiring the assets and carrying out the affairs of the predecessor under a new name (often through acquisition or merger). The term "successor" does not include new offices/divisions ofthe same company or a company 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-

(l) Not less than 5 | percent of which is owned by one or more veterans (as defined at 38 U.S.C. l0l(2)) or, in the case of any publicly owned business, not less than 51 percent ofthe stock of which is owned by one or more veterans; and

(2) The management and daily business operations of r.lhich are controlled by one or more veterans.

Women-owned small business (WOSB) concem eligible under the WOSB Program (in accordance with l3 CFR part 127), means a small business concern that is at least 5l 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 of the United States.

Women-owned small business concern means a small business concern- ( I ) That is at least 5 I percent owned by one or more women; or, in the case of any publicly owned business, at leastsl percent ofthe stock of which is owned by one or more women; and

(2) Whose management and daily business operations are controlled by one or more women.

(b) ( l) Annual Representitions and Certifications. Any changes provided by the Offeror in paragraph (b)(2) ofthis provision do not automatically change the representations and certifications in SAM

(2) The offeror has completed the annual representations and certifications electronically in SAM accessed ihiough http://www.sam.gov. After reviewing SAM information, the Offeror verifies by submission of this offer that the repiesentations and certifications currently posted electronically at FAR 52.212-3, Offeror Representations and Certifications-Commercial ltems, have been entered or updated in the last l2 months, are current, accurate, complete, and applicable to this solicitation (including the business size standard(s) applicable to the NAICS code(s) referencei for this solicitation), at the time this offer is submitted and are incorporated in this offer by reference (see FAR 4. l20l ), except for paragraphs

[Offeror to identifl the appiicable paragiaphs at (c) through (v) ofthis provision that the offeror has completed for the purposes of this solicitation only, if any

Theie amended representation(s) and/or certification(s) are also incorporated in this offer and are current, accurate' and complete as ofthe 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 certifications posted electronically on SAM'

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

States or its outlying areas. Check all that apply.

( I ) Small business concem. The ofdroi represents as part of its offer that it - is, ! is not a small business concem.

(2)Veteran-ownedsmallbusinessconcern'[Complet;,;llvifttreotTerorrepresenteditseIfasasmall business concem in paragraph (c)(l) ofthis provision.] The offeror represents as part of its offer that it o is, o is not a veteran-owned small business concem.

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

(4) Small disadvantaged business concem. fComplete only if the offeror represented itselfas a small business concem in paragraph (c)(1) of this provision.] The offeror represents, that it n is, o is not a small disadvantaged business concem as defined in l3 CFR 124. I 002.

(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 r is, r is not a women-owned small business concern.

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

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

(ii) It o is, D is not a joint venture that complies with the requirements of I 3 CFR part 127 , and the representation in paragraph (c)(6)(i) ofthis provision is accurate for each WOSB concern eligible under the WOSB Program participating in thejoint venture. [The offeror shall enter the name or names oft]e WOSB concern eligible under the WOSB Program and other small businesses that are participating in the joint venture: .] Each WOSB concern eligible under the WOSB Program participating in the joint venture shall submit a separate signed copy ofthe WOSB representation.

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

(i) It n is, o 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) lt r is, n is not ajoint venture that complies with the requirements of l3 CFR part 127, and the representation in paragraph (c)(7)(i) of this provision is accurate for each EDWOSB concern participating in thijoint venture. [The offeror shall enter the name or names ofthe EDWOSB concem and other small businesses that ari participating in thejoint venture: .l Each EDWOSB concern participating in the joint venture shall submit a separate signed copy ofthe EDWOSB representation

Note: Complete paragraphs (c)(8) and (cX9) only ifthis solicitation is expected to exceed the simplified acquisition threshold.

(8) Women-owned business concem (other than small business concem). [Complete only ifthe offeror is a women-owned business concem and did not represent itself as a small business concern in paragraph

(c)( I ) ofthis provision.] The offeror represents that it I is a women-owned business concern.

