RFQCRHC-20-01.pdf

RXQUEST FOR QUOTATIONS

(THIS IS NOT AN ORDER)

THIS RFQ !S A S]\4ALL BUSINESS SET-ASIDE

PAGE OF PAGI]S

1of 2

I REQUESI'NO

cRHC-20-01

2, DATE ISSUED

10t02t2019

3. REQUISITION/PURCHASE REQUEST NO

IHS-Manual 393

4 CERT FOR NAT. DEF

LTT{DER BDSA REG 2

AND/OR DMS REG I

RA'IlNC

5A ISSULD BY

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

6 DELMR BY fDdrel

See schedule

5b FOR INFORMATION CALL (IiO COLLECT CALLS) 7, DELIVERY OTHIR

X roa nesttNoto't f1 rs"" scn"o,'"t

NAME

Stephanie Charger stephanie.redelk@ihs.sov

TELEPIIONE NUMBER ,tA10N

AREA CODE

NUMBER

964-0507 a NAME OF CONSIGNEE

Chevenne River Service Unit 8 TO: b STREET ADDRESS

24276 166th St , PO Box 1 01 2 a NAME b COMPANY c. CITY

Eagle Butte c STREET ADDRESS d CITY e. STATE ItZIPCODE d STATE

SD

e ZIP CODE

57625

I() PI-EASE FURNISH QUOTATIONS TO

,I'HE

ISSUING OFFICD IN BLOCK

5a ON OR BY l:00 PN4 MST ON (Ddf4

October 16,2019

IMPORTANT This is a requesl for information, and quotatrons fumished are nol ofners.Ifyou atc umble to quotc. please so indicate on $is form and relum it ro the address in Block 5a. This request does nol conlmit the CovernnrenL to pa) an) costs incurred in the prepamtion ofthe submission ofthis quotadon or to contract for supplies or services SLrpplics are of domestic origin unless otherwise indcated by quoter Any representations and/or certifications attached to this Request lbr c)uotations must be conDleted bv thequoter

I l. SCHEDULE 0tcllde applicable Federo

ITF]M NO

(al

SUPPLIES/SERVICES

(b)

QUANTITY

tcl

TJNIT

(d)

UNIT PRICE

(e)

N MOUNT

(0

Firm Fixed-Price, Blanket Purchase Agreement (BPA) for Food Supplies, Perishable and Non- Perishable, for the Cheyenne River Health Center, located in Eagle Butte, SD.

See attached specification sheet for a list of items, quantities/unit ofmeasure and average yearly use, that will be required under this BPA. This list isnot all-inclusive.

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

Items order against the BPA will be delivered 3-5 days after placement of order, unless otherwise agreed. Delivery ad dress:24276 l6o'h Srreet.

Airport Rd, Eagle Bune, South Dakota 57625.

The CRHC anticipates issuing up to two awards f"n'n th ic RFO

I2 DISCOUNT FOR PROMPT

PAYMENI'

IO CALENDAR DAYSa b20

CALENDAR

DAYS%

c 30 CALENDAR DAYS vo d CALENDAR DAYS

NL'IVI]ER I PERCFJN1 AOI

r.,olf ruairionut p"'' rsions and re!M!4!!!9lll are ar€ not allached

13 NAME AND ADDRESS OF QUI )TER rs. scxerune or peRsoN AUTHORIZED 10

SIGN QUOTATION

15 DATE OF

QUO TATTON

a NAME OF QUOTER b S.IREEI' ADDRESS c COUN'IY

I6 SIGNER

a NAME (fype olPrint) bT EPHONIi

AREA CODE

d CIIY e STATE T ZIP CODE c TIILE (tt'Pe or Print) N UM BhI(

LOCAL REPRODU' F Inc cdrtron not usable Prescribed by CSA-FAR (a8 Cl:R) 53'215-l(a)

ITEM

NO.

(a)

SUPPLIESi SERVICES (b)

QUANTITY

(c)

UNIT

(d)

UNIT PRICE

(e, AMOUNT

(f)

Period of Performance rvill be a Base Year(BY) plus 4 additiona l/Option Years(OY), as fbllows:

BY: l1/l/19 - 10131120

OYI: l1lIl20 - t0131121

OY2: lllll2l - t0131122

OY3: l\lll22 - 10131123

OY4: lllll23 - 10131/24

Attachments:

-Specifi cation ltem list -Provisions/Clauses, incorporated by full text and by reference.

-Past Performance Questionnaire

Basis for Award:

-Past Performance -Ability to meet specification requirements -Ability to meet delivery schedule

-Price reasonableness

DUNS & Bradstreet Number:

lThe Duns & Bradstreet number is required.

Provided you do not have it, you may call 866-705-

571 1 and obtain one.) Yoa will need a DUNS &

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 qov 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.oig hhs.eov) throughout the duration of the contract.

Federal Tax lD Number:

Ernail Address:

Net Terms:

Cheyenne River Health Center Soecification Sheet

Vendors are to provide a full line of food service supplies, perishable and non-perishable items, to meet the needs of the Dietary/Nutrition Department of the Cheyenne River Health Center, Weekly delivery is anticipated, with delivery required 3-5 days after placement of order, unless otherwise agreed.

This is not an all-inclusive list for supplies. Foods will change per seasonal menus and product availabrlity to meet the needs of the Dietary/Nuhition Department needs.

The YrlyQW column is not the amount that will be ordered all at once, but spread out throughout an entire year. This is an approximately yearly usage of the item, to assist with cosUprice.

