Exhibit J- GSA Form 3518 SAM Representations and Certifications.pdf
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- Attached to
- Anchorage Air Force Reserve Recruiting Office
- Solicitation number
- DACA455270014500
About this file
This is a GSA Form 3518-SAM, an addendum to System for Award Management (SAM) representations and certifications for acquisitions of leasehold interests in real property.
The form requires offerors to complete annual representations and certifications when responding to a Request for Lease Proposals. Key requirements include: certification of SAM registration with an active status, confirmation of the applicable NAICS code (531120 for general real property leases, with alternatives for self-storage, land, or residential properties), and acknowledgment of the small business size standard of 38.5 million dollars in annual average gross revenue for the past three fiscal years. Offerors must also represent their corporate tax compliance status and criminal history, specifically certifying whether they have any unpaid federal tax liabilities for which all remedies have been exhausted and are not being paid under an agreement, and whether they or their officers were convicted of felony violations under federal law within the preceding 24 months. The form requires entry of the offeror's DUNS number, which can be obtained through Dun and Bradstreet via the internet or telephone. The form must be signed by an authorized representative of the offeror (defined as the owner of the offered property) and include contact information, date, and attachment to the lease proposal offer.
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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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