CRHC20-45.pdf

REQUEST FOR QUOTATIONS

(THIS IS NOT AN ORDER)

THIS RFQ JS SMALL BUSINESS SET.ASIDE

PAGE OF PAGES

1ot2

I REQUEST NO

CRHC-20'45

2 DATE ISSUED

08t01t2020

3, REQUISITION/PURCHASE REQUEST NO,

1Hs1408487

4 CERT,FOR NAT. DEF

UNDER BDSA REC 2

AND/OR DMS REC I

RATING

5A.ISSUED BY

Eagle Butte Indian Health Service, Cheyenne River Service Unit 24276 1661h St, PO Box 1012, Easle Butte, SD 57625

6 DELIVER BY (Dote)

See schedule

5b, FOR INI.-ORMATION CALL (NO COLLECTCALLS) 7 DELIVERY OTHER

X ros oeslNarrcN f1(u" s,n"a,u)

NAME

Stephanre Charger stephanie.redelk@ihs.gov

TELEPHONE NUMBER 9 DESTINATION

AREA CODE NUMBER

964-0507

a. NAME OF CONSIGNEE

Cheyenne River Service Unit t TOI b. STREET ADDRESS

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

Eagle Butte c STREET ADDRESS d CITY e. STATE I f. ZIPCODE d STATE

SD

e ZIP CODE

57625

IO, PLEASE FURNISH QUOTATIONS TO

THE ISSUINC OFFICE IN BLOCK

5a ON OR BY l:00 PM MST ON (rar, August 14, 2020 tron. and quotations fumished are not olliers Ifyou are urable toquote, please so indicare on this form and retum it to the address in Block 5a This request does notcommitthe Govemmcnt to pay an!

costs incurred In the preparation ofrhe submrssion of lhis quolalion or to contract for supplies or serviccs Slpplies are o^l domestic origin unless otherwise indicated by quoter- Any repressntalions and/or cenifications attached to this Request for

Ouotarions must be comDleted by thequoter fl SCHEDULE l./nclude aonlictble Federul, State qnd locul laxes)

ITEM NO.

(a)

SUPPLIES/SERVICES

(b)

QUANI'ITY

(c)

LNIT

(d)

TNIT PRICE

(e)

AMOTNT

(0

**BUY INDIAN SET-ASIDE*|' Firm Fixed Price

Purchase Order for One(l) 2020 John Deerc 624L Wheel Loader, for the Maintenance Deparfnent, Cheyenne River Health Center, Eagle Butte, SD hice is all inclusive. See Attached Specification Sheet.

2020 John Deere 624L Wheel Loader No FreighUS&H, price is all inclusive

I ea

D Discouffi FoR PROMPT-l a I0CALENDAR DAYS

PAYMENT | %

rd representations E are ! ue no anacher

b. 20

CALENDAR

DAYS%

c. 30 CALENDAR DAYS Yo d CALENDAR DAYS

NUMBER PERCENTACE

tJ. unvE nND eOORESS OF QUOTER ls. stcttnrune or pERsoN AUTHoRIzED To

SIGN QUOTATION

I5, DATE OF

QUOTATION

a NAME OF QUOTER b STREET ADDRESS c COUNTY

16 SICNER

a.NAME (Trpe oJ Print) b TELEPHONE

AREA CODE

c.Tl-lLE (type or Pridt) NUMBER d CITY e STATE { ZIP COIJI

Inc.

edition not usablc Prescribed by CSA'FAR (48 CFR) 53- ta, ITEM

NO.

(a)

SUPPLIES/SERVICES

(b)

QUANTITY

(c)

UNIT

(d) tIN IT PRICE (e)

AMOUNT

(f)

DLTNS & Bradstreet Number:

(The Duns & Bradstreet number is required.

Provided you do not have it, you may call 866-705- 571 1 and obtain one.) You will need a DUNS & d lbetgrclase

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 (http://exlusions.oi g.hhs. gov) throughout the duration of the contract.