PRODUCT SIZE/UNIT Yrly

QTY

cosr PRODUCT # and/or

SUBSTITUTE ITEM

Produce 1 Apple, Gala 1oocucs 28/cs

Strawberry B/1tb 1-4/cs

Oranges 24cUbg b/cs

4 Bananas 6/cs

Onion,Yellow Jumbo 't 0lb/cs 10/cs

6 Russet Potato 90cV50lb/cs t0/ cs

Dairv 7 1% Milk, Low Fat, Vitamin A&D 48/.5pt per 28lcs

8 Yoplait Yogurt, asst 48l4oz 70/cs

I Blue Bunny PoPsicle, Twin, asst

2l24l3oz 6/cs

10 Mozzerella String Cheese ss

16811oz 78/cs

11 Large Grade AA Foos

1Sdz 77 /cs

12 lce Cream

SS

48l4oz zlcs

13 lce Cream, Vanilla, 48l4oz llcs

14 Sherbert Orange cup. ss

48l4oz 2/cs

,lE Cheddar Cheese Wht Sharp, Baby

121101 .75o2 I lcs

PRODUCT SIZE/UNIT Yrly

QTY

cosr PRODUCT # and/or

SUBSTITUTE ITEM

16 Coffee Creamer. pwd 10/10Oea zl cs

Beveraqe 17 Spring Water, Plastic

Bottle 24116.9o2 160/cs

18 Tea Bags, hot blk enq brkfst

6l25bx 8/cs

19 Oceanspray Cranberry juice, can

4815.5o2 8/cs

20 Crystal Lt Lemonade drink mix 202

4l3oea 2lcs

21 Orange Juice 4815,5o2 14tcs

22 Apple Juice 4815.5o2 12lcs

ZJ Grape Juice 4815.5o2 2lcs

24 Folgers Coffee, can 6/30.5o2 4/cs

25 Drink Mix, Lemonade 4l30ea 8/cs

Drv Grocery 2001.75o2 2lcs26 Peanut Butter, ss cUns

27 Honey Grahmm Cracker

200l2ea 1 6/cs

28 Swanson Chicken, can

6129.5o2 2lcs

29 Apple Sauce, ss Plst 7214oz 1 6/cs

30 Pear, in .ice, ss Plst 36l4oz 6/cs

Orange, in jce, ss Plst 36l4oz 4lcs

32 Peach, in jce, ss Plst 36l4oz 2lcs

Pineapple, jce, ss nlc.ft..-.

