Solicitation_FA3010-14-R-0003_Packing_and_Crating_Area_II_and_III.doc

Section SF 1449 - CONTINUATION SHEET

Mississippi Service - Schedule I

FFP

Packing and Crating-Schedule I - Outbound Service

POP 03/01/2014 - 12/31/2014

FOB: Destination

NSN: V003-00-000-0000

PURCHASE REQUEST NUMBER: F2J3T13346AM02

SIGNAL CODE: A

NET AMT

0001AA

Outbound - Area II

Schedule I, Area II

IAW the attached Performance Work Statement, Attachment 1 - dated 12/02/2013 and Exhibit AA.

FOB: Destination

NSN: V003-00-000-0000

NET AMT

0001AB

Outbound - Area III

Schedule I, Area III

IAW the attached Performance Work Statement, Attachment 1 - dated 12/02/2013 and Exhibit AA.

FOB: Destination

NSN: V003-00-000-0000

NET AMT

Mississippi Service - Schedule II

Packing and Crating-Schedule II - Inbound

POP 03/01/2014 - 12/31/2014

FOB: Destination

NSN: V003-00-000-0000

NET AMT

0002AA

Inbound - Area II

Schedule II, Area II

IAW the attached Performance Work Statement, Attachment 1 - dated 12/02/2013 and Exhibit AA.

FOB: Destination

NSN: V003-00-000-0000

NET AMT

0002AB

Inbound - Area III

Schedule II, Area III

IAW the attached Performance Work Statement, Attachment 1 - dated 12/02/2013 and Exhibit AA.

FOB: Destination

NSN: V003-00-000-0000

NET AMT

Mississippi Service - Schedule III

Packing and Crating-Schedule III - IntraCity

POP 03/01/2014 - 12/31/2014

FOB: Destination

NSN: V003-00-000-0000

NET AMT

0003AA

IntraCity - Area II

Schedule III, Area II

IAW the attached Performance Work Statement, Attachment 1 - dated 12/02/2013 and Exhibit AA.

FOB: Destination

NSN: V003-00-000-0000

NET AMT

0003AB

IntraCity - Area III

Schedule III, Area III

IAW the attached Performance Work Statement, Attachment 1 - dated 12/02/2013 and Exhibit AA.

FOB: Destination

NSN: V003-00-000-0000

NET AMT

Mississippi Service - Schedule I

Packing and Crating-Schedule I - Outbound Service

POP 01/01/2015 - 12/31/2015

FOB: Destination

NSN: V003-00-000-0000

NET AMT

1001AA

Outbound - Area II

Schedule I, Area II

IAW the attached Performance Work Statement, Attachment 1 - dated 12/02/2013 and Exhibit AB.

FOB: Destination

NSN: V003-00-000-0000

NET AMT

1001AB

Outbound - Area III

Schedule I, Area III

IAW the attached Performance Work Statement, Attachment 1 - dated 12/02/2013 and Exhibit AB.

FOB: Destination

NSN: V003-00-000-0000

NET AMT

Mississippi Service - Schedule II

Packing and Crating-Schedule II - Inbound

POP 01/01/2015 - 12/31/2015

FOB: Destination

NSN: V003-00-000-0000

NET AMT

1002AA

Inbound - Area II

Schedule II, Area II

IAW the attached Performance Work Statement, Attachment 1 - dated 12/02/2013 and Exhibit AB.

FOB: Destination

NSN: V003-00-000-0000

NET AMT

1002AB

Inbound - Area III

Schedule II, Area III

IAW the attached Performance Work Statement, Attachment 1 - dated 12/02/2013 and Exhibit AB.

FOB: Destination

NSN: V003-00-000-0000

NET AMT

Mississippi Service - Schedule III

Packing and Crating-Schedule III - IntraCity

POP 01/01/2015 - 12/31/2015

FOB: Destination

NSN: V003-00-000-0000

NET AMT

1003AA

IntraCity - Area II

Schedule III, Area II

IAW the attached Performance Work Statement, Attachment 1 - dated 12/02/2013 and Exhibit AB.

