DARPA-PS-26-10-Attachment_E-Representations_And_Certifications.docx

CERTIFICATIONS FOR AGREEMENT NO. HR0011-17-9-0005

CERTIFICATIONS FOR AGREEMENT NO. HR0011-2X-9-XXXX

1. The undersigned certifies, to the best of his or her knowledge and belief, that this institution, organization, and its principals:

(a) Pursuant to E.O. 12549 and implementing rule, are not presently debarred, suspended, proposed for debarment, declared ineligible or voluntarily excluded from covered transactions by any Federal department or agency

(b) Pursuant to the Anti-Drug Abuse Act of 1988, Pub. L. 100-690, will provide a drug-free workplace. The place of performance is:

(Street Address) (City, County, State) (Zip Code)

(c) Complies with the provisions of DoD Directive 5500.11 “Nondiscrimination in Federally Assisted Programs,” which implements Title VI of the Civil Rights Act of 1964.

2. The following certification applies only to actions exceeding $100,000.00:

(a) Per 31 U.S.C. § 1352, “Limitation on use of appropriated funds to influence certain Federal contracting and financial transactions.”

(1) No Federal appropriated funds have been paid or will be paid by or on behalf of the undersigned, to any person for influencing or attempting to influence an officer or employee of an agency, a Member of Congress, an Officer or employee of Congress, or an employee of a Member of Congress in connection with the awarding of any Federal contract, the making of any Federal grant, the making of any Federal loan, the entering into of any cooperative agreement, and the extension, continuation, renewal, amendment, or modification of any Federal contract, grant, loan, cooperative agreement, or other transaction.

(2) If any funds other than Federal appropriated funds have been paid or will be paid to any person for influencing or attempting to influence an officer or employee of any agency, a Member of Congress, an officer or employee of Congress, or an employee of a Member of Congress in connection with the Federal contract, grant, loan, cooperative agreement, or other transaction, the undersigned shall complete and submit Standard Form LLL, “Disclosure Form to Report Lobbying,” in accordance with its instructions.

(3) The undersigned shall require that the language of this certification be included in the award documents for all subawards at all tiers (including subcontracts, subgrants, and contracts under grants, loans, cooperative agreements, and other transactions) and that all subrecipients shall certify and disclose accordingly.

This certification is a material representation of fact upon which reliance was placed when you transaction was made or entered into. Submission of this certification is a prerequisite for making or entering this transaction imposed by 31 U.S.C. § 1352. Any person who fails to file the required certification shall be subject to a civil penalty of not less than $10,000.00 and not more than $100,000.00 for each such failure.

3. Representation by corporations regarding an unpaid delinquent tax liability or a felony conviction under any Federal law.

(a) In accordance with Section 101(a) of the Continuing Appropriations Act, 2016, Pub. L. 114-53, and any subsequent FY2016 appropriations act that extends to FY2016 funds the same restrictions as are contained in Sections 744 and 745 of Division E, Title VII, of the Consolidated and Further Continuing Appropriations Act, 2015 (Pub. L. 113-235), none of the funds made available by this or any other Act may be used to enter into a contract with any corporation that—

(1) Has any unpaid Federal tax liability that has been assessed, for which all judicial and administrative remedies have been exhausted or have lapsed, and that is not being paid in a timely manner pursuant to an agreement with the authority responsible for collecting the tax liability, where the awarding agency is aware of the unpaid tax liability, unless the agency has considered suspension or debarment of the corporation and made a determination that is further action is not necessary to protect the interests of the Government; or

(2) Was convicted of a felony criminal violation under any Federal law within the preceding twenty-four (24) months, where the awarding agency is aware of the conviction, unless the agency has considered suspension or debarment of the corporation and made a determination that this action is not necessary to protect the interests of the Government.

(b) The Offeror represents that—

(1) It is [ ] is not [ ] a corporation that has any unpaid Federal tax liability that has been assessed, for which all judicial and administrative remedies have been exhausted or have lapsed, and that is not being paid in a timely manner pursuant to agreement with the authority responsible for collecting the tax liability.

(2) It is [ ] is not [ ] a corporation that was convicted of a felony criminal violation under a Federal law within the preceding twenty-four (24) months.

(Typed Name and Title of Official Responsible) (Name of Organization/Institution)

(Signature of Official Responsible) (Date)