RFQ.pdf

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Attached to
Robotic Grit Blast Booth System Federal contract opportunity
Solicitation number
F3QCCM8079A002
Issued by
Department of the Air Force Materiel Command Lifecycle Management Center Robins Air Force Base

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RFQ

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CDRLs_A004-_Chart.pdf PDF
CDRLs_A001-_Contractor's_Standard_Operating_Procedures.pdf PDF
CDRLs_A006-_Acceptance_Test_Plan_-_Factory.pdf PDF
Purchase_Desription-Robotic_Robotic_Grit_Blast_Booth_System_B169_L8WC14-4_27_18.pdf PDF
CDRLs_A007-_Acceptance_Test_Plan_-_Site.pdf PDF
CDRLs_A003-_COTS.pdf PDF
Questions_and_Answers_-_Job_Walk.pdf PDF
CDRLs_A005-_Training.pdf PDF
CDRLs_A002-_Mishap.pdf PDF

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SOLICITATION F3QCCM8079A002 is issued as a Request for Quotation (RFQ)

Thisisacombinedsynopsis/solicitationforcommercialitemspreparedinaccordancewiththeformatin
FARsubpart12.6assupplementedwithadditionalinformationincludedinthisnotice.This
announcementconstitutestheonlysolicitation;quotesarebeingrequestedandawrittensolicitationwill
notbeissued.ThissolicitationisbeingconductedunderSimplifiedAcquisitionProcedures(SAP)asa
RequestforQuote(RFQ)No.F3QCCM8079A002.

THIS SOLICITATION IS A 100% TOTAL SMALL BUSINESS SET‐ASIDE.

SMALLBUSINESSSIZESTANDARD
(a) NAICS:333999
(b) No.ofEmployees:500
(c)Dollars:N/A

REQUIREMENT:

ROBOTICGRITBLASTBOOTHSYSTEM,Building(B)169
ThisisaFirmFixedPrice(FFP)competitiverequirementtopurchaseandinstallanewandcomplete
RoboticGritBlastBoothSysteminB169IAWPurchaseDescriptiondated27Apr2018.Installationofthe
RoboticGritBlastBoothSystemforB169shallbecompleted15monthsaftercontractaward.Inaddition,
trainingandproductionsupportshallnotexceed3(three)monthsfollowinginstallation.ThetotalPeriod
ofPerformance(PoP)shallnotexceed18months.Price(s)shouldbeFOBDestination(RobinsAFBGA
31098).Inadditiontopriceanddelivery,quoteshouldincludeyourCAGEcode,DUNSnumber,and
taxpayerIDnumber.AJustificationforBrandNamewillbeutilizedtoobtaintheprocurementofcertain
requirements.TheBrandNameJustificationwillbepostedwiththeRFQ.

The following CLINs are applicable to the effort:

CLIN0001–Materialto include Installation
CLIN0002–PathPlanningSoftware‐SystemEnhancement
CLIN0003–PartLocalizationSystem- System Enhancement
CLIN0004–A001Contractor’sStandardOperatingProcedure
CLIN0005–A002Accident/IncidentReport
CLIN0006–A003CommercialOff‐The‐ShelfEquipmentManualRequirements
CLIN0007–A004ProjectPlanningChart
CLIN0008–A005TrainingMaterials
CLIN0009–A006AcceptanceTestPlan–Factory
CLIN0010–A007AcceptanceTestPlan–Site
DeliveryInformation:Deliveryinstructionswillbeprovidedintheawarddocumentbythetechnical
pointofcontact.
QuotationsshouldbeemailedtoChristianRaffieldatChristian.Raffield@us.af.milnolaterthan31May
2018,1:00pmEST.Theanticipatedawarddateis29Jun2018.Pleasedonotrequestawardstatus
priortothisdate.
Thefollowingclausesareapplicabletosubjectsolicitation(currentthrough2005‐96dated06NOV17
andDFARSChangeNotice20171228):
FAR52.2033Gratuities(APR1984)(10U.S.C.2207)
FAR52.204‐7SystemforAwardManagement
FAR52.204‐13SystemforAwardManagementMaintenance
FAR52.212‐1InstructionstoOfferors
FAR52.212‐4ContractTermsandConditions‐CommercialItems
FAR52.219‐6,NoticeofTotalSmallBusinessSet‐Aside(June2003)(15U.S.C.644).
FAR52.222‐50,CombatingTraffickinginPersons(Aug2007)(Appliestoallcontracts).
FAR52.223‐11‐‐Ozone‐DepletingSubstancesandHighGlobalWarmingPotentialHydrofluorocarbons
FAR52.228‐5Insurance—WorkonaGovernmentinstallation(JAN1997)(IAWFAR28.310)
FAR52.232‐33PaymentbyElectronicFundsTransfer‐‐SystemforAwardManagement.
FAR52.237‐1SiteVisit
FAR52.237‐2ProtectionofGovernmentBuildings,EquipmentandVegetation
FAR52.246‐16ResponsibilityforSupplies(APR1984)(IAWFAR46.316)
FAR52.243‐1Changes‐FixedPrice(AUG1987)(IAWFAR43.205(a)(1)
FAR52.247‐34FOBDestination
FAR52.249‐2TerminationforConvenienceoftheGovernment(Fixed‐Priced)(OCT2010)
(IAWFAR48.201(b),FAR48.201(f))
FAR52.249‐8Default(Fixed‐PricedSupplyandService)(APR1984)(IAWFAR49.504(a)(1))
FAR52.252‐1SolicitationProvisionsIncorporatedbyReference
Thissolicitationincorporatesoneormoresolicitationprovisionsbyreference,withthesameforceand
effectasiftheyweregiveninfulltext.Uponrequest,theContractingOfficerwillmaketheirfulltext
available.Theofferoriscautionedthatthelistedprovisionsmayincludeblocksthatmustbecompleted
bytheofferorandsubmittedwithitsquotationoroffer.Inlieuofsubmittingthefulltextofthose
provisions,theofferormayidentifytheprovisionbyparagraphidentifierandprovidetheappropriate
informationwithitsquotationoroffer.Also,thefulltextofasolicitationprovisionmaybeaccessed
electronicallyatthis/theseaddress(es):

http://farsite.hill.af.mil/vmfara.htm http://farsite.hill.af.mil/vmdfara.htm http://farsite.hill.af.mil/vmaffara.htm