Federal Tax ID Number:

Email Address:

Net Terms:

NOTTCE TO QUOTERS

R-EOUEST FOR OUOTES GFO): CRHC20-45

OUOTE DUE DATE: Quotes are due August 14,2020 @ 1:00 PM MST

RETURN RF'O 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, for One(1) 2020 John Deere 624L Wheel Loader, 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.

This RFQ is issued as a 100% Indian Small Business Economic Enterprise Set Aside and the associated NAICS code is 333120 with a small business size standard of 1,250 employees.

BASIS FORAWARD:

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

1. Meet Specifications

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

3. Past Performance

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

w\!1,.sam.gov

INSTRUCTION TO OUOTERS:

To be considered an acceptable quote, the lbllowing items ggq! be completed and retumed by the due date stated above.

I . Complete and sign SF- 1 8 - Request for Quotation (Signature required)

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

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

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

ATTACHMENTS:

l. SF-18 Request for Quotations

2. Notice to Quoters

3. Specification Sheet

4. Clauses incorporated by reference

5. Clauses incorporated in full text

6. Representations and Certifications 7, Indian Health Service Buy Indian Act Indian Firm Representation Form

NO CONTRACT AWARD SHALL BE MADtr TO ANY VENDOIi OR PROVIDER LISTED ON TIIIi

OIG EXLUSION LIST TIIROUGHOUT THE DURATION OF TFIE,

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

ACQUISITION OFFICIAL IF THERE IS A CIIANGE IN t)ROVII)1.]r.

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 Contracting Officer.

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

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

SCOPE OF WORIVSPECIFICATIONS

Item#l I

John Deere PowerTech Engine Quantity - 1 ea. I f-Speed Powershift Transmission with Lock-up

Torque Converter 140 amp Alternator Flat Back Curved Stack Engine Air Intake System with Centrifugal Precleaner Automatic Reversing Hydraulic Fan Standard Fuel Filter with Water Seperator and Standard Fuel Fill JDLink Ultimate 5 Year Subscription Standard Cab ?in. Monitor with Dedicated Rear Camera Display Ilydrau Hydraulic Fluid High Lift Z-Bar Steering Wheel Only Deluxe Seat, Cloth with Air Suspension Joystick Controls Two Function Hydraulics Ride Control English Decals and Manuals 30 amp Converter No Payload Scale without Cycle Counter High Traction-Front & Rear Hydraulically Locking Differential Axles Automatic Differential Lock Michelin XTLA. 20.5R25 L2 Single Star Radial Tires with 3pc Rims Full Width Front Fenders Left and Right Side StePs 60in Wide Fork Frame 60in Construction Tines Premium LED Work and Drive Lights Rear Hitch and Counterweight Rear Camera LED Strobe Beacon with Left Beacon Bracket Heated Exterior Mirrors Standard Radio Cab with Air A/C

Hydraulic Coupler - JRB 416 Pattern Bolt-on Teeth with Cutting Edge Segment

3.0 Cubic Yard Bucket (Coupler Only)

Engine Block Heater Environmental Drains and Sampling Ports Throttle Lock Fire Extinguisher Engine Cornpartment Light Transmission and Bottom Guards Slow Moving Vehicle (SMV) Emblem Second Set of Hydraulic Outputs for Henke V Plow weieht of34.715 - 35.769 oounds

Itern #2 | 12 foot Henke V Plow:

FVl2

Quantity - 1 ea. 144" width 48" height 6" Cutting Edge 130" width at Full V 124" width angled left or right 118" width at Inverted V Bucket Mount Compatible with John Deere 624L and Case 721G Screw Adjustable 11" Cast Mushroom Shoes Multi-box Reinforced 1/4" Moldboard with 1/2" Ribs.