FOB: Destination

NSN: V003-00-000-0000

NET AMT

1003AB

IntraCity - Area III

Schedule III, Area III

IAW the attached Performance Work Statement, Attachment 1 - dated 12/02/2013 and Exhibit AB.

FOB: Destination

NSN: V003-00-000-0000

NET AMT

Mississippi Service - Schedule I

Packing and Crating-Schedule I - Outbound Service

POP 01/01/2016 - 12/31/2016

FOB: Destination

NSN: V003-00-000-0000

NET AMT

2001AA

Outbound - Area II

Schedule I, Area II

IAW the attached Performance Work Statement, Attachment 1 - dated 12/02/2013 and Exhibit AC.

FOB: Destination

NSN: V003-00-000-0000

NET AMT

2001AB

Outbound - Area III

Schedule I, Area III

IAW the attached Performance Work Statement, Attachment 1 - dated 12/02/2013 and Exhibit AC.

FOB: Destination

NSN: V003-00-000-0000

NET AMT

Mississippi Service - Schedule II

Packing and Crating-Schedule II - Inbound

POP 01/01/2016 - 12/31/2016

FOB: Destination

NSN: V003-00-000-0000

NET AMT

2002AA

Inbound - Area II

Schedule II, Area II

IAW the attached Performance Work Statement, Attachment 1 - dated 12/02/2013 and Exhibit AC.

FOB: Destination

NSN: V003-00-000-0000

NET AMT

2002AB

Inbound - Area III

Schedule II, Area III

IAW the attached Performance Work Statement, Attachment 1 - dated 12/02/2013 and Exhibit AC.

FOB: Destination

NSN: V003-00-000-0000

NET AMT

Mississippi Service - Schedule III

Packing and Crating-Schedule III - IntraCity

POP 01/01/2016 - 12/31/2016

FOB: Destination

NSN: V003-00-000-0000

NET AMT

2003AA

IntraCity - Area II

Schedule III, Area II

IAW the attached Performance Work Statement, Attachment 1 - dated 12/02/2013 and Exhibit AC.

FOB: Destination

NSN: V003-00-000-0000

NET AMT

2003AB

IntraCity - Area III

Schedule III, Area III

IAW the attached Performance Work Statement, Attachment 1 - dated 12/02/2013 and Exhibit AC.

FOB: Destination

NSN: V003-00-000-0000

NET AMT

Mississippi Service - Schedule I

Packing and Crating-Schedule I - Outbound Service

POP 01/01/2016 - 12/31/2016

FOB: Destination

NSN: V003-00-000-0000

NET AMT

3001AA

Outbound - Area II

Schedule I, Area II

IAW the attached Performance Work Statement, Attachment 1 - dated 12/02/2013 and Exhibit AD.

FOB: Destination

NSN: V003-00-000-0000

NET AMT

3001AB

Outbound - Area III

Schedule I, Area III

IAW the attached Performance Work Statement, Attachment 1 - dated 12/02/2013 and Exhibit AD.

FOB: Destination

NSN: V003-00-000-0000

NET AMT

Mississippi Service - Schedule II

Packing and Crating-Schedule II - Inbound

POP 01/01/2017 - 12/31/2017

FOB: Destination

NSN: V003-00-000-0000

NET AMT

3002AA

Inbound - Area II

Schedule II, Area II

IAW the attached Performance Work Statement, Attachment 1 - dated 12/02/2013 and Exhibit AD.

FOB: Destination

NSN: V003-00-000-0000

NET AMT

3002AB

Inbound - Area III

Schedule II, Area III

IAW the attached Performance Work Statement, Attachment 1 - dated 12/02/2013 and Exhibit AD.

FOB: Destination

NSN: V003-00-000-0000

NET AMT

Mississippi Service - Schedule III

Packing and Crating-Schedule III - IntraCity

POP 01/01/2017 - 12/31/2017

FOB: Destination

NSN: V003-00-000-0000

NET AMT

3003AA

IntraCity - Area II

Schedule III, Area II

IAW the attached Performance Work Statement, Attachment 1 - dated 12/02/2013 and Exhibit AD.