Hunt Tomato Sauce, can

36l4oz 2lcs

24l15oz 4/cs

35 Whole Stewed Tomatoes, can

241#300cn 4lcs

36 Saltine Cracker, unsltd

300l2ea 4lcs

37 Smuckers MaPle Svfl rn ss cuo

10011 .4oz 2lcs

38 Supplement, glcrn Strawberry shake

24l$oz 30ics

12lcs39 Supplement, glcrn Chocolate shake

24l8oz cosT PRODUCT # and/or

SUBSTITUTE ITEM

40 Supplement, glcrn Vanilla shake

24l8oz 6/cs

41 Supplement, Ensure+stwbv rtu

24l8oz 32lcs

42 Supplement, Ensure+choc rtu

24l8oz 40/cs

43 Supplement, Ensure+vnl tru

24lBoz 14lcs

44 Supplement, Ensure+butr pecn

24l8oz 1 6/cs

AE Supplement, Ensure+mxd brry

24l8oz 6/cs

46 Supplement, argnd chry pwdr

411419.291 2lcs

47 Supplement, argnd ornq pwor

411419.291 2lcs

48 Mix, mfn basic pho-free add

615oz 2lcs

49 Fig Newton Cookie, 10l12l2oz 4/cs

50 Cookie Oreo, ss 721.81o2 4lcs

51 Fruit Cocktail 6/#10cn 2lcs

52 Veg bf soup 2417.25o2 4/cs

Sugar, ss pkt 200Oea 2lcs

54 Sugar, Splenda, ss pki

2000ea 4lcs

55 Salt, ss 3/1000ea 2lcs

56 Spice, ss 3/100Oea 2lcs

57 Dressing, Ranch, ss nor reh

6011 .5oz 6/cs

58 Dressing, Ranch, ss cup

10Ol1.5oz 2lcs

Dressing, 1000isld, ss pouch

100l1oz 2lcs

60 Dressing, itln, nnrrch ss 6011 .5oz 2lcs

61 Mustard, ss Pouch 5001.2o2 8/cs oz Miracle WhiP dressing

2Q0l.44oz 1 6ics

63 Mayo, light, ss Pouch 2001.44o2 2lcs

64 Pasta. mac elbow 2t1jtb 2lcs

2tstb 4/cs65 Pasta, egg noodle curlV 112" wide

PRODUCT stzE/uNtT Yrly cosT PRODUCT # and/or

SUBSTITUTE ITEM

66 Jelly, asst ss cup 200t.50 2lcs o/ Jelly, asst #4 ss cup 24l8oz 2lcs oo Quaker oatmeal, cnstr

12/42o2 2lcs

69 Cereal, cherrio whlqrain, ss

9611oz 2lcs

70 Cereal, Rice Crispy, SS

961.625o2 2lcs

71 Syrup Maple, ss cup 10011 .4oz 4lcs

72 Crisco Veg Oil 4l1ga 2lcs

73 Conola Oil 6114oz 2lcs

74 Chicken, chnk tff ckd can shlf

6129.5o2 4lcs

75 Tomato Soup 2417.25o2 6/cs

76 Chicken Noodle soup 2417.2502 2lcs

77 mix sce chs cedr 6l1602 2lcs

7B BBQ Sauce 411ga 2lcs

79 Soup. Cream of Chkn 2417.25o2 2lcs

80 Soup, Cream of NII rshronm

2417.2502 2lcs

81 Snack Trail mix, trpcl frt

72l2oz 2lcs

Meat-Pork/Beef 82 Ham, sliced .52, smoked 6t2tb 24lcs

83 Beef.stk ball tip cc 2816oz 1 O/cs

84 Jimmy Dean Pork sar rseoe Dattv

10tb 8/cs

85 Pork Chops, cc 32l5oz Sics

86 Pork Rib Back 1.75- 2lb

33.421ba 207tb

87 Pork Loin bnls cc 2lllba 92lb

8B Bacon pork 9-1 2 ct 2t7.5b 2lcs

89 Beef, grnd chuk/ 90/10 cab med

4/5lbs 4lcs

90 Hotdogs, beef 't 0lbs 2lcs

COST PRODUCT # and/or

SUBSTITUTE ITEM

Poultrv 91 Turkey, brst slices, .7oz smkd 6tztb 26lcs

92 Chicken brst, single 5z

15tb 6/cs

93 Chicken, nugget .692 10.35rb 2lcs

94 Chicken, 8pc 12hd 2.12-3lbs

37.5rb 2lcs

95 Fish, Cod 10tb 2lcs

Grocerv Refriq & F rozen

96 Bread, wheat 24 sliced loaf

10l24oz

97 Carrot, cc med 3i8" fcv fzn

12tztb 26lcs

98 Potato, ff 112" cctft lrne

12l2lb 4lcs

99 Vegetable blend 12l2lb 4/cs

100 Asparagus, cut&tiP qro a

6t2.5lb 4lcs

101 Potatos stufd chs ccclr h,vice

48l5oz 2lcs

102 Bean green cut 12l2lb 4ics

103 Vegatable bld non stil frv

6/4lbs 2lcs

104 Potato ff wedg 10 cute btrd 6/5tb 2lcs

105 Pita bread 1211jea 4lcs '106 Broccoll 6/4lbs 2lcs

107 Margarine 900-5gr 2lcs

108 Knife, mw wht PoIYP bulk plst

1000ea 4/cs

109 Spoon, tea nm wht nolvn bulk

1000ea 4/cs

110 Fork, wht polYP bulk Plst

1000ea 4lcs

111 Napkin, wht 14.88x16.75 2

30/100ea 4lcs

25l40ea 4/cs112 Bowl, wht 102 cosT PRODUCT # and/or

SUBSTITUTE ITEM

113 Paper bag, wht c-out 6tb

2150oea 4/cs

114 Container, fm

3./CXC./C I

6/84ea 2lcs

115 Straw, jmb 7.75" wht flex

251400ea 2lcs

116 Bag, food storage 6.5x7

200Oea 2lcs

I 1'' Bag, food storage 10x11

250ea 2lcs

118 Pan liner 34x18 nvlonq hi

50ea 2lcs

1'19 Pan liner 16.4x24.4 1000ea 2lcs

120 Alumn, foil, 18"x1000 rl roll 2lcs

121 Cup,plst 8z 48/cs 2lcs

Request For Quote/ CRHC-20-01

CLAUSES INCORPORATED BY REFERENCE

(Firm Fixed-Price Service-Commercial Item)

FAR CITATION(S): 52.252-l: Solicitation Provision Incorporated by Reference. (FEB f998) & 52.252-2 Clauses

Incorporated by Reference (FEB f998) This solicitation & contract incorporates one or more solicitation provisions & clauses by reference, with the same force and effect as ifthey were given in full text. Upon request, the Conttacting Officer will rnake their full text available. The off'eror is cautioned that the listed provisions may include blocks that must be cornpleted by the offeror and submined with its quotation or offer. [n lieuof submitting the full text ofthose provisions, the offeror may identify theprovision by paragraph identifier and provide the appropriate information with its quotation or offer. Also, the ftrll text ofa solicitation provision & clauses may be accessed electronically at this/these address(es): httos:,fwwrv.acouisition.gor'/far'

L Federal Acouisition Regulations (FAR) (48 CFR ChaDter l) Clauses

|. 52.204-1

2. 52.204-9

3. 52.204-13

4. 52.204-16

5. 52.204-18

6. 52.204-t9

1 <1 )it _1')

8. 52.211-1'7

9. 52.212-1 r 0. 52.212-4

I l. ) l,l t)-)

12. 52.2t1-5

I 3, 52.223-6

14. 52.225-13 r < <') llq_]

16. 52.232-1 t'7. 52.232-8

18. 52.232-18

19. 52.232-33

System for Award Managcment

Pelsonal Identity Verification of Contractor Personnel

System for Award Management Maintenance

Cornmercial and Government Entity Code Reporting

Commercial and Govemment Entity Code Maintenance lncorporation by Reference of Representations and Certifications

Altemative Line ltem ProPosal

Delivery of Excess Quantities lnstructions to Offerors - Commercial Items

Contract Terms and Conditions - Commercial ltems

Facsim ile Proposals

Evaluation of OPtions

Drug-Free WorkPlace

Restrictions on Certain Foreign Purchases

Federal, State, and Local Taxes

Payments

Discounts for PromPt Payment

Availability of Funds

Payment by Elecfionic Funds Transfer System for Award Mgtm Page L f28

Oct20l8

Jan 201 I

Oct 2018

Ju1 201 6

Jul 2016

Dec 2014

Jan 2017

Sep 1989

Oct 201 8

Oct 2018

Oct I 99?

Jul 1990

May 2001

Jun 2008

Feb 2013

Apr 1984

Feb 2002

Apr 1984

Oct 201 8

20.

21.

22.

LJ.

'1,1 z).

26.

27.

28.

29.

