Attachment_2_-_Contractor_Submittal_Form.pdf

Attachment 2 Contractor Submittal Form

FA2517-17-Q-5023

PAFB Chemical Water Treatment

Offeror to complete the following:

1 Contractor Name 2 DUNS Number 3 CAGE Code 4 NAICS Code (Offeror must be registered in SAM under NAICS 238220 in order to be considered responsive)

5 Point of Contact 6 Address

7 Phone Number 8 Email address 9 Payment Terms (Net 30 unless any discount terms are offered)

10 [Contractor Name]: Takes no Exception to the PWS and Attachments

Takes Exception to the PWS and Attachments

Period of Performance:

16 Sept 2017 to 15 Sept 2018

PRICING SHEET

CLIN SERVICE UNIT OF

ISSUE

QUANTITY UNIT

PRICE

TOTAL PRICE

0001 Heated & Chilled Closed Loop Water Systems

Semi- Annually

0002 Clean & Passivate Closed Loop Systems Bldgs. 1013, 1143, 121, 910

Annually 1

0003 Open Loop Condenser Water Systems Monthly 12

0004 Bldg 1470 Cooling Tower Annually 1

0005 Water Treatment Training Semi-

TOTAL PRICE $

Please complete the following:

FAR 52.212-3 -- Offeror Representations and Certifications -- Commercial Items ( Jan 2017)

**Note to Offerors: Please reference http://farsite.hill.af.mil/vffara.htm for full text of this provision.

The offeror shall complete only paragraphs (b) of this provision if the Offeror has completed the annual representations and certification electronically via the System for Award Management (SAM) Web site accessed through http://www.sam.gov/portal. If the Offeror has not completed the annual representations and certifications electronically, the Offeror shall complete only paragraphs (c) through (u) of this provision.

(b)

(1) Annual Representations and Certifications. Any changes provided by the offeror in paragraph (b)(2) of this provision do not automatically change the representations and certifications posted on the SAMwebsite.

(2) The offeror has completed the annual representations and certifications electronically via the SAM website accessed through https://www.acquisition.gov. After reviewing the SAM database information, the offeror verifies by submission of this offer that the representation and certifications currently posted electronically at FAR 52.212-3, Offeror Representations and Certifications—Commercial Items, have been

Option to Extend Services Six Months:

16 Sept 2018 to 15 Mar 2019

PRICING SHEET

CLIN SERVICE UNIT OF

ISSUE

QUANTITY UNIT

PRICE

TOTAL PRICE

1001 Heated & Chilled Closed Loop Water Systems

Semi-

1002 Clean & Passivate Closed Loop Systems Bldgs. 1013, 1143, 121, 910

Annually 0

1003 Open Loop Condenser Water Systems Monthly 6

1004 Bldg 1470 Cooling Tower Annually 0

1005 Water Treatment Training Semi- Annually

TOTAL PRICE $

http://farsite.hill.af.mil/vffara.htm http://www.sam.gov/portal https://www.acquisition.gov/ 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), as of the date of this offer and are incorporated in this offer by reference (see FAR 4.1201), except for paragraphs ____________.

[Offeror to identify the applicable paragraphs at (c) through (u) of this provision that the offeror has completed for the purposes of this solicitation only, if any. These amended representation(s) and/or certification(s) are also incorporated in this offer and are current, accurate, and complete as of the 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.]

(End of Provision)

FAR 52.204-20 – Predecssor of Offeror (July 2016)

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

“Commercial and Government Entity (CAGE) code” means--

(1) An identifier assigned to entities located in the United States and its outlying areas by the Defense Logistics Agency (DLA) Contractor and Government Entity (CAGE) Branch to identify a commercial or government entity, or

(2) An identifier assigned by a member of the North Atlantic Treaty Organization (NATO) or by the NATO Support and Procurement Agency (NSPA) to entities located outside the United States and its outlying areas that DLA Commercial and Government Entity (CAGE) Branch records and maintains in the CAGE master file. This type of code is known as a NATO CAGE (NCAGE) code.

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

“Successor” means an entity that has replaced a predecessor by acquiring the assets and carrying out the affairs of the predecessor under a new name (often through acquisition or merger). The term “successor” does not include new offices/divisions of the same company that only changes its name. The extent of the responsibility of the successor for the liabilities of the predecessor may vary, depending on State law and specific circumstances.

(b) The Offeror represents that it [ ] is or [ ] is not a successor to a predecessor that held a Federal contract or grant within the last three years.

(c) If the Offeror has indicated “is” in paragraph (b) of this provision, enter the following information for all predecessors that held a Federal contract or grant within the last three years (if more than one predecessor, list in reverse chronological order):

Predecessor CAGE code: ________ (or mark “Unknown”).

Predecessor legal name: ______________________________.

(Do not use a “doing business as” name).

(End of provision)

FAR 52.222-22 – Previous Contracts and Compliance Reports (Feb 1999)

The offeror represents that --

(a) It * has, * has not participated in a previous contract or subcontract subject to the Equal Opportunity clause of this solicitation;

(b) It * has, * has not filed all required compliance reports; and

(c) Representations indicating submission of required compliance reports, signed by proposed subcontractors, will be obtained before subcontract awards.

(End of Provision)

Offeror to complete the following:

DFARS 252.209-7999, Representation by Corporations Regarding an Unpaid Delinquent Tax Liability or a Felony Conviction under any Federal Law (Class Deviation 2012-O0004) (January 23, 2012)

(a) In accordance with sections 8124 and 8125 of Division A of the Consolidated Appropriations Act, 2012, (Pub. L. 112-74), 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 this 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 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 an 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 24 months.

(End of provision)

Company Name

Name

Title

Signature Date