FOB: Destination

NSN: V003-00-000-0000

NET AMT

3003AB

IntraCity - Area II

Schedule III, Area III

IAW the attached Performance Work Statement, Attachment 1 - dated 12/02/2013 and Exhibit AD.

FOB: Destination

NSN: V003-00-000-0000

NET AMT

INSPECTION AND ACCEPTANCE TERMS

Supplies/services will be inspected/accepted at:

DELIVERY INFORMATION

31-DEC-2014

JOHN IDLEMAN

627 PARADE LANE

KEESLER AFB MS 39534-2120

228-377-3645

FOB: Destination F2J3T1

31-DEC-2015

JOHN IDLEMAN

627 PARADE LANE

KEESLER AFB MS 39534-2120

228-377-3645

F2J3T1

31-DEC-2016

JOHN IDLEMAN

627 PARADE LANE

KEESLER AFB MS 39534-2120

228-377-3645

F2J3T1

31-DEC-2017

JOHN IDLEMAN

627 PARADE LANE

KEESLER AFB MS 39534-2120

228-377-3645

F2J3T1

CLAUSES INCORPORATED BY REFERENCE

CLAUSES INCORPORATED BY FULL TEXT

52.212-2 EVALUATION--COMMERCIAL ITEMS (JAN 1999)

(a) The Government will award a contract resulting from this solicitation to the responsible offeror whose offer conforming to the solicitation will be most advantageous to the Government, price and other factors considered. Offers will be evaluated by area which may result in multiple awards (award per area).

(b) Basis for Award. This is a competitive best value acquisition utilizing simplified procedures authorized by FAR 13.5, "Test Program for Certain Commercial Items." For proposals determined technically acceptable, a trade-off between price and past performance will be conducted. Past performance is significantly more important than price when being evaluated.

(c) Price. Initially, all technically acceptable offers shall be ranked according to total price per area. An offer will be determined technically acceptable if no exception is taken to the specifications and requirements listed in the Request for Proposal (RFP). The price evaluation will document the reasonableness and affordability of the proposed total evaluated price. Completion and submission of all Exhibits (Exhibit AA through Exhibit AD) is necessary in order to be considered for award. Only firm fixed-price offers will be evaluated. An offer using a sliding price scale or subject to escalation based on any contingency will not be accepted and will be considered nonconforming to this solicitation.

(d) Past performance. Past performance will be evaluated based on relevancy (size/scope/complexity), quality of product/service, timeliness of delivery/performance and business relations (customer service). Relevant performance includes performance of efforts involving packing and crating of household goods services that are similar or greater in scope, magnitude and complexity than the effort described in this solicitation. The contracting officer shall seek relevant performance information on all offerors based on (1) information obtained from the Contractor Performance Assessment Report (CPAR) system or (2) data independently obtained from other government and commercial sources. In addition, the offeror may be asked to submit references that can provide relevant past performance information if the contracting officer cannot locate CPAR information. The purpose of the past performance evaluation is to allow the government to assess the offeror’s ability to perform the effort described in this RFP, based on the offeror’s demonstrated present and past performance. The assessment process will result in an overall performance confidence assessment of Substantial Confidence, Satisfactory Confidence, Limited Confidence, No Confidence, or Unknown Confidence as defined below. Offerors with no relevant past or present performance history or the offeror’s performance record is so limited that no confidence assessment rating can be reasonably assigned shall receive the rating "Unknown Confidence," meaning the rating is treated neither favorably nor unfavorably.

(e) Past performance Ratings.

Substantial Confidence: Based on the offeror’s performance record, the government has a high expectation that the offeror will successfully perform the required effort.

Satisfactory Confidence: Based on the offeror’s performance record, the government has an expectation that the offeror will successfully perform the required effort.

Limited Confidence: Based on the offeror’s performance record, the government has a low expectation that the offeror will successfully perform the required effort.

No Confidence: Based on the offeror’s performance record, the government has no expectation that the offeror will be able to successfully perform the required effort.

Unknown Confidence: No performance record is identifiable or the offeror’s performance record is so limited that no confidence assessment rating can be reasonably assigned.

(f) Selection process. To be considered for award an offeror must have a satisfactory or better past performance record. In evaluating past performance, the government reserves the right to give greater consideration to information on those contracts deemed most relevant to the effort described in this solicitation.

