Exhibit J- GSA Form 3518 SAM Representations and Certifications.pdf
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- Attached to
- Wasilla Armed Forces Recruiting Office
- Solicitation number
- DACA855270000100
About this file
This is a GSA Form 3518-SAM, an addendum to the System for Award Management (SAM) Representations and Certifications for acquisitions of leasehold interests in real property.
The form applies to Request for Lease Proposals and establishes three primary representation and certification requirements. Section 1 specifies that the default NAICS code is 531120 (real property leasing and management), with exceptions for self-storage (531130), land (531190), or residential properties (531110). The small business size standard is $38.5 million in annual average gross revenue for the last three fiscal years, or 500 employees for concerns offering products not manufactured in-house. The offeror must certify active registration in SAM. Section 2 requires corporations to represent that they do not have unpaid federal tax liabilities (for which all judicial and administrative remedies have been exhausted) that are not being paid pursuant to an agreement with the responsible tax authority, and that neither the corporation nor its officers or agents have been convicted of federal felonies within the preceding 24 months. Section 3 requests the offeror's Data Universal Numbering System (DUNS) number, with instructions for obtaining one through Dun and Bradstreet via internet or telephone. The form requires signature by the offeror or legally authorized representative, along with name, address, telephone number, and date.
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Text version
GSA FORM 3518-SAM PAGE 1 (REV 01/16)
Complete appropriate boxes, sign the form, and attach to offer.
The Offeror makes the following additional Representations. NOTE: The "Offeror," as used on this form, is the owner of the property offered, not an individual or agent representing the owner.
1. ANNUAL REPRESENTATIONS AND CERTIFICATIONS FOR LEASEHOLD ACQUISITIONS
(APR 2015)
(a) (1) The North American Industry Classification System (NAICS) code for this acquisition is 531120, unless the real property is self-storage (#531130), land (#531190), or residential (#531110).
(2) The small business size standard is 38.5 Million in annual average gross revenue of the concern for the last 3 fiscal years.
(3) The small business size standard for a concern which submits an offer in its own name, other than on a construction or service contract, but which proposes to furnish a product which it did not itself manufacture, is 500 employees.
(b) The System for Award Management (SAM) is a centrally located, searchable database which assists in the development, maintenance, and provision of sources for future procurements. The Offeror, by signing this addendum, hereby certifies he is registered in SAM.
[ ] Registration Active and Copy Attached
2. 552.203-72 REPRESENTATION BY CORPORATIONS REGARDING AN UNPAID
DELINQUENT FEDERAL TAX LIABILITY OR A FELONY CONVICTION UNDER ANY FEDERAL LAW
(DEVIATION) (OCT 2013)
(a) In accordance with Sections 630 and 631 of Division of the Consolidated Appropriations Act, 2012 (Pub. L. 112-74), and Section 101 of the Continuing Appropriations Act, 2014 (Pub. L.
113-16) none of the funds made available by the Continuing Appropriations Act 2014 may be used to enter into a contract action 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 this further action is not necessary to protect the interests of the Government, or
(2) Was convicted, or had an officer or agent of such corporation acting on behalf of the corporation convicted of a felony criminal violation under any Federal law within the preceding 24 months, where the awarding agency is aware of the conviction, unless the agency has considered suspension or debarment of the corporation or such officer or agent and made a determination that this action is not necessary to protect the interests of the Government.
(b) The Contractor 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
ADDENDUM to the System for Award Management (SAM) REPRESENTATIONS AND CERTIFICATIONS (Acquisitions of Leasehold Interests in Real Property)
Request for Lease Proposals Number
Dated
GSA FORM 3518-SAM PAGE 2 (REV 01/16)
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.
(2) It is [ ] is not [ ] a corporation that was convicted, or had an officer or agent of the corporation acting on behalf of the corporation, convicted of a felony criminal violation under any Federal law within the preceding 24 months.
3. OFFEROR’S DUNS NUMBER
(a) Enter number: ____________________
(b) An offeror may obtain a DUNS number (i) via the Internet at http://fedgov.dnb.com/webform or if the offeror does not have internet access, it may call Dun and Bradstreet at 1-866-705-5711 if located within the United States; or (ii) If located outside the United States, by contacting the local Dun and Bradstreet office. The offeror should indicate that it is an offeror for a U.S. Government contract when contacting the local Dun and Bradstreet office.
OFFEROR OR
LEGALLY AUTHORIZED
REPRESENTATIVE
NAME, ADDRESS (INCLUDING ZIP CODE)
Signature
TELEPHONE NUMBER
Date http://fedgov.dnb.com/webform
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