II.

s2.232-39

52.232-40

52.233-l

52.243-1

52.244-6

52.246-2

52.246-16

52.247 -34

52.249-l

52.249-8

Unenforceability of Unauthorized Obligations

Providing Accelerated Payments to Small Business Subcontractors

Disputes

Changes-Fixed-Price

Subcontracts for Commercial ltems

Inspection of Supplies-Fixed Price

Responsibility for Supplies

F.o.b. Destination

Termination for Convenience ofthe Government

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

Jun 201 3

Dec 2013

May 2014

Aug 1987

Aug 2019

Aug 1996

Apr 1984

Nov 199 |

Apr 1984

Apr 1984

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

z.

3.

A

5.

6.

52.204-l

52.21], -8

52.212-2

52.212-3

52.212-5

52.217-9

Approval of Contract

Time of Delivery

Evaluation-Commercial Iterns

Offeror Representation and Certifi cations

- Commercial ltems

Contract Terms and Conditions Required to Implement

Statutes or Executive Orders - Commercial Items

Option to Extend the Term ofthe Contract

(End of Clause)

52.211-8 - Time of DeliverY.

Page 2 of28

Dec 1989

Jun 1997

Oct 20 l4

Ian2011

May 2019

Mar 2000

52.204-l -- APProval of Contr ct.

As prescribed in 4.103, insert the following clause:

Approval of Contract (Dec 1989)

This contract is subject to the written approval ofthe contracting officer and shall not be binding until so approved.

As prescribed in 1 I .404(a)(2), inserl the following clause:

Time of Delivery (Jun 1997)

(a) The Government requires delivery to be made according to the lbllowing schedule:

REQUIRED DELIVERY SCHEDULE

fContracting Officer insert specific detailsl

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

The Government reserves the right to award under either the required delivery schedule or the proposed delivery schedule, when an offeior offers an earlier delivery schedule than required above. If the offeror propo.., no other delivery schedule, the required delivery schedule above will apply.

OFFEROR'S PROPOSED DELIVERY SCHEDULE

ITEM NO.

BPA Call Slip

QUANTITY

BPA Call Slip

WITHIN DAYS AFTER

DATE OF CONTRACT

IBPA Call Slip

WITHIN DAYS AFTER

DATE OF CONTRACT

ITEM NO, QUANTITY

(b) Attention is directed to the Contract Award or acceptance of off'er mailed, or othetwise fumis Government will mail or otherwise fumish to t award is dated. Therefore, the offeror should compute t actual date of award, rather than the date the written notice of award is received from the Contracting Olficer through the ordinary mails. However, the Government will evaluate an offer that proposes delivery based on the

Contr-actor's date of receipt of the contract or notice of award by adding

(1 ) five calendar diys for delivery of the award through the ordinary mails' or izj on. *orting day irtne solicitation states that the contract or notice of award will be transmitted ilectronically. (Th" t..m "working day" excludes weekends and u.s Federal holidays ) If' as so computed, ttre offerea delivery Ai" i. tat". than the required delivery date, the offer will be considered nonresponsive and rej ected.

(End of CIause)

52.212-2 -- Evaluation -- Commercial Items'

As prescribed in 12.3 01(c), the contracting officer may insert a provision substantially as fbllows:

Evaluation -- Commercial Items (Oct 2014) will award a contract resulting from this solicitation to the responsible offeror whose offer licitation will be most advantageous to the Govemment, price and other factors considered' s shall be used to evaluate offers:

(i) Past Performance

(ii) Ability to meet specification requiremenl)

(iii) Ability lo meet delivery schedule

Page 3 of28

(iv) Price Reasonableness (325-595 variance in comparison with other quotes)

Govemment anticipate issuing up to two BPA (Blanket Purchase Agreement) awards from this solicitation.

Technical and past performance, when combined, are approximately equal to cost or price

(b) Options. The Govemment will evaluate offers for award purposes by adding the total price for all options to the total price for the basic requirement. The Govemment may determine that an offer is unacceptable if the option prices are significantly unbalanced. Evaluation ofoptions shall not obligate the Government to exercise the option(s).

(c) A written notice of award or acceptance of an offer, mailed or otherwise fumished to the successful oft-eror within the time for acceptance specified in the offer, shall result in a binding contract without fuilher action by either party. Before the offer's specified expiration time, the Govemment may accept an offer (or part ofan ofTer), whether or not there are negotiations after its receipt, unless a written notice of withdrawal is received before award.

(End ofProvision)

52.217 -8 - Option to Extend Services.

As prescribed in 17.208(f), inseft a clause substantially the same as the following:

Option to Extend Services (Nov 1999) f'he Govemment may require continued performance of any services within the limits and at the rates specified in the contract. These rates may be adjusted only as a result ofrevisions to prevailing labor rates provided by the Secretary of Labor. The option provision may be exercised more than once, but the total extension of perlbrmance hereunder shall not exieed 6 months. The Contracting Officer may exercise the option by written notice to the Contractor within 10 days.

(End of Clause)

52.212-3 -- Offeror Representations and certifications -- commercial Items.

As prescribed in 12.301(b)(2), insert the following provision:

offeror Representations and certifications -- commercial Items (Oct 2018)

The Ofi'eror shall complete bnty paragraph (b) of this provision ifthe Offeror has completed the annual ly accessed through

,T a'ons

(a) DeJinitions. As used in this provision-- ':6conomically disadvantaged women-owned small business (EDWOSB) concem" means a small business concem that ii at least 51 percent directly and unconditionally owned by, and the management and daily burin"r, operations of which are controlled by, one or more women who are citizens ofthe United States and who are economically disadvantaged in accordance with 13 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-

(6) Exacted from any person under the age of 18 under the menace ofany penalty for its nonperformanceandforwhichtheworkerdoesnotofferhimselfvoluntarily;or

(7) Performed by any person under the age of 18 pursuant to a contract the enforcement of which can be accomplished by process or penalties.