FAR52.252‐5AuthorizedDeviationsinProvisions:(a)TheuseinthissolicitationofanyFederal
AcquisitionRegulation(48CFRChapter1)provisionwithanauthorizeddeviationisindicatedbythe
additionof"(DEVIATION)"afterthedateoftheregulation
(b) TheuseinthissolicitationofanyDFARS(48CFRChapter2)provisionwithanauthorizeddeviationis
ClausesIncorporatedbyReference:fill‐in:www.farsite.hill.af.mil
DFARS252.203‐7000RequirementsRelatingtoCompensationofFormerDODOfficials
DFARS252.204‐7004AlternateA,SystemforAwardManagement.
DFARS252.204‐7008CompliancewithSafeguardingCoveredDefenseInformationControls
DFARS252.204‐7012SafeguardingCoveredDefenseInformationandCyberIncidentReporting
DFARS252.211‐7003ItemUniqueIdentificationandValuation.1stfillin:N/A
DFARS252.211‐7008UseofGovernment‐AssignedSerialNumbers
DFARS252.225‐7001BuyAmericanActandBalanceofPaymentsProgram
DFARS252.232‐7003ElectronicSubmissionofPaymentRequestsandReceivingReports
DFARS252.232‐7010LeviesonContractPayments
DFARS252.243‐7002RequestsforEquitableAdjuustment(DEC2012)(IAWDFARS243.205‐71)
DFARS252.223‐7006ProhibitionofStorage,Treatment,andDisposalofToxicorHazardousMaterial‐‐
Basic(SEP2014)(IAWDFARS223.7106)(IAWDFARS223.7106)
AFFARS5352.201‐9101Ombudsman–MichellePonsell(MichellePonsell@us.af.mil;312‐472‐4097)
AFFARS5352.223‐9001HealthandSafetyonGovernmentInstallations(NOV2012)(IAWAFFARS

5323.9001)

5352.242‐9000 Contractor Access to Air Force Installations

Asprescribedin5342.490‐1,insertaclausesubstantiallythesameasthefollowingclauseinsolicitations
andcontracts:

CONTRACTOR ACCESS TO AIR FORCE INSTALLATIONS (NOV 2012)

(a) Thecontractorshallobtainbaseidentificationandvehiclepasses,ifrequired,forallcontractor
personnelwhomakefrequentvisitstoorperformworkontheAirForceinstallation(s)citedinthe
contract.Contractorpersonnelarerequiredtowearorprominentlydisplayinstallationidentification
badgesorcontractor‐furnished,contractoridentificationbadgeswhilevisitingorperformingworkonthe

installation.

(b) Thecontractorshallsubmitawrittenrequestoncompanyletterheadtothecontractingofficerlisting
thefollowing:contractnumber,locationofworksite,startandstopdates,andnamesofemployeesand
subcontractoremployeesneedingaccesstothebase.Theletterwillalsospecifytheindividual(s)
authorizedtosignforarequestforbaseidentificationcredentialsorvehiclepasses.Thecontracting
officerwillendorsetherequestandforwardittotheissuingbasepassandregistrationofficeorSecurity
Forcesforprocessing.Whenreportingtotheregistrationoffice,theauthorizedcontractorindividual(s)
shouldprovideavaliddriver’slicense,currentvehicleregistration,andvalidvehicleinsurance
certificate,toobtainavehiclepass.
(c) Duringperformanceofthecontract,thecontractorshallberesponsibleforobtainingrequired
identificationfornewlyassignedpersonnelandforpromptreturnofcredentialsandvehiclepassesfor
anyemployeewhonolongerrequiresaccesstotheworksite.
(d) Whenworkunderthiscontractrequiresunescortedentrytocontrolledorrestrictedareas,the
contractorshallcomplywithAFI31‐101,IntegratedDefense,andAFI31‐501,PersonnelSecurityProgram
Managementcitingtheappropriateparagraphsasapplicable.
(e) Uponcompletionorterminationofthecontractorexpirationoftheidentificationpasses,theprime
contractorshallensurethatallbaseidentificationpassesissuedtoemployeesandsubcontractor
employeesarereturnedtotheissuingoffice.

(f) Failure to comply with these requirements may result in withholding of final payment.

AFFARS 5352.223‐9001 Health and Safety on Government Installations (NOV 2012) (IAW AFFARS 5323.9001)

52.209‐11–RepresentationbyCorporationsRegardingDelinquentTaxLiabilityoraFelony
ConvicationunderanyFederalLaw
(a) Asrequiredbysections744and745ofDivisionEoftheConsolidatedandFurtherContinuing
AppropriationsAct,2015(Pub.L113‐235),andsimilarprovisions,ifcontainedinsubsequent
appropriationsacts,theGovernmentwillnotenterintoacontractwithanycorporationthat‐‐
(1) HasanyunpaidFederaltaxliabilitythathasbeenassessed,forwhichalljudicialand
administrativeremedieshavebeenexhaustedorhavelapsed,andthatisnotbeingpaidinatimely
mannerpursuanttoanagreementwiththeauthorityresponsibleforcollectingthetaxliability,
wheretheawardingagencyisawareoftheunpaidtaxliability,unlessanagencyhasconsidered
suspensionordebarmentofthecorporationandmadeadeterminationthatsuspensionor
debarmentisnotnecessarytoprotecttheinterestsoftheGovernment;or
(2) WasconvictedofafelonycriminalviolationunderanyFederallawwithinthepreceding24
months,wheretheawardingagencyisawareoftheconviction,unlessanagencyhasconsidered
suspensionordebarmentofthecorporationandmadeadeterminationthatthisactionisnot
necessarytoprotecttheinterestsoftheGovernment.

(b) The Offeror represents that—

(1) Itis[]isnot[]acorporationthathasanyunpaidFederaltaxliabilitythathasbeenassessed,
forwhichalljudicialandadministrativeremedieshavebeenexhaustedorhavelapsed,andthatis
notbeingpaidinatimelymannerpursuanttoanagreementwiththeauthorityresponsiblefor
collectingthetaxliability;and
(2) Itis[]isnot[]acorporationthatwasconvictedofafelonycriminalviolationunderaFederal
lawwithinthepreceding24months.

(End of provision)

52.212‐2 ‐‐ Evaluation ‐‐ Commercial Items.