Full Length 7" x 22.7#lft, S&C Center Channel 5" Center Pin Assembly of 1" DOM, and a 3" Solid Cold Rolled Steel Center Pin Nitrogen Accumulators for Cylinder Shock Load Protection

Item #3 | 11,5 foot Arctic Sectional Sno-Pusher:

Model HD-l1.5

Quantity-1 ea. I 137.5"width 47" heiglrt 73" depth Individual Moldboard Design Spring-Loaded Steel Cutting Edges Mechanical Side Panels Polyurethane Mounting Blocks Slip-Hitch Universal Coupler Svstem

Additional 12 months or total of2000 hours after initial 12 month w

Shipping/Freight I All-inclusive withpurchase

OEPARTMENT OF HEALTH & HUMAN SERVICES

Division of Acquisition Policy (DAP) 5600 Fishers Lane

Rockville, MD 20857

INDIAN HEALTH SERVICE

BUY INDIAN ACT

INDIAN FIRM REPRESENTATION FORM

SOLICIATION NUMBER:

PROJECT TITLE:

DATE:

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

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

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

(2) At the time ofcontract award; and

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

lndividual 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 of the successful Offeror is in question. In addition to the self-certification requirements, successful Offerors must also be registered with DIIN and

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

Any false or misleading information submitted by an enterprise when submitting an offer in consideration ofan award set-aside under the authority of the Buy Indian Act is a violation of the law and punishable under I 8 U.S.C. I001.

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 ofthe Buy Indian Act.

Business Name meet the definition ofan "lndian Firm"

Certif,ing Signature

DUNS Number Print Name

CLAUSf,S INCORPORATED BY REFERENCE (Firm Fixed-Price -Commercial Items)

FAR CITATIONT 52.252-l: 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 force and effect as if they were given in full text. Upon request, the Contracting Officer will make their full 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 identif 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): hnpgltltry!.4qqulsjtlA!.ga!1&l t.

No. FAR Citation Clause Title Clause Date

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

52.204-18 Commercial and Government Entity Code Maintenance

52.204-19 Incorporation by Reference of Representations and Certifications

52.211-6 Brand Name or Equal

52.211-17 Delivery of Excess Quantities

52.212-1 Instructions to Offerors - Commercial Items

52.212-4 Contract Terms and Conditions - Commercial Items

Oct 201 8

Oct 2018

Jul 2016

Jul 2016

Dec 2014

Aug 1999

Sep 1989

Mar 2020

Oct 2018

Oct 199'7

Apr I984

Feb 2002

Apr 1984

Jun 2013

Dec 2013

May 2014

Aug 1987

Aug 2019

Apr 1984

12.

13.

10. 52.215-5 Facsimile Proposals

ll. 52.232-1 Payments

15.

16.

17.

18.

19.

52.232-8 Discounts for Prompt Payment

52.232-ll Extras

52.232-39 Unenforceability of UnauthorizedObligations

52.232-40 Providing Accelerated Payments to Small Business subcontractors

52.233-l Disputes

52.243-1 Changes-Fixed-Price

52.244-6 Subcontracts for Commercial ltems

52.246-16 Responsibility forSupplies

Page lof2l

20. 52.247-34 F.o.b. - Destination Nov l99l

2l. 52.249-l Termination for Convenience of the Govemment Apr 1984 (Fixed-Price)(Short Form)

22. 52.249-8 Default (Fixed-Price Supply and Service) Apr 1984

23. 52.253-l Computer Generated Forms

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

Jan l99l

No. FAR Citation Clause Title Clause Date

l. 52.204-l Approval of Contract

2. 52.204-3 Ta.rpayer ldentification (P)

3. 52.212-3 Offeror Representation and Certifications

- Commercial ltems

Dec 1989

Oct 1998

Mar 2020

4. 52.212-5 Contract Terms and Condition Required to Implement Mar 2020 Statutes or Executive Orders - Commercial Items

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

52,20+3 Taxpayer Identification

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 returns on a consolidated basis, and of which the offeror is a member.

"Taxpayer Identification Number (TIN)," as Lsed in this provision, means the number required by the Intemal Revenue Service (lRS) to be used by the offeror in reporting income tax and other retums. The TIN may be either a Social Security Number or an Employer Identification Number.

(b) All offerors must submitthe information required in paragraphs (d) through (f) ofthis provision to comply with debt collection requirements of3l U.S.C. 7701(c) and3325(d), reporting requirements of26 U.S.C.6041,4051A, and 6050M, and implementing regulations issued by the IRS. Ifthe resulting contract is subject to the payment reporting requirements described in Federal Acquisition Regulation (FAR) 4.904, the failure or refusal by the offeror to fumish the information may result in a 31 percent reduction of payments otherwise due under the contract.