(9) Tie bid priority for labor surplus area concerns. If this is an invitation for bid, small business offerors may identifu the'labor iurplus areas in which costs to be incurred on account ofmanufacturing or production (by offeror or firsltier subcontractors) amount to more than 50 percent ofthe contract prlce:

itO) HUgZon. small business concern. [Complete only ifthe offeror represented itselfas a small business co*em in paragraph (c)( t ) of this provision.l The offeror represents, as part of its offer, that-

(i) lt I is, o is-not a HUBZone small business concern listed, on the date of this representation, on the List of i)ualified HUBZone Small Business Concems maintained by the Small Business Administration, 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) It o is, - is not a HUBZone joint venture that complies with the requirements of l3 CFR Part 126, and the c;110;1i; oftlis provision is accurate for each HUBZone small business concem ejoint venture. [The s ofeach ofthe HUBZone small ng in the HUBZone j Each HUBZone small business concem participating in the HUBZone joint ventu gned copy ofthe HUBZone reDresentation.

(d) Representations required to implement provisions

-of Executive Orderl1246-

( 1) Previous contracts and compliance tn" ""1""1J:?i;ents that-

(i) lt n has, ! has not participated in a previous contract or subcontract subject to the Equal Opportunity clause of this solicitation; and

(ii) It o has, r has not filed all required compliance reports.

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

(i) It n has developed and has on fi le, a 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 n has not previously had contracts subject to the written affirmative action programs requirement ofthe rules and regulations ofthe Secretary ofLabor.

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

1 3 52). (Applies only if the contract is expected to exceed $ I 50,000.) By subm ission 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 or an employee ofa Member ofCongress on his or her behalfin connection with the award ofany resultant contract. Ifany registrants under the Lobbying Disclosure Act of 1995 have made a lobbying contact on behalf of the offeror with respect to this contract, the offeror shall complete and submit, with its offer, OMB Standard Form

LLL, Disclosure of Lobbying Activities, to provide the name ofthe registrants. The offeror need not report regularly employed officers or employees of the offeror to whom payments ofreasonable compensation were made.

(f) Buy American Certificate. (Applies only ifthe clause at Federal Acquisition Regulation (FAR) 52.225-1, Buy

Arnerican-Supplies, is included in this solicitation.)

(l) The offeror certifies that each end product, except those listed in paragraph (0(2) 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 offeror shall list as foreign end products those end products manufactured in the United States that do not qualifo 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) of the definition of "domestic end product." The terms "commercially available off-the-shelf (COTS) item"

"component," "domestic end product," "end product," "foreign end product," and "United States" are defined in the clause of this solicitation entitled "Buy American-Supplies."

(2) Foreign End Products:

LINE ITEM NO. COUNTRY OF ORIGIN

[List as necessary]

(3) Th" Gou"rn11ent will evaluate offers in accordance with the policies and procedures of FAR pan 25.

ts) 1l) Buy American-Free Trade Agreements-lsraeli Trade Act Certificate. (Applies only ifthe clause at FAR

Si.ZZi-1, 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 (gX I )(ii) or (g)( I )(iii) of this piovision, is a domestic end product and that for other than COTS items, the offeror has considered components ofunknown 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-the-shelf (COTS) item," ..component," "domestic end product," "end product " "foreign end product," "Free Trade

Agreement country," "Frei Trade Agreement country end product," "lsraeli end product," and "United States" u,i defined in the tlause of this solic'itation entitled "Buy American-Free Trade Agreements-lsraeli Trade

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

Bahrainian, Mo.o""an, Omani, Panamanian, or P ,ruvian end products) or lsraeli end products as defined in the clause of this solicitation entitled "Buy American-Free Trade Agreements-lsraeli Trade Act":

Page 7 of2l

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

[List as necessary]

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

(g)( I )(ii) of this provision) as defined in the clause of this solicitation entitled "Buy American-Free Trade

Agreements-lsraeli 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, COUNTRY OF ORIGIN

IList as necessary]

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

(2) Buy American-Free Trade Agreements-Israeli Trade Act Ceftificate, Alternate L lf Altemate I to the clause at FAR

52.225-3 is included in this solicitation, substitute the following paragraph (g)(t)(ii) for paragraph (gXt)(ii) ofthe basic provision:

(gJ fl)

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

Canadian End Products:

LINE ITEM NO, COUNTRY OF ORIGIN

IList as necessary]

(3) Buy American-Free Trade Agreements-lsraeli Trade Act Certificate, Altemate II. lf Altemate II to the clause at FAR 52.225-3 is included in this solicitatron, substitute the following paragraph (g)(l)(ii) for paragraph (gX I )( ii) ofthe basic provision:' tlXl Xiij fn" offeror certifies that the following supplies are Canadian end products or Israeli end products as

Oenn"d'in tG claus" ofthis solicitation entitled "Buy American-Free Trade Agreements-lsraeli Trade Act":

Canadian or Israeli End Products:

LINE ITEMNO.