.,Highest-levei owner" mians the entity that owns or controls an immediate owner of the offeror' or that owns or c"ontrols one or more entities that control an immediate owner of the offeror' No entity owns or exercises control of the highest level owner.

PaBe 4 ol 28

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

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

395(c).

"Manuf'actured end product" means any end product in product and service codes (PSCs) 1000-9999, except-

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

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

(3) PSG 88, Live Animals;

(4) PSG 89, Subsistence;

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

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

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

(8) PSC 9610, Ores;

(9) PSC 9620, Minerals, Natural and Synthetic; and ( l0) PSC 9630, Additive Metal Materials'

.,place of manufacture" means the place where an end product is assembled out of components, or otherwise made or processed from raw materials into the finished product that is to be provided to the Govemment. lf a product is disassembled and reassembled, the place of reassembly is not the place of manufacture l.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 exrraction activities, oil-related activities, or the production of military equipment, as those terms are de1lned in the Sudan Accountability and Divestment Act of2007 (Pub. L. I 10-174) Restricted business operations do not include business operations that the person (as that term is defined in Section 2 ofthe Sudan

Accountability and Divestment Act of 2007) conducting the business can demonstrate-

6) Are conducted under contract directly and exclusively with the regional govemment of southem

Sudan;

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

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

i+j Consist of providin! loods or services to an internationally recognized peacekeeping fbrce or humanitarian organlzatron;

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

(6) Have been voluntarily suspended'

Sensitive technologY-

(1) Means hird*are, software, telecommunications equipment, or any other technology that is to be used specilicallY-

(i) To restrict the free flow of unbiased iil; to disrupt, monitor, or otherwise re oflran; and

(2) Does not include information or informational which the President does not have the authonty to regulate or prohibit pursuant to section 203(b)(3) ofthe Intemational Emergency

Economic Powers Act (50 U.S.C. 1702(b)(3)'

"service-disabled veteran-owned small business concem"- ( I ) Means a small business concern-

Page 5 of2E

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

(ii) The management and daily business operations of which are controlled by one or more service-disabled veterans or, in the case of a service-disabled veteran with permanent 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. 101(2), with a disability that is service-connected, as defined in 38 U.S.C. 101(i6).

"Small business concern" 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 121 and size standards in this solicitation.

"Small disadvantaged business concem, consistent with l3 CFR 124.1002," means a small business concern under the size standard applicable to the acquisition, that--

(1) ls at least 51 percent unconditionally and directly owned (as defined at 13 CFR 124.105) by--

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

and

(ii) Each individual claiming economic disadvantage has a net worth not exceeding $750.000 after taking inro account the applicable exclusions set forth at I 3 CFR 1 24. 104(cX2); and

(2) The management and daily business operations of which are controlled (as defined at 13.CFR t;4.rcq by individuals, who meet the criteria in paragraphs (1)(i) and (ii) of this definition.

.,Subsidiary,'means an entity in which more than 50 percent of the entity is owned-

( | ) Directly by a parent corporation: or

(2) Through another subsidiary of a parent corporation.

,'successor" means an entlty that has ieplaced a predecessor by acquiring the assets and carrying out the aflairs of the predecessor under a new name (often through acquisition or merger). The term "successor" does not include new olfices/divisions of the same company or a company that only changes its name. The extent ofthe responsibility ofthe successor for the liabilities of the predecessor may vary, depending on State Iaw and specifi c circumstances.

' Veteran-owned small business concem" means a small business concem-

(l) Not less than 5l percent of which is owned )y one or more veterans(as defined at 38 U.S.C. 101(2) or, in t6. case ofany publicly owned business, lot less than 5l percent ofthe stock of which is owned by one or more veteransl and

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

,,Women-owned buSiness concern" means a conoern which is at least 51 percent owned by one or more women;

or in the case ofany publicly owned business, at least 51 percent ofthe its stock is owned by one or more u,omen; and whose management and daily business operations are controlled by one or more women'

''Women-owned small business concern" means a small business concern -'

(1) That is at least 51 percent o\'vned by one or more wom owneo business, at least 51 percent of the stock of which is owne

(2) Whose management and daily business operations are n'

..Women-owned small business (WOSB] concem eligible under the WOSB Program (in accordance with l3

CFR part I 27),', means a small business concem thatls at least 51 percent directly and unconditionally owned

Uv, ,ii,fr. n.'unug"n'.n, una Ouifv Uutin.ss operations of which are controlled by, one or more women who are citizens of the United States.

(bl

Page 6 of28

Request For Quotei CRHC-20-01

(1) Annual Representations and CertiJications. Any changes provided by the OlJbror in paragraph (b)(2) oJ this provision do not automatically change the representotions and certdications in SAM.

(2) The offeror has completed the annual representations and certifications electronically in SAM accessed through http://wlr!'.sam.eov. After reviewing SAM information, the Offeror verifies by submission of this ofl'er that the representations and certifications currently posted electronically at FAR 52.212-3, Offeror Representations and Certifications-Commercial Items, have been entered or updated in the last 12 months, are current, accurate, complete, and applicable to this solicitation (including the business size standard applicable to the NAICS code referenced for this solicitation), at the time this offer is submitted and are incorporated in this offer by reference (see FAR 4.1201), except for paragraphs _. [Offeror to identify the applicable paragraphs at (c) though (u) of this provision that the olferor has completed for the purposes of this solicitation only, ifany. These amended representation(s) and/or certification(s) are also incorporated in this offer and are current, accurate, and complete as ofthe date of this 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 is to be performed in the

United States or its outlying areas. Check all that apply.

l) Small business concern. The offeror represents as part of its offer that it f] is, ll is not a small business concem.