(c) The TIN may be used by the Government to collect and report on any delinquent amounts arising out ofthe offeror's relationship with the Govemment (31 U.S.C. 7701@(3). If the resulting contact 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) Taxpayer Identification Number (TIN)

! rrN:

! tlN has been applied for.

! flN is not required because:

Page 2 of2l

! 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 of the Federal Govemment.

(e) Type of organization.

n Sole proprietorship;

n Partnership;

n Corporate entity (not tax-exempt);

n Corporate entity (tax-exempt);

! Govemment entity (Federal, State, or local);

n Foreign govemment;

n lntemational organization per26 CFR 1.6049-4 n other

(0 Common parent.

n Offeror is not owned or controlled by a common parent as defined in paragraph (a) of this provision.

! Name and TIN ofcommon parent:

Name

TIN

(End of provision)

52.212-3 -- Offeror Representations and Certifications -- Commercial ltems.

The Offeror shall complete only paragraph (b) ofthis provision if the Offeror has completed the annual representations and certification electronically in the System for Award Management (SAM) accessed through https://www.sam gov. If the Offeror has not completed the annual representations and certifications electronically, the Offeror shall complete only paragraphs (c) through (v)) ofthis 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 concern that is at least 51 percent direclly 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. lt automatically qualifies as a women-owned small business eligible under the WOSB Program.

Forced or indentured child labor means all work or service-

( l) Exacted from any person under the age of I 8 under the menace of any penalty for its nonperformance and for which the worker does not offer himself voluntarily; or

Pagc I of2 |

(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 of the offeror. No entity 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.

lnverted 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 of Plant Materials;

(6) PSC 9430, Miscellaneous Crude Animal Products, lnedible,

(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 ofcomponents, or othenvise 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 notthe place ofmanufacture.

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 l0-174).

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 d emonstrate- ( 1) Are conducted under contract directly and exclusively with the regional govemment of southern 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 of providing goods or services to an internationally 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 hardware, software, telecommunications equ ipment, or any other technology that is to be used specifically-

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

(ii) To disrupt, monitor, or otherwise restrict speech ofthe people oflran; 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(b)(3)ofthe International Emergency Economic Powers

Act (50 U.S.C. 1702(bX3).

Service-disabled veteran-owned small business concern-

(1) Means a small business concern- 1i) Not 1ess than 5 I percent of which is owned by one or more serv ice-d isabled veterans or, in the case ofany publicly owned business, not less than 5l percent ofthe stock of which is owned by one or more service-disabled veteransl ano

(ii) The management and daily business operations of which are controlled by one or more servtce-

Pagc 4 of 2l disabled veteransor, in the case of a service-disabled veteran with permanent and severe disability, the spouse or perrnanent 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 concern means a concern, including its affiliates, that is independently owned and operated, not dominant in the field ofoperation in which it is bidding on Government contracts, and qualified as a smaf l business under the criteria in I 3 CFR Part 121 and size standards in this solicitation.

Small disadvantaged business concem, consistent with I 3 CFR 124-1002, means a small business concern under the size standard applicable to the acquisition, th

( I ) Is at least 51 percent unconditionally and directly owned (as defined at l3 CFR 124. 105) by-

(i) One or more socially disadvantaged (as defined at I 3 CFR I 24.103) and econom ically 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 l3 CFR 124.104(c)(2); and

(2) The management and daily business operations of which are controlled (as defined at l3.CFR | 24. 106) by individuals, who meet the criteria in paragraphs ( I )(i) 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 officesidivisions 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 concern ( I ) Not less than 5 I percent of which is owned by one or more vetemns (as defined at 38 U.S.C. l0l(2)) or, in the case ofany 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 which are controlled by one or more veterans.