If the lowest priced evaluated offer per area is judged to have a Substantial Confidence performance assessment, that offer represents the best value for the government and the evaluation process stops at this point. Award shall be made to that offeror without further consideration of any other offers for that area.

If the lowest priced offeror is not judged to have a Substantial Confidence performance confidence assessment, the next lowest priced offeror will be evaluated and the process will continue (in order by price) until an offeror is judged to have a Substantial Confidence performance confidence assessment or until all offerors are evaluated. The Contracting Officer shall then make an integrated assessment best value ward decision.

If an offeror submits offers for multiple areas and is the lowest offerer for one area, but; not for the other(s), award will only be made for the “lowest offer area.”

(g) Clarifications. Offerors may be asked to clarify certain aspects of their proposal and respond to adverse past performance information to which the offeror has not previously had an opportunity to respond. Adverse past performance is defined as past performance information that supports a less than satisfactory rating on any evaluation element or any unfavorable comments received from sources without a formal rating system. Communication conducted to resolve minor or clerical errors will not constitute discussions and the contracting officer reserves the right to award a contract without the opportunity for proposal revision.

(h) Award without Discussion. The government intends to award a contract without discussions with respective offerors. The government, however, reserves the right to conduct discussion if deemed in its best interest.

(i) Options. The Government will evaluate offers for award purposes by adding the total price for all options to the total price for the basic requirement. The Government may determine that an offer is unacceptable if the option prices are significantly unbalanced. Evaluation of options shall not obligate the Government to exercise the option(s).

(j) Notice of award. A written notice of award or acceptance of an offer, mailed or otherwise furnished to the successful offeror within the time for acceptance specified in the offer, shall result in a binding contract without further action by either party. Before the offer's specified expiration time, the Government may accept an offer (or part of an offer), whether or not there are negotiations after its receipt, unless a written notice of withdrawal is received before award.

(End of provision)

52.212-3 OFFEROR REPRESENTATIONS AND CERTIFICATIONS--COMMERCIAL ITEMS (NOV 2013) ALTERNATE I (APR 2011)

An offeror shall complete only paragraph (b) of this provision if the offeror has completed the annual representations and certifications electronically via http://www.acquisition.gov. If an offeror has not completed the annual representations and certifications electronically at the System for Award Management (SAM) website, the offeror shall complete only paragraphs (b) through (i) of this provision.

(a) Definitions. As used in this provision:

"Emerging small business" means a small business concern whose size is no greater than 50 percent of the numerical size standard for the NAICS code designated.

"Forced or indentured child labor" means all work or service-

(1) Exacted from any person under the age of 18 under the menace of any penalty for its nonperformance and for which the worker does not offer himself voluntarily; or

(2) Performed by any person under the age of 18 pursuant to a contract the enforcement of which can be accomplished by process or penalties.

Inverted domestic corporation, as used in this section, means a foreign incorporated entity which is treated as an inverted domestic corporation under 6 U.S.C. 395(b), i.e., a corporation that used to be incorporated in the United States, or used to be a partnership in the United States, but now is incorporated in a foreign country, or is a subsidiary whose parent corporation is incorporated in a foreign country, that meets the criteria specified in 6 U.S.C. 395(b), applied in accordance with the rules and definitions of 6 U.S.C. 395(c). An inverted domestic corporation as herein defined does not meet the definition of an inverted domestic corporation as defined by the Internal Revenue Code at 26 U.S.C. 7874.

“Manufactured end product” means any end product in Federal Supply Classes (FSC) 1000-9999, except—

(1) FSC 5510, Lumber and Related Basic Wood Materials;

(2) Federal Supply Group (FSG) 87, Agricultural Supplies;

(3) FSG 88, Live Animals;

(4) FSG 89, Food and Related Consumables;

(5) FSC 9410, Crude Grades of Plant Materials;

(6) FSC 9430, Miscellaneous Crude Animal Products, Inedible;

(7) FSC 9440, Miscellaneous Crude Agricultural and Forestry Products;

(8) FSC 9610, Ores;

(9) FSC 9620, Minerals, Natural and Synthetic; and

(10) FSC 9630, Additive Metal Materials.