(2) Veteran-owned small business concern. [Complete only if the offeror represented itselfas a srnall business concern in paragraph (c)( I ) of this provision.l The offeror represents as part of its oifer that it

Ll is, Ll is not a veteran-owned small business concern.

$ Serv ice-aisaUIed veteran-owned small busin:ss concem. [Complete only if the offeror represented itself as a veteran-owned small business concem in paragraph (c)(2) ofthis provision'] The off'eror represents as part of its offer that it f] is, l] is not a service-disabled veteran-owned smallbusiness concem.

(4) Small disadvantaged business concem. [Complete only if the offeror represented itselfas a small business concem in paragraph (c)(1) ofthis provision.] The offeror represents that it [-] is' f] is not' a small disadvantaged business concem as defined in 13 CFR 124'1002'

(5) Women-owned small business concern. [Complete only if the offeror represented itself as a small business concern in paragraph (c)(1) of this provision.l The offeror represents that it fl is, fl is not a women-owned small business concem.

Note: Complete paragraphs (c)(8) and (c)(9) only if this solicitation is expected to exceed the simplified acquisition threshold.

(6) WOSB concern eligible under the woSB Program. [complete only if the ol'feror represented itself as a women-owneo sm-all business concem in p rragraph (c)(5) of this provision.] The otferor replesents that- (i)It|]is,f]isnotaWosBconcemeligibleundertheWosBProgram,hasprovidedallthe i.qul."A documents to the WOSB Repository, and no change in circumstances or adverse decisions have been issued that affects it

(ii) It Ll is, fl is not a joint venture that and the representation in paragraph (c)(6 eligible under the WOSB Program partt name or name s of the WOSB concem e businesses that are participating in the j under the WOSB Program participating of the WOSB representation'

Page 7 oi-2E separate signed copy of the EDWOSB representation.

(8) Women-owned business concern (other than small business concem). IComplete only if the offeror is a women-owned business concem and did not represent itselfas a small business concern in paragraph (c)(1) of this provision.] The offeror represents that it f] is, a women-owned business concern.

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

(10) HUBZone small business concern. [Complete only if the ofTeror represented itself as a small business concem in paragraph (c)(1) of this provision.] The offeror represents, as pan of its offer, that--

(i) It fl is, ll is not a HUBZone small business concem listed, on the date of this represenrauon, 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

13 CFR Part 126 and

(ii) It Liis, fl is not a HUBZone joint venture that complies with the requirements of 13 CFR pa1- Il6,and-Le representation in paragraph (c)(10Xi) ofthis provision is accurate for each

HUBZon" small buiiness concern participating in the HUBZone joint venture. lThe ofJbror shall enter the names of each of the HUBZone small business concerns participating in the HUBZone

Joint yenture.. .] Each HUBZone small business concem pa(icipating in the

HUBZone joint venture shall submit a separate signed copy ofthe HUBZone representatron.

(d) Representations required to implement provisions ofExecutive Order 11246 --

(1) Previous contracts and compliance The offeror represents that --

(i) lt L] has, f] has not, participated in a previous contract or subcontract subject to the Equal

Opportunity clause of this solicitation; and

(ii) It U has, ll has not, filed all required compliance reports'

(2) Afiirmative Action r represents that --

(DItL]hasde!hasnotdevelopedanddoesnothaveonfile,ateach establishment, ams required by rules and regulations ofthe Secretary of

Labor (41 CFR parts 60-l and 60-2)' or

(ii) lt L] has noi previously had contracts subject to the written affirmative action programs of thi rules and regulations of the Secretary of Labor'

(e) Certific Payments to Influince Federal Transactions (31U.S.C. 1352) (Applies only if the contract is ea $tSO,OOO.; By submission of its offer' the offeror certifies to the best of its

Request For Quote/ CRHC-20-01

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

(i) It ll is, [_] is not an EDWOSB concern, has provided all the required documents to tlre WOSB Repository, and no change in circumstances or adverse decisions have been issued that affects its eligibility; and

(ii) It U is, ! is not a joint 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 concem parlicipating in the joint venture. [The offeror shall enter the name or names of the

EDWOSB concem and other small businesses that are participating in the joint venturc:

.] Each EDWOSB concern participating in the joint venture shall submit a

Page 8 of28 knowledge and belief that no Federal appropriated funds have been paid or will be paid to any person fbr influencing or attempting to influence an oflicer or employee ofany agency, a Member ofCongress. an officer or employee of Congress 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 behalfofthe 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 of the registrants. The offeror need not report regularly employed officers or employees ofthe offeror to whom payments of reasonable compensation were made.

(\ Buy American Certificare. (Applies only if the clause at Federal Acquisition Regulation (FAR) 52.225- I , Buy American - Supplies, is included in this solicitation.)

6 ) The offeior certifres that each end product, except those listed in paragraph (f)(2) of this provision. is a domestic end product and that for other than COTS items, the off'eror has considered components ot unknown origin to have been mined, produced, or manufactured outside the United States. The of'feror shall list as foreign end products those end products manufactured in the United States that do not qualify as domesiic end products, i.e., an end product that is not a COTS item and does not meet the

.on1pon.nt test in paragiaph (2) of the definition of "domestic end product." The terms "commercially avaiiable off+he-shelf iCOTS) item," "component," "domestic end product,"'-end product," "foreign end oroduct." and',Uniied 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) The Govemment will evaluate offers in accordance with the policies and procedures ofFAR Part 25'

(e)

(l) Buy American -- Free Trade Agreements -- Israeli Ttade Act certificate. (Applies only i he clause ut-pan sz.zzs-:, Buy American -- Free Trade Agreements -- Israeli Trade Act, is included this solicitation.)