Women-owned small business (WOSB) concem eligible underthe WOSB Program (in accordance with l3 CFR part 127), means a small business concern that is at least 5 I percent directly and unconditiona lly 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 concem- ( I ) That is at least 5 I percent owned by one or more women; or, in the case of any publicly owned business, at least5 I percent of the 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) ( I ) Annual Representarions and Certifications. Any changes provided by the Offeror in paragraph (bX2) of this 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 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 52.21 2-3, 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. 120 l), except for paragraphs

[Offeror to identifu the applicable paragraphs at (c) through (v) of this 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 comolete 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 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 n is, o is not a small business concem.

(2) Veteran-owned small business concern. [Complet;r;1lV if the offeror represented itself as a small business concem in paragraph (c)( I ) of this provision.] The offeror represents as part of its offer that it o is, o is not a veteran-owned small business concem.

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

(4) Small disadvantaged business concem. [Complete only ifthe offeror represented itself as a small business concern in paragraph (c)( l) of this provision.] The offeror represents, that it D is, r is not a small disadvantaged business concern as defined in | 3 CFR 124. I 002.

(5) Women-owned small business concern. [Complete only if the offeror represented itself as a small business concern in paragraph (c)( | ) of this provision.] The offeror represents that it r-- is, n is not a women-owned small business concern.

(6) WOSB concem eligible under the WOSB Program. [Complete only if the offeror represented itself as a women-owned small business concern in paragraph (cX5) ofthis provision.] The offeror represents that-

(i) It r is, n is not a WOSB concern 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; and

(ii) lt a is, r is not a joint venture that complies with the requirements of l3 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 the joint venture. [The offeror shall enter the name or names of the

WOSB concern eligible under the WOSB Program and other small businesses that are pafticipating in the joint venture: .l Each WOSB concem eligible under the WOSB Program participating in rhe joint venture shall submit a separate signed copy ofthe WOSB representation.

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

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

(ii) It n is, I is not ajoint venture that complies with the requirements of l3 CFR part 127, and the repr€sentation in paragraph (c)(7)(i) ofthis provision is accurate for each EDWOSB concem participating in thejoint venture. [The offeror shall enter the name or names ofthe EDWOSB concem and other small businesses that are 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 (c)(9) only if this solicitation is expected to exceed the simplified acquisition threshold.

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

(c)( l) of this provision.] The offeror represents that it tr is a women-owned business concem.

(9) Tie bid priority for labor surplus area concerns. Ifthis is an invitation for bid, small business offerors may identiff 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 of the contract orice:

(10) IIUBZone small business concem. [Complete only if the offeror represented itselfas a small business concem in paragraph (c)( 1) of this provision.l The offeror represents, as pan of its offer, that-

(i) It n is, o is not a HUBZone small business concern listed, on the date of this representation, on the List of

Qualified 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 I 26; and

(ii) It n is, - is not a HUBZonejoint venture that complies with the requirements of l3 CFR Part 126, and the representation in paragraph (c)(l0Xi) of this provision is accurate for each HUBZone small business concem participating in the HaBZonejoint venture. [The offeror shall enter the names ofeach ofthe HUBZone small business concems participating in the tIUBZonejoint venture: .] Each HUBZone small business concem participating in the HUBZone joint venture shall submit a separate signed copy ofthe HUBZone representation.

(d) Representations required to implement provisions of Executive Orderl 1246-

(l) Previous contracts and compliance The offerorre?i:i.*ttn"u

(i) It o has, r has not participated in a previous contract or subcontract subjegt to the Equal Opportunity clause of this solicitation; and

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

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

(i) It r has developed and has on file, o 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) lt n has not previously had contracts subject to the written affirmative action programs requirement ofthe rules and regulations ofthe Secretary of Labor.

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

l3 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 of Congress or an employee of a Member ofCongress on his or her behalf in connection with the award of any resultant contract. If any registrants under the Lobbying Disclosure Act of 1995 have made a lobbying contact on behalf of the offeror with respect to this conhact, the offeror shall complete and submit, with its offer, OMB Standard Form LLL, Disclosure of Lobbying Activities, to provide the name of the registrants. The offeror need not report regularly employed officers or employees of the offeror to whom payments of reasonable compensation were made.