“Place of manufacture” means the place where an end product is assembled out of components, or otherwise made or processed from raw materials into the finished product that is to be provided to the Government. If a product is disassembled and reassembled, the place of reassembly is not the place of manufacture.

Restricted business operations means business operations in Sudan that include power production activities, mineral extraction activities, oil-related activities, or the production of military equipment, as those terms are defined in the Sudan Accountability and Divestment Act of 2007 (Pub. L. 110-174). Restricted business operations do not include business operations that the person (as that term is defined in Section 2 of the Sudan Accountability and Divestment Act of 2007) conducting the business can demonstrate—

(1) Are conducted under contract directly and exclusively with the regional government of southern Sudan;

(2) Are conducted pursuant to specific authorization from the Office of Foreign Assets Control in the Department of the Treasury, or are expressly exempted under Federal law from the requirement to be conducted under such authorization;

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

(4) Consist of providing goods or services to an internationally recognized peacekeeping force or humanitarian organization;

(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) Means hardware, software, telecommunications equipment, or any other technology that is to be used specifically--

(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) Does not include information or informational materials the export of which the President does not have the authority to regulate or prohibit pursuant to section 203(b)(3) of the International Emergency Economic Powers Act (50 U.S.C. 1702(b)(3)).

Service-disabled veteran-owned small business concern—

(1) Means a small business concern--

(i) Not less than 51 percent of which is owned by one or more service-disabled veterans or, in the case of any publicly owned business, not less than 51 percent of the stock of which is owned by one or more service-disabled veterans; and

(ii) The management and daily business operations of which are controlled by one or more service-disabled veterans or, in the case of a service-disabled veteran with permanent and severe disability, the spouse or permanent caregiver of such veteran.

(2) Service-disabled veteran means a veteran, as defined in 38 U.S.C. 101(2), with a disability that is service-connected, as defined in 38 U.S.C. 101(16).

"Small business concern" means a concern, including its affiliates, that is independently owned and operated, not dominant in the field of operation in which it is bidding on Government contracts, and qualified as a small business under the criteria in 13 CFR Part 121 and size standards in this solicitation.

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.

Veteran-owned small business concern means a small business concern—

(1) Not less than 51 percent of which is owned by one or more veterans (as defined at 38 U.S.C. 101(2)) or, in the case of any publicly owned business, not less than 51 percent of the stock of which is owned by one or more veterans; and

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

"Women-owned small business concern" means a small business concern—

(1) That is at least 51 percent owned by one or more women or, in the case of any publicly owned business, at least 51 percent of its stock is owned by one or more women; or

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

"Women-owned business concern" means a concern which is at least 51 percent owned by one or more women; or in the case of any publicly owned business, at least 51 percent of the stock of which is owned by one or more women; and whose management and daily business operations are controlled by one or more women.

(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 electronically on the SAM website.

(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 representations and certifications currently posted electronically at FAR 52.212-3, Offeror Representations and Certifications--Commercial Items, have been 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 (n) 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 on ORCA.]

(c) Offerors must complete the following representations when the resulting contract will be performed in the United States or its outlying areas. Check all that apply.

(1) Small business concern. The offeror represents as part of its offer that it ( ) is, ( ) is not a small business concern.

(2) Veteran-owned small business concern. (Complete only if the offeror represented itself as a small business concern in paragraph (c)(1) of this provision.) The offeror represents as part of its offer that it ( ) is, ( ) is not a veteran-owned small business concern.

(3) Service-disabled veteran-owned small business concern. (Complete only if the offeror represented itself as a veteran-owned small business concern in paragraph (c)(2) of this provision.) The offeror represents as part of its offer that it ( ___ ) is, ( ___ ) is not a service-disabled veteran-owned small business concern.

(4) Small disadvantaged business concern. (Complete only if the offeror represented itself as a small business concern in paragraph (c)(1) of this provision.) The offeror represents, for general statistical purposes, that it ( ___ ) is, ( ___ ) is not a small disadvantaged business concern as defined in 13 CFR 124.1002.