[List as necessary]

(4) Buy American-Free Trade Agreements-lsraeliTrade Act Certificate, Alternate III. If Altemate lll to the clause at 52.225-3 is included in this soiicitution, substitute the following paragraph (g)(l)(ii) for paragraph (g)(l)(ii) of the basic orovision:

Page 8 of 2l

(g)( t Xil) 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 lsraeli end products as defined in the clause of this solicitation entitled "Buy American-Free Trade Agreements- Israeli Trade Act":

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

LINE ITEM NO. COUNTRY OF ORIGIN

IList as necessary]

(5) Trade Agreements Certificate. (Applies only ifthe clause at FAR 52.225-5, Trade Agreements, is included in this solicitation.)

(i) The offeror certifies that each end product, except those listed in paragraph (g)(5Xii) of this 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 products.

Other End Products:

LINE ITEM NO. Y OF ORIGIN

IList as necessaryl

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

For line items covered by dre WTO GPA, the Government will evaluate offers of U.S.-made or designated country end products without regard to the restrictions of the Buy American statute The

Government 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 fulfill the requirements of the solicitation.

(h) Cenification Regarding Responsibiliry Matters (Executive Order 12689). (Applies only if the contract value is expected to exceed ihe simplified acquisition threshold.) The offeror certifies, to the best of its knowledge and belief, that the offeror and/or any of its principals- ( I ) o Are, I are not presenily debarred, suspended, proposed for debarment, or declared ineligible for the award of contracts by any Federal agencY;

(2) n Have, I have not, wiihin a three-year period preceding this offer, been convicted ofor had a civiljudgment iendered against them for: commission of fraud or a criminal offense in connection with obtaining, attempting to obtain, or ferforming a Federal, state or local government contract or subcontract; violation of Federal or state antitrust statutes relating to the submission of offers; or commission of embezzlement, theft, forgery' bribery' falsification or destruction ofrecords, making false statements, tax evasion, violating Federal criminal tax laws, or receiving stolen ProPerty;

(3) tr Are, - are not pres;ntly indicted for, or otherwise criminally or civilly charged by a Government entity with, commission ofany ofthese offenses enumerated in paragraph (h)(2) ofthis clause; and^

(4) o Have, tr have nor, within a three-year period preceding this offer, been_notified of any delinquent Federal taxesinanamountthatexceeds$3,500forwhichthe|iabilityremainsunsatisfied.

(i) Taxes are c llo

(A) The e I lt has been assessed A

Iiabilitypelchallenge.lnthecaseofa judicia|isjudicialappealrightshave been exhausted.

Pagc 9 of2l

(B) The taxpayer is delinquent in making payment. A taxpayer is delinquent if the 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 nolice 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 liabiliq'. Should the taxpayer seek Tax Court review, this will not be a final tax liability until the ta-xpayer has exercised alljudicial appeal rights.

(B) The IRS has filed a notice ofFederal tax lien with respect to an assessed tax liability, and the taxpayer has been issued a notice under l.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 Courl ifthe IRS determines to sustain the lien filing. In the course of the hearing, the taxpayer is entitled to contest the underlying tax liabiliry 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 alljudicial appeal rights.

(C) The ta"rpayer has entered into an installment agreement pursuant to I.R.C, $6159. The taxpayer is making timely palrnents and is in full compliance with the agreement terms. The taxpayer is not delinquent because the taxpayer is not currently required to make full payment.

(D) The taxpayer has filed for bankruptcy protection. The taxpayer is not delinquent because enforced collection action is stayed under I I 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 solicitation that are included in the List of Products Requiring Contractor Certification as to Forced or Indentured Child Labor, unless excluded at 22.1503(b).1 ( l) Listed end products.