(f) Buy American Certificate. (Applies only if the clause at Federal Acquisition Regulation (FAR) 52.225-1, Buy Americar-Supplies, is included in this solicitation.)

(l) The offeror certifies that each end product, except those listed in paragraph (1)(2) of this 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 qualily as domestic end products,i.e., an end product that is not a COTS itern 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 ofthis solicitation entitled "Buv American-Suoolies."

(2) Foreign End Products:

LINE ITEM NO. COUNTRY OF ORIGIN

[List as necessary]

(3) The Government will evaluate offers in accordance with the policies and procedures of FAR parl 25.

(e)

(1) Buy American-Free Trade Agreements-lsraeli Trade Act Certificate. (Applies only ifthe clause at FAR 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 (gX I )(ii) or (g)( I )(iii) of this provision, 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," "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 Agreementrlsraeli 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 Israeli end products as defined in the clause of this solicitation entitled "Buy American-Free Trade Agreements-lsraeli Trade Act":

Page 7 of 2l

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

LINE ITEM NO. OUNTRY OF ORIGIN

[List as necessary]

(iii) The offeror shall list those supplies that are foreign end products (other than those listed in paragraph (g)(t)(ii) of this provision) as defined in the clause ofthis 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 qualify 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. ]COUNTNY OF ORIGIN

IList as necessary]

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

(2) Buy American-Free Trade Agreements-lsraeli Trade Act Certificate, Alternate [. If Alternate I to the clause at FAR 52.225-3 1s included in this solicitation, substitute the following paragraph (g)(l)(ii) for paragraph (g)(1)(ii) ofthe basic provision:

(9, (t)

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

Canadian End Products:

LINE ITEM NO. COUNTRY OF ORIGIN

[List as necessary]

(3) Buy American-Free Trade Agreements-lsraeli Trade Act Certificate, Alternate II. If Altemate II to the clause at FAR 52.225-3 is included in this solicitation, substitute the following paragraph (g)( I )(ii) for paragraph (gx l)(ii) of the basic provision:

(g)( | )(ii) The offeror certifies that the following supplies are Canad ian end products or Israeli end products as defined in the clause ofthis solicitation entitled "Buy American-Free Trade Agreements-lsraeli Trade Act":

Canadian or Israeli End Products:

ILINE ITEM NO. COUNTRY OF ORIGIN

IList as necessary]

(4) Buy American-Free Trade Agreements-lsraeli Trade Act Certificate, Altemate IIL If Alternate lll to the clause at 52.i25-3 is included in this solicitation, substitute the following paragraph (g)( t )(ii) for paragraph (g)( I )( ii) of the basic provision:

Page 8 ol 2|

(gX I Xii) The offeror certifies that the following supplies are Free Trade Agreement country end products (other than Bahrainian, Korean, Moroccan, Omani, Paramanian, or Peruvian end products) or Israeli end products as defined in the clause ofthis 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 lsraeli End Products:

LINE ITEM NO. COUNTRY OF ORICIN

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 (gxs)(ii) 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. COUNTRY OF ORIGIN

IList as necessary]

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

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

Government willconsider 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) Certification Regarding Responsibility Matters (Executive Order 12689). (Applies only ifthe contract value is expected to exceed the simplified acquisition threshold.) The offeror certifies, to the best of its knowledge and beliel that the offeror and/or any of its principals- ( I ) o Are, tr are not presently debaned, suspended, proposed for debarment, or declared ineligible for the award of contracts by any Federal agency;

(2) o Have, tr have not, within a three-year period preceding this offer, been convicted ofor had a civiljudgment rendered against them for: commission of fraud or a criminal offense in connection with obtaining, attempting to obtain, or performing a Federal, state or local govemment contract or subcontract; violation of Federal or state antitrust statutes relating to the submission of offers; or commission of embezzlement, theff, forgery, bribery, falsification or destruction of records, making false statements, tax evasion, violating Federal criminal tax laws, or receiving stolen property;

(3) n Are, tr are not presently indicted for, or otherwise criminally or civilly charged by a Government entity with, commission ofany ofthese offenses enumerated in paragraph (hX2) of this clause; and

(4) o Have, o have not, within a three-year period preceding this offer, been notified ofany 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 rax liability is finally determined. The liability is finally determined if it has been assessed. A liability is not finally determined ifthere is a pending administative orjudicial challenge. In the case ofa judicial challenge to the liability, the liability is not finally determined until alljudicial appeal rights have been exhausted.