As prescribed in 12.301(c), the Contracting Officer may insert a provision substantially as follows:

Evaluation ‐‐ Commercial Items (Oct 2014)

(a) TheGovernmentwillawardacontractresultingfromthissolicitationtotheresponsibleofferor
whoseofferconformingtothesolicitationwillbemostadvantageoustotheGovernment,priceandother
factorsconsidered.Thefollowingfactorsshallbeusedtoevaluateoffers:

(i) technical capability of the item offered to meet the Government requirement

(ii) terms and conditions of the RFQ

(ii) offers the lowest reasonable and balanced price

TheGovernmentwillevaluateeachofferor'sproposedpricessubmittedincompletedRFQ,for
reasonablenessandbalanceasdiscussedinthefollowingparagraphs(i)and(ii).Offerorsareadvisedto
reviewalldataitemsandensurethattheyareproposingtothespecificdatarequirementsandlevelof
effortinvolved.
Reasonableness:Theexistenceofadequatepricecompetitionisexpectedtosupporta
determinationofreasonableness.Priceanalysistechniquesmaybeusedtovalidateprice
reasonableness.Ifadequatepricecompetitionisnotobtainedand/orifpricereasonablenesscannotbe
determinedusingpriceanalysisofGovernmentobtainedinformation,additionalinformationinmaybe
requiredtosupporttheproposedprice.
Balance:Unbalancedpricingexistswhen,despiteanacceptableprice,thepriceofoneormore
contractlineitemsissignificantlyoverstatedorunderstatedasindicatedbytheapplicationofproposal
analysistechniques.TheGovernmentwillanalyzetheproposedpricestodeterminewhetherthereare
unbalancedseparatelypricedlineitems.Pricessubmittedwillbecomparedandevaluatedtoassurethat
alogicalprogressionexistsasrelatedtopriceandquantitychangeswithineachofferor’sresponsetothe
pricingstructureintheSchedule.Offerorsarecautionedagainstsubmittinganofferthatcontains
unbalancedpricing;offersthataredeterminedtobeunbalancedmayberejectedifthelackofbalance
posesanunacceptablerisktotheGovernment.
(b) Options.TheGovernmentwillevaluateoffersforawardpurposesbyaddingthetotalpriceforall
optionstothetotalpriceforthebasicrequirement.TheGovernmentmaydeterminethatanofferis
unacceptableiftheoptionpricesaresignificantlyunbalanced.Evaluationofoptionsshallnotobligatethe
Governmenttoexercisetheoption(s).
(c) Awrittennoticeofawardoracceptanceofanoffer,mailedorotherwisefurnishedtothesuccessful
offerorwithinthetimeforacceptancespecifiedintheoffer,shallresultinabindingcontractwithout
furtheractionbyeitherparty.Beforetheoffer’sspecifiedexpirationtime,theGovernmentmayacceptan
offer(orpartofanoffer),whetherornottherearenegotiationsafteritsreceipt,unlessawrittennoticeof
withdrawalisreceivedbeforeaward.

(End of Provision)

IAW FAR 52.212‐3, Reps/Certs should be completed on‐line at SAM Federal Registration.

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 (Nov2017)

Theofferorshallcompleteonlyparagraphs(b)ofthisprovisioniftheOfferorhascompletedtheannual
representationsandcertificationelectronicallyviatheSystemforAwardManagement(SAM)Website
locatedathttp://www.sam.gov/portal.IftheOfferorhasnotcompletedtheannualrepresentationsand
certificationselectronically,theOfferorshallcompleteonlyparagraphs(c)through(u)ofthisprovision.

(a) Definitions. As used in this provision‐‐

“Economicallydisadvantagedwomen‐ownedsmallbusiness(EDWOSB)concern”meansasmallbusiness
concernthatisatleast51percentdirectlyandunconditionallyownedby,andthemanagementanddaily
businessoperationsofwhicharecontrolledby,oneormorewomenwhoarecitizensoftheUnitedStates
andwhoareeconomicallydisadvantagedinaccordancewith13CFRpart127.Itautomaticallyqualifies
asawomen‐ownedsmallbusinesseligibleundertheWOSBProgram.

“Forced or indentured child labor” means all work or service—

(6) Exactedfromanypersonundertheageof18underthemenaceofanypenaltyforits
nonperformanceandforwhichtheworkerdoesnotofferhimselfvoluntarily;or
(7) Performedbyanypersonundertheageof18pursuanttoacontracttheenforcementofwhich
canbeaccomplishedbyprocessorpenalties.
“Highest‐levelowner”meanstheentitythatownsorcontrolsanimmediateowneroftheofferor,orthat
ownsorcontrolsoneormoreentitiesthatcontrolanimmediateowneroftheofferor.Noentityownsor
exercisescontrolofthehighestlevelowner.
“Immediateowner”meansanentity,otherthantheofferor,thathasdirectcontroloftheofferor.
Indicatorsofcontrolinclude,butarenotlimitedto,oneormoreofthefollowing:Ownershipor
interlockingmanagement,identityofinterestsamongfamilymembers,sharedfacilitiesandequipment,
andthecommonuseofemployees.
“Inverteddomesticcorporation,”meansaforeignincorporatedentitythatmeetsthedefinitionofan
inverteddomesticcorporationunder6U.S.C.395(b),appliedinaccordancewiththerulesanddefinitions
of6U.S.C.395(c).

“Manufactured end product” means any end product in product and service codes (PSCs) 1000‐9999, except—

(1) 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

(10) PSC 9630, Additive Metal Materials.

“Placeofmanufacture”meanstheplacewhereanendproductisassembledoutofcomponents,or
otherwisemadeorprocessedfromrawmaterialsintothefinishedproductthatistobeprovidedtothe
Government.Ifaproductisdisassembledandreassembled,theplaceofreassemblyisnottheplaceof

manufacture.

“Predecessor” means an entity that is replaced by a successor and includes any predecessors of the predecessor.

“Restrictedbusinessoperations”meansbusinessoperationsinSudanthatincludepowerproduction
activities,mineralextractionactivities,oil‐relatedactivities,ortheproductionofmilitaryequipment,as
thosetermsaredefinedintheSudanAccountabilityandDivestmentActof2007(Pub.L.110‐174).
Restrictedbusinessoperationsdonotincludebusinessoperationsthattheperson(asthattermis
definedinSection2oftheSudanAccountabilityandDivestmentActof2007)conductingthebusinesscan

demonstrate—

(1)Areconductedundercontractdirectlyandexclusivelywiththeregionalgovernmentof
southernSudan;
(2)AreconductedpursuanttospecificauthorizationfromtheOfficeofForeignAssetsControlin
theDepartmentoftheTreasury,orareexpresslyexemptedunderFederallawfromthe
requirementtobeconductedundersuchauthorization;

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

(4)Consistofprovidinggoodsorservicestoaninternationallyrecognizedpeacekeepingforceor
humanitarianorganization;

(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)Meanshardware,software,telecommunicationsequipment,oranyothertechnologythatisto
beusedspecifically—

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

(ii) To disrupt, monitor, or otherwise restrict speech of the people of Iran; and

(2)DoesnotincludeinformationorinformationalmaterialstheexportofwhichthePresident
doesnothavetheauthoritytoregulateorprohibitpursuanttosection203(b)(3)ofthe
InternationalEmergencyEconomicPowersAct(50U.S.C.1702(b)(3)).