(5) Women-owned small business concern. (Complete only if the offeror represented itself as a small business concern in paragraph (c)(1) of this provision.) The offeror represents that it ( ___ ) is, ( ___ ) is not a women-owned small business concern.

Note to paragraphs (c)(8) and (9): Complete paragraphs (c)(8) and (c)(9) only if this solicitation is expected to exceed the simplified acquisition threshold.

(6) WOSB concern eligible under the WOSB Program. [Complete only if the offeror represented itself as a women-owned small business concern in paragraph (c)(5) of this provision.] The offeror represents that--

(i) It ___ is, ___ is not a WOSB concern eligible under the WOSB Program, has provided all the required documents to the WOSB Repository, and no change in circumstances or adverse decisions have been issued that affects its eligibility; and

(ii) It [ ___ ballot] is, [ ___ ballot] is not a joint venture that complies with the requirements of 13 CFR part 127, and the representation in paragraph (c)(6)(i) of this provision is accurate for each WOSB concern eligible under the WOSB Program participating in the joint venture. [The offeror shall enter the name or names of the WOSB concern eligible under the WOSB Program and other small businesses that are participating in the joint venture: ----------.] Each WOSB concern eligible under the WOSB Program participating in the joint venture shall submit a separate signed copy of the WOSB representation.

(7) Economically disadvantaged women-owned small business (EDWOSB) concern. [Complete only if the offeror represented itself as a WOSB concern eligible under the WOSB Program in (c)(6) of this provision.] The offeror represents that--

(i) It [ ___ ballot] is, [ ___ ballot] is not an EDWOSB concern, has provided all the required documents to the WOSB Repository, and no change in circumstances or adverse decisions have been issued that affects its eligibility; and

(ii) It [ ___ ballot] is, [ ___ ballot] is not a joint venture that complies with the requirements of 13 CFR part 127, and the representation in paragraph (c)(7)(i) of this provision is accurate for each EDWOSB concern participating in the joint venture. [The offeror shall enter the name or names of the EDWOSB concern and other small businesses that are participating in the joint venture: ----------.] Each EDWOSB concern participating in the joint venture shall submit a separate signed copy of the EDWOSB representation.

(8) Women-owned business concern (other than small business concern). (Complete only if the offeror is a women-owned business concern and did not represent itself as a small business concern in paragraph (c)(1) of this provision.) The offeror represents that it ( ___ ) is, a women-owned business concern.

(9) Tie bid priority for labor surplus area concerns. If this is an invitation for bid, small business offerors may identify the labor surplus areas in which costs to be incurred on account of manufacturing or production (by offeror or first-tier subcontractors) amount to more than 50 percent of the contract price:

(10) Small Business Size for the Small Business Competitiveness Demonstration Program and for the Targeted Industry Categories under the Small Business Competitiveness Demonstration Program. (Complete only if the offeror has represented itself to be a small business concern under the size standards for this solicitation.)

(i) (Complete only for solicitations indicated in an addendum as being set-aside for emerging small businesses in one of the designated industry groups (DIGs).) The offeror represents as part of its offer that it ( ) is, ( ) is not an emerging small business.

(ii) (Complete only for solicitations indicated in an addendum as being for one of the targeted industry categories (TICs) or designated industry groups (DIGs).) Offeror represents as follows:

(A) Offeror's number of employees for the past 12 months (check the Employees column if size standard stated in the solicitation is expressed in terms of number of employees); or

(B) Offeror's average annual gross revenue for the last 3 fiscal years (check the Average Annual Gross Number of Revenues column if size standard stated in the solicitation is expressed in terms of annual receipts).

(Check one of the following):

Average Annual

Number of Employees Gross Revenues

___ 50 or fewer ___ $1 million or less

___ 51 - 100 ___ $1,000,001 - $2 million

___ 101 - 250 ___ $2,000,001 - $3.5 million

___ 251 - 500 ___ $3,500,001 - $5 million

___ 501 - 750 ___ $5,000,001 - $10 million

___ 751 - 1,000 ___ $10,000,001 - $17 million

___ Over 1,000 ___ Over $17 million

(11) (Complete only if the solicitation contains the clause at FAR 52.219-23, Notice of Price Evaluation Adjustment for Small Disadvantaged Business Concerns or FAR 52.219-25, Small Disadvantaged Business Participation Program-Disadvantaged Status and Reporting, and the offeror desires a benefit based on its disadvantaged status.)