(i) The offeror certifies that each end pro

(gX l)(iii) o1'this provision, is a domestic otferor has considered components of un manuf'actured outside the United States' or peruvian end froduct," "commercially available off+he-shelf (COTS) item," "component,"

"domestic end pioduct,' gn end ountry"' ,.Free Trade Agreement "lsrael are dehned in the clause of d "Buy --lsraeli

Trade Act."

(ii) The offeror certifies that the following supplies are eno products (other than Bahainian' Moroccan' Omani' Pa ucts) or

Israeli end products as defined in the clause of this soli -Free Trade Agreements-lsraeli Trade Act":

Free Trade Agreement Countiy End Products (Other than Bahrainian, Moroccan, Omani, Panamantan' or

Peruvian End Products) or Israeli End Products:

LINE ITI]M NO. COLINTRY OF ORIG1N

lList as necessaryf

(iii) The offeror shall list those supplies that are foreign end products (other than those lisled in paragraph (g)(1Xii) or 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 lbreign 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, ]COTINTRY OF ORIGIN

lList as necessafy)

(iv) The Govemment will evaluate offers in accordance with the policies and procedures of FAR

Part 25.

(2) Buy American-Free Trade Agreements-Israeli Trade Act Certificate, Alternate L lf Altemate I to the clause atF AR 52.225-3 is included in this solicitation, substitute the following paragraph (g)(tXii) for paragraph (g)(l)(ii) ofthe basic provision:

(gXl)(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-Israeli Trade Act":

Canadian End Products:

Line Item No.:

IList as necessatYJ

(3) Buy Anerican Free Trade Agreements-Israeli Trade Act Certificate, Alternale 11 lf Altemate IT to ihe cluuse at FAR 52.225-3 is included in this solicitation, substitute the following paragraph (g)(t)(ii) for paragraph (gXlXii) ofthe basic provision:

(glfiltiil The offeroicertifies that the following supplies are Canadian end products or liraeli end products as defined in the clause ofthis solicitation entitled "Buy American--

Free Trade Agreements--lsraeli Trade Act":

Canadian or Israeli End Products:

Line Item No.:

'Country of Origin:

lList as necessarY)

Page l0 ol28

(4) Btty American-Free Trade Agreements-lsraeli Trade Act Cerlificate, Alternate /11 If Altemate III to the clause at 52.225-3 is included in this solicitation, substitute the following paragraph (g)(l)(ii) fot paragraph (g)( I )(ii) of the basic provision:

(g)(1)(ii) The offeror certifies that the following supplies are Free Trade Agreement country end products (other than Bahrainian, Korean, Moroccan, Omani, Panamanian, or Peruvian end products) or Israeli end products as defined in the clause ofthis solicitation entitled "Buy American-Free Trade Agreements-lsraeli Trade Act":

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

of Origin:

fList as necessaryl

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

(i) The offeror ceftifies that each end product, except those listed in paragraph (g)(5)(ii) of this piovision, is a U.S.-made or designated country end product as defined in the clause of this 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

Country of Origin:Line Item No.:

lList as necessarYf

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

(h) Certilic (Executive Order 12689). (Applies only if the contract value is expected eshold.) The offeror certihes, to the best of its knowledge and belief, als--

(rj Ll ere, fl are not presently debarred, suspended, proposed for debarment, or declared ineligible for the award of contracts by any Federal agency;

(2) U Have, flhave not, *itt'innutt'.I-*",t:::::f:.rT,.iffjii.",lfl;iil?i::J',fi1;i.T,1X',i,,,' or Perfor I or state or commission of embezzlement, theft, forgery, b aking talse statements, tax evasion, violating Federal ano

Page I I of2E

(3) fl Are, ll 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) f] Have, fl have not, within a tkee-year period preceding this otter, been notilied ofany delinquent Federal taxes in an amount that exceeds $3,500 for which the liability remains unsatisfied.

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

(A) The tax liability is finally determined. The liability is finally determined if it has been assessed. A liability is not finally determined if there is a pending administrative or judicial challenge. In the case ofajudicial challenge to the liability, the liability is not finally determined until all judicial appeal rights have been exhausted'

(B) The taxpayer is delinquent in making pctymenl A taxpayet 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 enfbrced collection action is precluded

(ii) Examples.

(A) The taxpayer has received a statutory notice of deficiency, under I.R C. $6212, which entitles the ia*puy"t to seek Tax Court review ofa proposed tax deficiency. This is not a delinquent taxiecause it is not a final tax liability. Should the taxpayer seek Tax Court revrew, rhis will not be a linal tax liability until the taxpayer has exercised alljudicial appear rights.

(B) The I-RS has filed a notice of Federal tax Iien with respect to an assessed tax liability' and the taxpayer has been issued a notice under I.R.C. $6320 entitting the taxpayer to request a hearing with the IRS Office of Appeals Contesting the lien filing, and to further appeal to the Tax Court if the IRS determines to sustain the lien filing. In the course ot the hearing, the taxpayer is entitled to contest the underlying tax liability because the taxPaYer has had no Prior oPPort because it is not a final tax liabili not be a final tax liabilitY until th

(C) The taxPaYer has entered into Expayer is making timely payments and is in full compliance with the agreement terms.

The taxpayer is no"t delinquent because the taxpayer is not cunently required to make tull payment.