:LINE ITEM NO, COUNTRY OF ORIGIN

(2) Certification. If the Contracting Officer has identified end products and countries of origin in paragraph ( i)( I ) ofthis provision, then the offeror must certiry to either (i)(2)(i) or (i)(2)(ii) by checking the appropriate block.l

(i) The offeror will not supply any end product listed in paragraph (i)( I ) of this provision that was mined, produced, or manufactured in the corresponding country as listed for that product

(ii) The offeror may supply an end product listed in paragraph (i)( l) ofthis provision that was mined, produced, or manufactured in the conesponding country as listed for that product. The offeror 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 fumished under this contract. On the basis ofthose effons, the offeror certifies that it is not aware of any such use of child labor.

O Place ofmanufacture. (Does not apply unless the solicitation is predominantly for the acquisition ofmanufactured end products.) For statistical purposes only, the offeror shall indicate whether the place ofmanufacture ofthe end products it expects to provide in response to this solicitation is predominantly-lja ln the Uniied States (Check this box ifthe total anticipated price ofoffered end products manufactured in the

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

(2) ! Ourside the United States.

(kj Certificates regarding exemptions from the application of the Seruice Contract Labor Standards (Certification by the ofieror 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 oflicer is to check a box to indicate if paragraph

(k)( I ) or (k)(2) applies.l ( I j Maintenanci, calibration, or repair of certain equipment as described in FAR 22. I 003-4(c)( I ). The offeror a does I does not certify that-

(i) The items ofequipment to be serviced under this contract are used regularly for other than Governmental purpor".

"nd 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;

Pas€ l0 of 2l

(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(dXl). The offeror o does o does not certiry 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 of an exempt subcontract) to the general public in substantial quantities in the course of normal business operations;

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

(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) Ifparagraph (k)(l) or (k)(2) ofthis clause applies-

(i) lf the offeror does not certifr to the conditions in paragraph (k)( l) or (k)(2) and the Contracting Officer did not attach a Service Contract Labor Standards wage determination to the solicitation, the offeror shall notifo the Contracting Officer as soon as possible; and

(ii) The Contracting Officer may not make an award to the offeror ifthe offeror fails to execute the certification in paragraph (k)(l) or (k)(2) ofthis clause or to contact the Contracting Officer as required in paragraph (k)(3)(i) of this clause.

(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.)

(l) All offerors must submit the information required in paragraphs (l)(3) through (l)(5) ofthis provision to comply with debt collection requirements of3l U.S.C. ?701(c) and 3325(d), reporting requirements of26 U.S.C. 6041, 604 lA, and 6050M, and implementing regulations issued by the Internal Revenue Service (lRS).

(2) The TIN may be used by the Govemment to collect and report on any delinquent amounts arising out ofthe offeror's relationship with the Covernment (31 U.S.C. ?701(c)(3)). Ifthe resulting contract is subject to the payment reporring requirements described in FAR 4.904, the TIN provided hereunder may be matched with IRS records to verif the accuracy ofthe offeror's TIN.

(3) Taxpayer Identification 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 govemment;

Offeror is an agency or instrumentality ofthe Federal Govemment'

(4) Type of organization.

Sole ProPrietorshiP;

Partnership;

Corporate entity (not tax-exempt);

Corporate entity (tax-exemPt);

Government entity (Federal, State, or local);

Foreign govemment;

lntemational organization per 26 CFR I .6049-4;

Other

(5) Common parent.

Offeror is not owned or controlled by a common pareng

Name and TIN of common parent:

paee ll of 2l

Name

TIN

(m) Restricted business operations in Sudan. By submission of its offer, the offeror certifies that th€ offeror does not conduct any restricted business operations in Sudan.

(n) Prohibition on Contracting with lnverted Domestic Corporations.

( l) Govemment agencies are not permitted to use appropriated (or otherwise made available) funds for contracts with either an inverted domestic corporation, or a subsidiary ofan inverted domestic corporation, unless the exception at 9. I08-2(b) applies or the requirement is waived in accordance with the procedures at 9.108-4.

(2) Representation. The Offeror represents that-

(i) It o is, r is not an inverted domestic corporation; and

(ii) It r is, - is not a subsidiary ofan inverted domestic corporation.

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

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

CISADA 106@state.gov.

(2) Representation and…