“Service‐disabled veteran‐owned small business concern”—

(1) Means a small business concern—

(i)Notlessthan51percentofwhichisownedbyoneormoreservice‐disabledveteransor,
inthecaseofanypubliclyownedbusiness,notlessthan51percentofthestockofwhichis
ownedbyoneormoreservice‐disabledveterans;and
(ii)Themanagementanddailybusinessoperationsofwhicharecontrolledbyoneormore
service‐disabledveteransor,inthecaseofaservice‐disabledveteranwithpermanentand
severedisability,thespouseorpermanentcaregiverofsuchveteran.
(2)Service‐disabledveteranmeansaveteran,asdefinedin38U.S.C.101(2),withadisabilitythat
isservice‐connected,asdefinedin38U.S.C.101(16).
“Smallbusinessconcern”meansaconcern,includingitsaffiliates,thatisindependentlyownedand
operated,notdominantinthefieldofoperationinwhichitisbiddingonGovernmentcontracts,and
qualifiedasasmallbusinessunderthecriteriain13CFRPart121andsizestandardsinthissolicitation.
“Smalldisadvantagedbusinessconcern,consistentwith13CFR124.1002,”meansasmallbusiness
concernunderthesizestandardapplicabletotheacquisition,that‐‐

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

(i) Oneormoresociallydisadvantaged(asdefinedat13CFR124.103)andeconomically
disadvantaged(asdefinedat13CFR124.104)individualswhoarecitizensoftheUnited
States;and
(ii) Eachindividualclaimingeconomicdisadvantagehasanetworthnotexceeding
$750,000aftertakingintoaccounttheapplicableexclusionssetforthat13CFR
124.104(c)(2);and
(2) Themanagementanddailybusinessoperationsofwhicharecontrolled(asdefinedat13.CFR
124.106)byindividuals,whomeetthecriteriainparagraphs(1)(i)and(ii)ofthisdefinition.

“Subsidiary” means an entity in which more than 50 percent of the entity is owned—

(1) Directly by a parent corporation; or

(2) Through another subsidiary of a parent corporation.

“Successor”meansanentitythathasreplacedapredecessorbyacquiringtheassetsandcarryingoutthe
affairsofthepredecessorunderanewname(oftenthroughacquisitionormerger).Theterm“successor”
doesnotincludenewoffices/divisionsofthesamecompanyoracompanythatonlychangesitsname.
Theextentoftheresponsibilityofthesuccessorfortheliabilitiesofthepredecessormayvary,depending
onStatelawandspecificcircumstances.

“Veteran‐owned small business concern” means a small business concern—

(1) Notlessthan51percentofwhichisownedbyoneormoreveterans(asdefinedat38U.S.C.
101(2))or,inthecaseofanypubliclyownedbusiness,notlessthan51percentofthestockof
whichisownedbyoneormoreveterans;and

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

“Women‐ownedbusinessconcern”meansaconcernwhichisatleast51percentownedbyoneormore
women;orinthecaseofanypubliclyownedbusiness,atleast51percentoftheitsstockisownedbyone
ormorewomen;andwhosemanagementanddailybusinessoperationsarecontrolledbyoneormore

women.

“Women‐owned small business concern” means a small business concern ‐‐

(1) Thatisatleast51percentownedbyoneormorewomenor,inthecaseofanypubliclyowned
business,atleast51percentofthestockofwhichisownedbyoneormorewomen;and

(2) Whose management and daily business operations are controlled by one or more women.

“Women‐ownedsmallbusiness(WOSB)concerneligibleundertheWOSBProgram(inaccordancewith
13CFRpart127),”meansasmallbusinessconcernthatisatleast51percentdirectlyandunconditionally
ownedby,andthemanagementanddailybusinessoperationsofwhicharecontrolledby,oneormore
womenwhoarecitizensoftheUnitedStates.

(b)