Page 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 notice of deficiency, under I.R.C. $621 2, which entitles the taxpayer to seek Tax Couft review ofa 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 tinal 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 l.R.C. $6320 entitling the ta,\payer 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. In the course of the 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 alljudicial appeal rights.

(C) The taxpayer has entered into an installment agreement pursuant to LR.C. $61 59. The taxpayer is making timely palments 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)( I ) any end products being acquired under this solicitation that are included in the List of Products Requiring Contractor Certification as to Forced or lndentured Child Labor, unless excluded at 22.1503(b).1

( I ) Listed end products.

LTNE ITEM NO. COUNTRY OF ORIGIN

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

(i) The offeror will not supply any end product listed in paragraph (i)(l) 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 corresponding 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 efforts, the offeror ceftifies 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 of manufactured end products.) For statistical purposes only, the offeror shall indicate whether the place of manufacture ofthe end products it expects to provide in response to this solicitation is predorninantly-

(l) I In the Unired States (Check this box if the 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 ) ! Outside the United States.

(k) iertificates regarding exemptions from the application ofthe Service Contract Labor Standards (Ceftification 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 offrcer is to check a box to indicate if paragraph

(k)( I ) or (k)(2) applies.l'( I) Maintenanil, calibration, or repair ofcertain equipment as described in FAR 22.I003-4(c)( I) The offeror I does I does not certii/ that-

(i) The items ofequipment to be serviced under this contract are used regularly for other than Govemmental 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;

Page l0 of 2l

(ii) The services will be fumished 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 ofsuch 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 I does o does not ceftiry that-

(i) The services under the contract are offered and sold regularly to non-Governmental customers, and are provided by the offeror (or subcontractor in the case ofan exempt subconffact) to the general public in substantial quantities in the course ofnormal 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 ofthe 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 (kX2) ofthis clause applies-

(i) Ifthe offeror does not ceftii/ 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 notiry the Contracting Officer as soon as possible; and

(ii) The Contracting Officer may not make an award tr the offeror if the offeror fails to execute the certification in paragraph (kX I ) or (kX2) of this clause or to cpntact the Contracting Officer as requ ired in paragraph (k)(3)(i) of this clause.

(l) Taxpayer ldentification Number (TIN) ( 26 U.S.C. 6 I 09, 3 I U.S.C. 7701 ). (Not applicable if the ofleror 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) of this provision to comply with debt collection requirements of 3 I U.S.C. 7701(c) and 3325(d), reporting requ irements of 26

U.S.C. 6041, 6041A, and 6050M, and implementing regulations issued by the lnternal Revenue Service (lRS).

(2) The TIN may be used by the Government to collect and report on any delinquent amounts arising out ofthe offeror's relationship with the Govemment (31 U.S.C. 7701(c)(3)). If 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 verifi the accuracy ofthe offeror's TIN.

(3) Ta"rpayer Identification Number (TIN).

TIN:

TIN has been applied for.

TIN is not reouired because:

Offeror is a nonresident alien, foreign corporation, or foreign partnership that does not have income effectively connected with the conduct ofa 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;

Coryorate entity (not tax-exempt);

Coryorate entity (tax-exempt);

Government entity (Federal, State, or local);

Foreign govemment;

International organization per 26 CFR1.6049-4;

Other

(5) Common parent.

Offeror is not owned or controlled by a common parent Name and rlN of common parent paee Il of 2l

Name

TIN

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

(n) Prohibition on Contracting with Inverted Domestic Corporations.

( | ) Government agencies are not permitted to use appropriated (or otherwise made available) funds for contracts with either an inverted domestic corporation,…