(i) General. The offeror represents that either--

(A) It ( ___ ) is, ( ___ ) is not certified by the Small Business Administration as a small disadvantaged business concern and identified, on the date of this representation, as a certified small disadvantaged business concern in the SAM Dynamic Small Business Search Database maintained by the Small Business Administration, and that no material change in disadvantaged ownership and control has occurred since its certification, and, where the concern is owned by one or more individuals claiming disadvantaged status, the net worth of each individual upon whom the certification is based does not exceed $750,000 after taking into account the applicable exclusions set forth at 13 CFR 124.104(c)(2); or

(B) It ( ___ ) has, ( ___ )( has not submitted a completed application to the Small Business Administration or a Private Certifier to be certified as a small disadvantaged business concern in accordance with 13 CFR 124, Subpart B, and a decision on that application is pending, and that no material change in disadvantaged ownership and control has occurred since its application was submitted.

(ii) Joint Ventures under the Price Evaluation Adjustment for Small Disadvantaged Business Concerns. The offeror represents, as part of its offer, that it is a joint venture that complies with the requirements in 13 CFR 124.1002(f) and that the representation in paragraph (c)(9)(i) of this provision is accurate for the small disadvantaged business concern that is participating in the joint venture. (The offeror shall enter the name of the small disadvantaged business concern that is participating in the joint venture: ___ .)

(12) Complete if the offeror has represented itself as disadvantaged in paragraph (c)(4) or (c)(10) of this provision.)

(The offeror shall check the category in which its ownership falls):

___ Black American.

___ Hispanic American.

___ Native American (American Indians, Eskimos, Aleuts, or Native Hawaiians).

___ Asian-Pacific American (persons with origins from Burma, Thailand, Malaysia, Indonesia, Singapore, Brunei, Japan, China, Taiwan, Laos, Cambodia (Kampuchea), Vietnam, Korea, The Philippines, U.S. Trust Territory of the Pacific Islands (Republic of Palau), Republic of the Marshall Islands, Federated States of Micronesia, the Commonwealth of the Northern Mariana Islands, Guam, Samoa, Macao, Hong Kong, Fiji, Tonga, Kiribati, Tuvalu, or Nauru).

___ Subcontinent Asian (Asian-Indian) American (persons with origins from India, Pakistan, Bangladesh, Sri Lanka, Bhutan, the Maldives Islands, or Nepal).

___ Individual/concern, other than one of the preceding.

(d) Certifications and representations required to implement provisions of Executive Order 11246—

(1) Previous Contracts and Compliance. The offeror represents that--

(i) It ( ___ ) has, ( ___ ) has not, participated in a previous contract or subcontract subject either to the Equal Opportunity clause of this solicitation, the and

(ii) It ( ___ ) has, ( ___ ) has not, filed all required compliance reports.

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

(i) It ( ___ ) has developed and has on file, ( ___ ) has not developed and does not have on file, at each establishment, affirmative action programs required by rules and regulations of the Secretary of Labor (41 CFR Subparts 60-1 and 60-2), or

(ii) It ( ___ ) has not previously had contracts subject to the written affirmative action programs requirement of the rules and regulations of the Secretary of Labor.

(e) Certification Regarding Payments to Influence Federal Transactions (31 U.S.C. 1352). (Applies only if the contract is expected to exceed $100,000.) By submission of its offer, the offeror certifies to the best of its knowledge and belief that no 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 on his or her behalf in connection with the award of any resultant contract. If any registrants under the Lobbying Disclosure Act of 1995 have made a lobbying contact on behalf of the offeror with respect to this contract, the offeror shall complete and submit, with its offer, OMB Standard Form LLL, Disclosure of Lobbying Activities, to provide the name of the registrants. The offeror need not report regularly employed officers or employees of the offeror to whom payments of reasonable compensation were made.