(1) AnnualRepresentationsandCertifications.Anychangesprovidedbytheofferorinparagraph
(b)(2)ofthisprovisiondonotautomaticallychangetherepresentationsandcertificationsposted
ontheSAMwebsite.
(2) Theofferorhascompletedtheannualrepresentationsandcertificationselectronicallyviathe
SAMwebsiteaccessedthroughhttps://www.acquisition.gov.AfterreviewingtheSAMdatabase
information,theofferorverifiesbysubmissionofthisofferthattherepresentationand
certificationscurrentlypostedelectronicallyatFAR52.212‐3,OfferorRepresentationsand
Certifications—CommercialItems,havebeenenteredorupdatedinthelast12months,are
current,accurate,complete,andapplicabletothissolicitation(includingthebusinesssize
standardapplicabletotheNAICScodereferencedforthissolicitation),asofthedateofthisoffer
andareincorporatedinthisofferbyreference(seeFAR4.1201),exceptforparagraphs____________.
[Offerortoidentifytheapplicableparagraphsat(c)through(u)ofthisprovisionthattheofferorhas
completedforthepurposesofthissolicitationonly,ifany.Theseamendedrepresentation(s)and/or
certification(s)arealsoincorporatedinthisofferandarecurrent,accurate,andcompleteasofthe
dateofthisoffer.Anychangesprovidedbytheofferorareapplicabletothissolicitationonly,anddo
notresultinanupdatetotherepresentationsandcertificationspostedelectronicallyonSAM.]
(c) Offerorsmustcompletethefollowingrepresentationswhentheresultingcontractistobeperformed
intheUnitedStatesoritsoutlyingareas.Checkallthatapply.
(1) Smallbusinessconcern.Theofferorrepresentsaspartofitsofferthatit[_]is,[_]isnotasmall
businessconcern.
(2) Veteran‐ownedsmallbusinessconcern.[Completeonlyiftheofferorrepresenteditselfasa
smallbusinessconcerninparagraph(c)(1)ofthisprovision.]Theofferorrepresentsaspartofits
offerthatit[_]is,[_]isnotaveteran‐ownedsmallbusinessconcern.
(3) Service‐disabledveteran‐ownedsmallbusinessconcern.[Completeonlyiftheofferor
representeditselfasaveteran‐ownedsmallbusinessconcerninparagraph(c)(2)ofthis
provision.]Theofferorrepresentsaspartofitsofferthatit[_]is,[_]isnotaservice‐disabled
veteran‐ownedsmallbusinessconcern.
(4) Smalldisadvantagedbusinessconcern.[Completeonlyiftheofferorrepresenteditselfasa
smallbusinessconcerninparagraph(c)(1)ofthisprovision.]Theofferorrepresentsthatit[_]is,
[_]isnot,asmalldisadvantagedbusinessconcernasdefinedin13CFR124.1002.
(5) Women‐ownedsmallbusinessconcern.[Completeonlyiftheofferorrepresenteditselfasa
smallbusinessconcerninparagraph(c)(1)ofthisprovision.]Theofferorrepresentsthatit[_]is,
[_]isnotawomen‐ownedsmallbusinessconcern.
Note:Completeparagraphs(c)(8)and(c)(9)onlyifthissolicitationisexpectedtoexceedthe
simplifiedacquisitionthreshold.
(6)WOSBconcerneligibleundertheWOSBProgram.[Completeonlyiftheofferorrepresented
itselfasawomen‐ownedsmallbusinessconcerninparagraph(c)(5)ofthisprovision.]Theofferor
representsthat—
(i)It[_]is,[_]isnotaWOSBconcerneligibleundertheWOSBProgram,hasprovidedallthe
requireddocumentstotheWOSBRepository,andnochangeincircumstancesoradverse
decisionshavebeenissuedthataffectsitseligibility;and
(ii)It[_]is,[_]isnotajointventurethatcomplieswiththerequirementsof13CFRpart
127,andtherepresentationinparagraph(c)(6)(i)ofthisprovisionisaccurateforeach
WOSBconcerneligibleundertheWOSBProgramparticipatinginthejointventure.[The
offerorshallenterthenameornamesoftheWOSBconcerneligibleundertheWOSB
Programandothersmallbusinessesthatareparticipatinginthejointventure:_________.]
EachWOSBconcerneligibleundertheWOSBProgramparticipatinginthejointventure
shallsubmitaseparatesignedcopyoftheWOSBrepresentation.
(7)Economicallydisadvantagedwomen‐ownedsmallbusiness(EDWOSB)concern.[Complete
onlyiftheofferorrepresenteditselfasaWOSBconcerneligibleundertheWOSBProgramin
(c)(6)ofthisprovision.]Theofferorrepresentsthat—
(i)It[_]is,[_]isnotanEDWOSBconcern,hasprovidedalltherequireddocumentstothe
WOSBRepository,andnochangeincircumstancesoradversedecisionshavebeenissued
thataffectsitseligibility;and
(ii)It[_]is,[_]isnotajointventurethatcomplieswiththerequirementsof13CFRpart
127,andtherepresentationinparagraph(c)(7)(i)ofthisprovisionisaccurateforeach
EDWOSBconcernparticipatinginthejointventure.[Theofferorshallenterthenameor
namesoftheEDWOSBconcernandothersmallbusinessesthatareparticipatinginthe
jointventure:_____________.]EachEDWOSBconcernparticipatinginthejointventureshall
submitaseparatesignedcopyoftheEDWOSBrepresentation.
(8)Women‐ownedbusinessconcern(otherthansmallbusinessconcern).[Completeonlyifthe
offerorisawomen‐ownedbusinessconcernanddidnotrepresentitselfasasmallbusiness
concerninparagraph(c)(1)ofthisprovision.]Theofferorrepresentsthatit[_]is,awomen‐
ownedbusinessconcern.
(9)Tiebidpriorityforlaborsurplusareaconcerns.Ifthisisaninvitationforbid,smallbusiness
offerorsmayidentifythelaborsurplusareasinwhichcoststobeincurredonaccountof
manufacturingorproduction(byofferororfirst‐tiersubcontractors)amounttomorethan50
percentofthecontractprice:
(10)HUBZonesmallbusinessconcern.[Completeonlyiftheofferorrepresenteditselfasasmall
businessconcerninparagraph(c)(1)ofthisprovision.]Theofferorrepresents,aspartofitsoffer,

that‐‐

(i)It[_]is,[_]isnotaHUBZonesmallbusinessconcernlisted,onthedateofthis
representation,ontheListofQualifiedHUBZoneSmallBusinessConcernsmaintainedby
theSmallBusinessAdministration,andnomaterialchangesinownershipandcontrol,
principaloffice,orHUBZoneemployeepercentagehaveoccurredsinceitwascertifiedin
accordancewith13CFRpart126;and
(ii)It[_]is,[_]isnotaHUBZonejointventurethatcomplieswiththerequirementsof13
CFRpart126,andtherepresentationinparagraph(c)(10)(i)ofthisprovisionisaccurate
foreachHUBZonesmallbusinessconcernparticipatingintheHUBZonejointventure.[The
offerorshallenterthenamesofeachoftheHUBZonesmallbusinessconcernsparticipatingin
theHUBZonejointventure:__________.]EachHUBZonesmallbusinessconcernparticipating
intheHUBZonejointventureshallsubmitaseparatesignedcopyoftheHUBZone

representation.

(d) Representations required to implement provisions of Executive Order 11246 ‐‐

(1) Previous contracts and compliance. The offeror represents that ‐‐

(i)It[_]has,[_]hasnot,participatedinapreviouscontractorsubcontractsubjecttothe
EqualOpportunityclauseofthissolicitation;and

(ii) It [_] has, [_] has not, filed all required compliance reports.