(D; Th. tu*puy.r has liled for bankruptcy protection The t9'rg119r

1s not delinquent because enfirced collection action is stayed under l l U.S.C $362 (the Bankruptcy

Code).

(i) wledge of Child Labor for Listed End Products (Executive Order 13126). [The

Co parai.aph (i)(1) any end products being acquired under this solicitation that are rnc ir.qrii.ing Coniracior Certification as to Forced or Indentured Child Labor' unless excluded at 22.1503(b).1 (l ) Listed End Product

Listed Countries of Origin:

(2) Certification. ltf tt e iontra.ting Officer has identified .nd ptodo"t, und countries of origin in

)Jr"gr"p'' fijtrl ofthis provision, tten the offeror must certify io either (i)(2Xi) or (iX2)(ii) bv checking the approPriate block.l Paec l2 of28 fl (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.

ll (ii) The offeror may supply an end product listed in paragraph (iXl) ofthis provision that rvas mined, produced, or manufactured in the corresponding country as listed for that product. The offeror certihes that is 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 of those efforts, the offeror certifies that it is not aware ofany such use of child labor.

() Place of manufacture. (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 predominantly-

(t) L] In the United States (Check this box if the total anticipated price of offered end products manufactured in the United States exceeds the total anticipated price of offered end products manufactured outside the United States); or

(2) ll Outside the United States.

(k) Certificales regarding exemptions from the application ofthe Service Contract Labor Standards.

iiertification by the offeror as to its compliance with respect to the contract also constitutes its cefiification as to compliance by its subcontractor if it subcontracts out the exempt services.) [The contracting officer is to check a box to indicate if paragraph (k)(1) or (k)(2) applies.l

(l) ll Maintenance, calibration, or repair of cerlain equipment as described in FAR 22.1003- (c)(l) The offeror ll does fl does not certify that-

(i) Th-items of equipment to be serviced under this contract are used regularly for other than

Govemmental purpo;es and are sold or traded by the offeror (or subcontractor in the case ofan exempt subcontraCt) in substantial quantities to the general public in the course of normal business oPerations;

(ii) The seivices 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 equiPmenl: 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'

12) [_] Certain services as Jescribed in FAR 22.1003-4(dXl ). The oft-eror fl does fl does not certity that-

(i) The services under the contract are offered and sold regularly to non-Governmental cusromers, 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 operatlons;

(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(dX2Xiii));

(iii) Each iervice empioyee who will perform the services under the contract will spend only a small portion ofhis or her time (a monttrly average ofless than 2o.percent ofthe available hours on an annualized basis, or less than 20 percent ofavailable hours during the contract period ifthe contract period is less t ovemment contract; and

(iv)'l.hecompensationanforallserviceemployeesperlbrming work under the contrac these employees and equivalent employees servicing commercial customers'

(3) If paragraph (k)(1) or (kX2) of this clause applies-

Pagc l3 of28

(D Ifthe off'eror does not certify to the conditions in paragraph (k)(1) or (k)(2) and the

Contracting Officer did not attach a Service Contract Labor Standards wage determination to tlre solicitation, the offeror shall notifu the Contracting Officer as soon as possible; and

(ii) The Contracting Officer may not make an award to the offeror if the offeror f-ails to execute the certification in paragraph (k)(1) or (k)(2) of this clause or to contact the Contracting Officer as required in paragraph (k)(3xi) of this clause.

(I) Taxpayer identification number (TIN) (26 U.S.C. 6109, 31 U.S.C. 7701). Qtlot appticable if the offeror is required to provide this information to the SAM database to be eligible for award.)

(1) All offerors must submit the information required in paragraphs (l)(3) through (l)(5) of this provision to comply with debt collection requirements of 31 U.S.C.7701(c) and 3325(d), reporting requirements of 26 U.S.C. 604l,604lA, and 6050M, and implementing regulations issued by the Internal Revenue

Service (IRS).

(2) The TIN may be used by the government to collect and report on any delinquent amounts arising out of the offeror's relationship with the Government (31 U.S.C. 7701(cX3)). 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 verify the accuracy of the offeror's TIN'

(3) Taxpayer Identification Number (TIN).

fl rlN:

[-] TIN has been aPPlied for.

ll TIN is not required because:

fj Offrro. is a nonresident alien, foreign corporation, or foreign partnership that does not have in-ncome effectively connected with the conduct of a trade or business in the United States and does not have an olfice or place ofbusiness or a fiscal paying agent in the United States;

l] Offeror is an agency or instrumentality of a foreign government;

!1 Om".ot is an agency or instrumentality of the Federal Govemment;

(4) Type of organization.

ll Sole ProPrietorshiP;

[_] PartnershiP;

ll Corporate entity (not tax-exempt);

fl Corporate entitY (tax-exemPt);

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

f] Foreign government;

[-] International organization per 26 CFR 1 6049-4;

Ll Other

(5) Common parent.

l] Offeror is not owned or controlled by a common parent:

I I Name and TIN of common Parent:

Name

TIN

,,,,ffits offer, the offeror certifies that the offeror udan corporation, unless the exception at 9' 108-2(b) the procedures at 9.108-4'

(2) Representatitrn. The of-feror represents that

Page l.1of2tl

(i) it [] is, [] is not an inverted domestic corporation; and

(ii) It [] is, [] is not a subsidiary ofan inverted domestic corporation.

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

(1) The offeror shall email questions conceming sensitive technology to the Department of State at

CISADAI06@state.sov.

(2) Representation and Certification. Unless a waiver is granted or an exception applies as provided in paragraph (o)(3) ofthis provision, by submission of its offer, the offeror-

(i) Represents, to the best of its knowledge and beliel that the…