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

(i)It[_]hasdevelopedandhasonfile,[_]hasnotdevelopedanddoesnothaveonfile,at
eachestablishment,affirmativeactionprogramsrequiredbyrulesandregulationsofthe
SecretaryofLabor(41CFRparts60‐1and60‐2),or
(ii)It[_]hasnotpreviouslyhadcontractssubjecttothewrittenaffirmativeaction
programsrequirementoftherulesandregulationsoftheSecretaryofLabor.
(e)CertificationRegardingPaymentstoInfluenceFederalTransactions(31U.S.C.1352).(Appliesonlyif
thecontractisexpectedtoexceed$150,000.)Bysubmissionofitsoffer,theofferorcertifiestothebestof
itsknowledgeandbeliefthatnoFederalappropriatedfundshavebeenpaidorwillbepaidtoanyperson
forinfluencingorattemptingtoinfluenceanofficeroremployeeofanyagency,aMemberofCongress,an
officeroremployeeofCongressoranemployeeofaMemberofCongressonhisorherbehalfin
connectionwiththeawardofanyresultantcontract.IfanyregistrantsundertheLobbyingDisclosureAct
of1995havemadealobbyingcontactonbehalfoftheofferorwithrespecttothiscontract,theofferor
shallcompleteandsubmit,withitsoffer,OMBStandardFormLLL,DisclosureofLobbyingActivities,to
providethenameoftheregistrants.Theofferorneednotreportregularlyemployedofficersor
employeesoftheofferortowhompaymentsofreasonablecompensationweremade.
(f)BuyAmericanCertificate.(AppliesonlyiftheclauseatFederalAcquisitionRegulation(FAR)52.225‐1,
BuyAmerican–Supplies,isincludedinthissolicitation.)
(1)Theofferorcertifiesthateachendproduct,exceptthoselistedinparagraph(f)(2)ofthis
provision,isadomesticendproductandthatforotherthanCOTSitems,theofferorhas
consideredcomponentsofunknownorigintohavebeenmined,produced,ormanufactured
outsidetheUnitedStates.Theofferorshalllistasforeignendproductsthoseendproducts
manufacturedintheUnitedStatesthatdonotqualifyasdomesticendproducts,i.e.,anend
productthatisnotaCOTSitemanddoesnotmeetthecomponenttestinparagraph(2)ofthe
definitionof“domesticendproduct.”Theterms“commerciallyavailableoff‐the‐shelf(COTS)
item,”“component,”“domesticendproduct,”“endproduct,”“foreignendproduct,”and“United
States”aredefinedintheclauseofthissolicitationentitled“BuyAmerican—Supplies.”

(2) Foreign End Products:

LINE ITEM NO. COUNTRY OF ORIGIN

[List as necessary]

(3)TheGovernmentwillevaluateoffersinaccordancewiththepoliciesandproceduresofFAR
Part25.

(g)

(1)BuyAmerican‐‐FreeTradeAgreements‐‐IsraeliTradeActCertificate.(Appliesonlyifthe
clauseatFAR52.225‐3,BuyAmerican‐‐FreeTradeAgreements‐‐IsraeliTradeAct,isincludedin
thissolicitation.)
(i)Theofferorcertifiesthateachendproduct,exceptthoselistedinparagraph(g)(1)(ii)or
(g)(1)(iii)ofthisprovision,isadomesticendproductandthatforotherthanCOTSitems,
theofferorhasconsideredcomponentsofunknownorigintohavebeenmined,produced,
ormanufacturedoutsidetheUnitedStates.Theterms“Bahrainian,Moroccan,Omani,
Panamanian,orPeruvianendproduct,”“commerciallyavailableoff‐the‐shelf(COTS)item,”
“component,”“domesticendproduct,”“endproduct,”“foreignendproduct,”“FreeTrade
Agreementcountry,”“FreeTradeAgreementcountryendproduct,”“Israeliendproduct,”
and“UnitedStates”aredefinedintheclauseofthissolicitationentitled“BuyAmerican‐‐
FreeTradeAgreements‐‐IsraeliTradeAct.”
(ii)TheofferorcertifiesthatthefollowingsuppliesareFreeTradeAgreementcountryend
products(otherthanBahrainian,Moroccan,Omani,Panamanian,orPeruvianend
products)orIsraeliendproductsasdefinedintheclauseofthissolicitationentitled“Buy
American—FreeTradeAgreements—IsraeliTradeAct”:
FreeTradeAgreementCountryEndProducts(OtherthanBahrainian,Moroccan,Omani,Panamanian,or
PeruvianEndProducts)orIsraeliEndProducts:

LINE ITEM NO. COUNTRY OF ORIGIN

[List as necessary]

(iii) Theofferorshalllistthosesuppliesthatareforeignendproducts(otherthanthose
listedinparagraph(g)(1)(ii)orthisprovision)asdefinedintheclauseofthissolicitation
entitled“BuyAmerican—FreeTradeAgreements—IsraeliTradeAct.”Theofferorshalllist
asotherforeignendproductsthoseendproductsmanufacturedintheUnitedStatesthat
donotqualifyasdomesticendproducts,i.e.,anendproductthatisnotaCOTSitemand
doesnotmeetthecomponenttestinparagraph(2)ofthedefinitionof“domesticend

product.”

Other Foreign End Products:

LINE ITEM NO. COUNTRY OF ORIGIN

[List as necessary]

(iv) TheGovernmentwillevaluateoffersinaccordancewiththepoliciesandproceduresof
FARPart25.
(2) BuyAmerican—FreeTradeAgreements—IsraeliTradeActCertificate,AlternateI.IfAlternateI
totheclauseatFAR52.225‐3isincludedinthissolicitation,substitutethefollowingparagraph
(g)(1)(ii)forparagraph(g)(1)(ii)ofthebasicprovision:
(g)(1)(ii)TheofferorcertifiesthatthefollowingsuppliesareCanadianendproducts
asdefinedintheclauseofthissolicitationentitled“BuyAmerican—FreeTrade
Agreements—IsraeliTradeAct”:

Canadian End Products:

Line Item No.:

[List as necessary]

(3) BuyAmerican—FreeTradeAgreements—IsraeliTradeActCertificate,AlternateII.IfAlternateII
totheclauseatFAR52.225‐3isincludedinthissolicitation,substitutethefollowingparagraph
(g)(1)(ii)forparagraph(g)(1)(ii)ofthebasicprovision:
(g)(1)(ii)TheofferorcertifiesthatthefollowingsuppliesareCanadianendproducts
orIsraeliendproductsasdefinedintheclauseofthissolicitationentitled“Buy
American‐‐FreeTradeAgreements‐‐IsraeliTradeAct'':

Canadian or Israeli End Products:

Line Item No.: Country of Origin:

[List as necessary]

(4)BuyAmerican—FreeTradeAgreements—IsraeliTradeActCertificate,AlternateIII.IfAlternate
IIItotheclauseat52.225‐3isincludedinthissolicitation,substitutethefollowingparagraph
(g)(1)(ii)forparagraph(g)(1)(ii)ofthebasicprovision:
(g)(1)(ii)TheofferorcertifiesthatthefollowingsuppliesareFreeTradeAgreement
countryendproducts(otherthanBahrainian,Korean,Moroccan,Omani,
Panamanian,orPeruvianendproducts)orIsraeliendproductsasdefinedinthe
clauseofthissolicitationentitled“BuyAmerican—FreeTradeAgreements—Israeli
TradeAct”:
FreeTradeAgreementCountryEndProducts(OtherthanBahrainian,Korean,Moroccan,Omani,
Panamanian,orPeruvianEndProducts)orIsraeliEndProducts:

Line Item No.: Country of Origin:

[List as necessary]

(5)TradeAgreementsCertificate.(AppliesonlyiftheclauseatFAR52.225‐5,TradeAgreements,is
includedinthissolicitation.)
(i)Theofferorcertifiesthateachendproduct,exceptthoselistedinparagraph(g)(5)(ii)of
thisprovision,isaU.S.‐madeordesignatedcountryendproductasdefinedintheclauseof
thissolicitationentitled“TradeAgreements.”
(ii)TheofferorshalllistasotherendproductsthoseendproductsthatarenotU.S.‐madeor
designatedcountryendproducts.

Other End Products

Line Item No.: Country of Origin:

[List as necessary]

(iii)TheGovernmentwillevaluateoffersinaccordancewiththepoliciesandproceduresof
FARPart25.ForlineitemscoveredbytheWTOGPA,theGovernmentwillevaluateoffers
ofU.S.‐madeordesignatedcountryendproductswithoutregardtotherestrictionsofthe
BuyAmericanstatute.TheGovernmentwillconsiderforawardonlyoffersofU.S.‐madeor
designatedcountryendproductsunlesstheContractingOfficerdeterminesthatthereare
nooffersforsuchproductsorthattheoffersforsuchproductsareinsufficienttofulfillthe
requirementsofthesolicitation.
(h)CertificationRegardingResponsibilityMatters(ExecutiveOrder12689).(Appliesonlyifthecontract
valueisexpectedtoexceedthesimplifiedacquisitionthreshold.)Theofferorcertifies,tothebestofits
knowledgeandbelief,thattheofferorand/oranyofitsprincipals‐‐
(1)[_]Are,[_]arenotpresentlydebarred,suspended,proposedfordebarment,ordeclared
ineligiblefortheawardofcontractsbyanyFederalagency;
(2)[_]Have,[_]havenot,withinathree‐yearperiodprecedingthisoffer,beenconvictedoforhad
aciviljudgmentrenderedagainstthemfor:commissionoffraudoracriminaloffensein
connectionwithobtaining,attemptingtoobtain,orperformingaFederal,stateorlocal
governmentcontractorsubcontract;violationofFederalorstateantitruststatutesrelatingtothe
submissionofoffers;orcommissionofembezzlement,theft,forgery,bribery,falsificationor
destructionofrecords,makingfalsestatements,taxevasion,violatingFederalcriminaltaxlaws,or
receivingstolenproperty;and
(3)[_]Are,[_]arenotpresentlyindictedfor,orotherwisecriminallyorcivillychargedbya
Governmententitywith,commissionofanyoftheseoffensesenumeratedinparagraph(h)(2)of
thisclause;and
(4)[_]Have,[_]havenot,withinathree‐yearperiodprecedingthisoffer,beennotifiedofany
delinquentFederaltaxesinanamountthatexceeds$3,500forwhichtheliabilityremains

unsatisfied.

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

(A)Thetaxliabilityisfinallydetermined.Theliabilityisfinallydeterminedifithas
beenassessed.Aliabilityisnotfinallydeterminedifthereisapending
administrativeorjudicialchallenge.Inthecaseofajudicialchallengetotheliability,
theliabilityisnotfinallydetermineduntilalljudicialappealrightshavebeen

exhausted.

(B)Thetaxpayerisdelinquentinmakingpayment.Ataxpayerisdelinquentifthe
taxpayerhasfailedtopaythetaxliabilitywhenfullpaymentwasdueandrequired.
Ataxpayerisnotdelinquentincaseswhereenforcedcollectionactionisprecluded.

(ii) Examples.

(A)Thetaxpayerhasreceivedastatutorynoticeofdeficiency,underI.R.C.§6212,
whichentitlesthetaxpayertoseekTaxCourtreviewofaproposedtaxdeficiency.
Thisisnotadelinquenttaxbecauseitisnotafinaltaxliability.Shouldthetaxpayer
seekTaxCourtreview,thiswillnotbeafinaltaxliabilityuntilthetaxpayerhas
exercisedalljudicialappearrights.
(B)TheIRShasfiledanoticeofFederaltaxlienwithrespecttoanassessedtax
liability,andthetaxpayerhasbeenissuedanoticeunderI.R.C.§6320entitlingthe
taxpayertorequestahearingwiththeIRSOfficeofAppealsContestingthelien
filing,andtofurtherappealtotheTaxCourtiftheIRSdeterminestosustainthelien
filing.Inthecourseofthehearing,thetaxpayerisentitledtocontesttheunderlying
taxliabilitybecausethetaxpayerhashadnoprioropportunitytocontestthe
liability.Thisisnotadelinquenttaxbecauseitisnotafinaltaxliability.Shouldthe
taxpayerseektaxcourtreview,thiswillnotbeafinaltaxliabilityuntilthetaxpayer
hasexercisedalljudicialappealrights.
(C)ThetaxpayerhasenteredintoaninstallmentagreementpursuanttoI.R.C.
§6159.Thetaxpayerismakingtimelypaymentsandisinfullcompliancewiththe
agreementterms.Thetaxpayerisnotdelinquentbecausethetaxpayerisnot
currentlyrequiredtomakefullpayment.
(D)Thetaxpayerhasfiledforbankruptcyprotection.Thetaxpayerisnotdelinquent
becauseenforcedcollectionactionisstayedunder11U.S.C.§362(theBankruptcy

Code).

(i)CertificationRegardingKnowledgeofChildLaborforListedEndProducts(ExecutiveOrder13126).
[TheContractingOfficermustlistinparagraph(i)(1)anyendproductsbeingacquiredunderthis
solicitationthatareincludedintheListofProductsRequiringContractorCertificationastoForcedor
IndenturedChildLabor,unlessexcludedat22.1503(b).]

(1) Listed End Product

Listed End Product: Listed Countries of Origin:

(2)Certification.[IftheContractingOfficerhasidentifiedendproductsandcountriesoforiginin
paragraph(i)(1)ofthisprovision,thentheofferormustcertifytoeither(i)(2)(i)or(i)(2)(ii)by
checkingtheappropriateblock.]
[_](i)Theofferorwillnotsupplyanyendproductlistedinparagraph(i)(1)ofthis
provisionthatwasmined,produced,ormanufacturedinthecorrespondingcountryas
listedforthatproduct.
[_](ii)Theofferormaysupplyanendproductlistedinparagraph(i)(1)ofthisprovision
thatwasmined,produced,ormanufacturedinthecorrespondingcountryaslistedforthat
product.Theofferorcertifiesthatishasmadeagoodfaithefforttodeterminewhether
forcedorindenturedchildlaborwasusedtomine,produce,ormanufactureanysuchend
productfurnishedunderthiscontract.Onthebasisofthoseefforts,theofferorcertifiesthat
itisnotawareofanysuchuseofchildlabor.
(j)Placeofmanufacture.(Doesnotapplyunlessthesolicitationispredominantlyfortheacquisitionof
manufacturedendproducts.)Forstatisticalpurposesonly,theofferorshallindicatewhethertheplaceof
manufactureoftheendproductsitexpectstoprovideinresponsetothissolicitationispredominantly—
(1)[_]IntheUnitedStates(Checkthisboxifthetotalanticipatedpriceofofferedendproducts
manufacturedintheUnitedStatesexceedsthetotalanticipatedpriceofofferedendproducts
manufacturedoutsidetheUnitedStates);or

(2) [_] Outside the United States.

(k)CertificatesregardingexemptionsfromtheapplicationoftheServiceContractLaborStandards.
(Certificationbytheofferorastoitscompliancewithrespecttothecontractalsoconstitutesits
certificationastocompliancebyitssubcontractorifitsubcontractsouttheexemptservices.)[The
contractingofficeristocheckaboxtoindicateifparagraph(k)(1)or(k)(2)applies.]
(1)[_]Maintenance,calibration,orrepairofcertainequipmentasdescribedinFAR22.1003‐
4(c)(1).Theofferor[_]does[_]doesnotcertifythat—
(i)Theitemsofequipmenttobeservicedunderthiscontractareusedregularlyforother
thanGovernmentalpurposesandaresoldortradedbytheofferor(orsubcontractorinthe
caseofanexemptsubcontract)insubstantialquantitiestothegeneralpublicinthecourse
ofnormalbusinessoperations;
(ii)Theserviceswillbefurnishedatpriceswhichare,orarebasedon,establishedcatalog
ormarketprices(seeFAR22.1003‐4(c)(2)(ii))forthemaintenance,calibration,orrepair
ofsuchequipment;and
(iii)Thecompensation(wageandfringebenefits)planforallserviceemployees
performingworkunderthecontractwillbethesameasthatusedfortheseemployeesand
equivalentemployeesservicingthesameequipmentofcommercialcustomers.
(2)[_]CertainservicesasdescribedinFAR22.1003‐4(d)(1).Theofferor[_]does[_]doesnot
certifythat—
(i)Theservicesunderthecontractareofferedandsoldregularlytonon‐Governmental
customers,andareprovidedbytheofferor(orsubcontractorinthecaseofanexempt
subcontract)tothegeneralpublicinsubstantialquantitiesinthecourseofnormalbusiness

operations;

(ii)Thecontractserviceswillbefurnishedatpricesthatare,orarebasedon,established
catalogormarketprices(seeFAR22.1003‐4(d)(2)(iii));
(iii)Eachserviceemployeewhowillperformtheservicesunderthecontractwillspend
onlyasmallportionofhisorhertime(amonthlyaverageoflessthan20percentofthe
availablehoursonanannualizedbasis,orlessthan20percentofavailablehoursduring
thecontractperiodifthecontractperiodislessthanamonth)servicingtheGovernment
contract;and
(iv)Thecompensation(wageandfringebenefits)planforallserviceemployees
performingworkunderthecontractisthesameasthatusedfortheseemployeesand
equivalentemployeesservicingcommercialcustomers.

(3) If paragraph (k)(1) or (k)(2) of this clause applies—

(i)Iftheofferordoesnotcertifytotheconditionsinparagraph(k)(1)or(k)(2)andthe
ContractingOfficerdidnotattachaServiceContractLaborStandardswagedetermination
tothesolicitation,theofferorshallnotifytheContractingOfficerassoonaspossible;and
(ii)TheContractingOfficermaynotmakeanawardtotheofferoriftheofferorfailsto
executethecertificationinparagraph(k)(1)or(k)(2)ofthisclauseortocontactthe
ContractingOfficerasrequiredinparagraph(k)(3)(i)ofthisclause.
(l)Taxpayeridentificationnumber(TIN)(26U.S.C.6109,31U.S.C.7701).(Notapplicableiftheofferoris
requiredtoprovidethisinformationtotheSAMdatabasetobeeligibleforaward.)
(1)Allofferorsmustsubmittheinformationrequiredinparagraphs(l)(3)through(l)(5)ofthis
provisiontocomplywithdebtcollectionrequirementsof31U.S.C.7701(c)and3325(d),reporting
requirementsof26U.S.C.6041,6041A,and6050M,andimplementingregulationsissuedbythe
InternalRevenueService(IRS).
(2)TheTINmaybeusedbythegovernmenttocollectandreportonanydelinquentamounts
arisingoutoftheofferor’srelationshipwiththeGovernment(31U.S.C.7701(c)(3)).Ifthe
resultingcontractissubjecttothepaymentreportingrequirementsdescribedinFAR4.904,the
TINprovidedhereundermaybematchedwithIRSrecordstoverifytheaccuracyoftheofferor’s

TIN.

(3) Taxpayer Identification Number (TIN).

[_] TIN:_____________________.

[_] TIN has been applied for.

[_] TIN is not required because:

[_]Offerorisanonresidentalien,foreigncorporation,orforeignpartnershipthatdoesnot
haveincomeeffectivelyconnectedwiththeconductofatradeorbusinessintheUnited
StatesanddoesnothaveanofficeorplaceofbusinessorafiscalpayingagentintheUnited

States;

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

[_] Offeror is an agency or instrumentality of the Federal Government;

(4) Type of organization.

[_] Sole proprietorship;

[_] Partnership;

[_] Corporate entity (not tax‐exempt);

[_] Corporate entity (tax‐exempt);

[_] Government entity (Federal, State, or local);

[_] Foreign government;

[_] International organization per 26 CFR 1.6049‐4;

[_] Other ____________________.

(5) Common parent.

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

[_] Name and TIN of common parent:

Name ____________________________________

TIN ______________________________________

(m) RestrictedbusinessoperationsinSudan.Bysubmissionofitsoffer,theofferorcertifiesthattheofferor
doesnotconductanyrestrictedbusinessoperationsinSudan.

(n) Prohibition on Contracting with Inverted Domestic Corporations—

(1) Governmentagenciesarenotpermittedtouseappropriated(orotherwisemadeavailable)
fundsforcontractswitheitheraninverteddomesticcorporation,orasubsidiaryofaninverted
domesticcorporation,unlesstheexceptionat9.108‐2(b)appliesortherequirementiswaivedin
accordancewiththeproceduresat9.108‐4.

(2) Representation. The offeror represents that—

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

(ii) It [ ] is, [ ] is not a…

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