(f) Buy American Act--Balance of Payments Program Certificate. (Applies only if the clause at Federal Acquisition Regulation (FAR) 52.225-1, Buy American Act--Balance of Payments Program--Supplies, is included in this solicitation.)

(1) The offeror certifies that each end product, except those listed in paragraph (f)(2) of this provision, is a domestic end product and that for other than COTS items, the offeror has considered components of unknown origin to have been mined, produced, or manufactured outside the United States. The offeror shall list as foreign end products those end products manufactured in the United States that do not qualify as domestic end products, i.e., an end product that is not a COTS item and does not meet the component test in paragraph (2) of the definition of “domestic end product.” The terms “commercially available off-the-shelf (COTS) item,” “component,” “domestic end product,” “end product,” “foreign end product,” and “United States” are defined in the clause of this solicitation entitled “Buy American Act--Supplies.”

(2) Foreign End Products:

(List as necessary)

(3) The Government will evaluate offers in accordance with the policies and procedures of FAR Part 25.

(g)(1) Buy American Act -- Free Trade Agreements -- Israeli Trade Act Certificate. (Applies only if the clause at FAR 52.225-3, Buy American Act -- Free Trade Agreements -- Israeli Trade Act, is included in this solicitation.)

The offeror certifies that each end product, except those listed in paragraph (g)(1)(ii) or (g)(1)(iii) of this provision, is a domestic end product and that for other than COTS items, the offeror has considered components of unknown origin to have been mined, produced, or manufactured outside the United States. The terms “Bahrainian, Moroccan, Omani, Panamanian, or Peruvian end product,” “commercially available off-the-shelf (COTS) item,” “component,” “domestic end product,” “end product,” “foreign end product,” “Free Trade Agreement country,” “Free Trade Agreement country end product,” “Israeli end product,” and “United States” are defined in the clause of this solicitation entitled “Buy American Act-Free Trade Agreements-Israeli Trade Act.”

(ii) ) The offeror certifies that the following supplies are Free Trade Agreement country end products (other than Bahrainian, Moroccan, Omani, Panamanian, or Peruvian end products) or Israeli end products as defined in the clause of this solicitation entitled ``Buy American Act--Free Trade Agreements--Israeli Trade Act'':

Free Trade Agreement Country End Products (Other than Bahrainian, Moroccan, Omani, Panamanian, or Peruvian End Products) or Israeli End Products:

[List as necessary]

(iii) The offeror shall list those supplies that are foreign end products (other than those listed in paragraph (g)(1)(ii) or this provision) as defined in the clause of this solicitation entitled “Buy American Act—Free Trade Agreements—Israeli Trade Act.” The offeror shall list as other foreign end products those end products manufactured in the United States that do not qualify as domestic end products, i.e., an end product that is not a COTS item and does not meet the component test in paragraph (2) of the definition of “domestic end product.”

Other Foreign End Products:

(iv) The Government will evaluate offers in accordance with the policies and procedures of FAR Part 25.

(2) Buy American Act—Free Trade Agreements—Israeli Trade Act Certificate, Alternate I (Jan 2004). If Alternate I to the clause at FAR 52.225-3 is included in this solicitation, substitute the following paragraph (g)(1)(ii) for paragraph (g)(1)(ii) of the basic provision:

(g)(1)(ii) The offeror certifies that the following supplies are Canadian end products as defined in the clause of this solicitation entitled “Buy American Act—Free Trade Agreements—Israeli Trade Act”:

Canadian End Products:

Line Item No.:

[List as necessary]

(3) Buy American Act—Free Trade Agreements—Israeli Trade Act Certificate, Alternate II (Jan 2004). If Alternate II to the clause at FAR 52.225-3 is included in this solicitation, substitute the following paragraph (g)(1)(ii) for paragraph (g)(1)(ii) of the basic provision:

(g)(1)(ii) The offeror certifies that the following supplies are Canadian end products or Israeli end products as defined in the clause of this solicitation entitled ``Buy American Act--Free Trade Agreements--Israeli Trade Act'':

Canadian or Israeli End Products:

(4) Buy American Act--Free Trade Agreements--Israeli Trade Act Certificate, Alternate III. If Alternate III to the clause at 52.225-3 is included in this solicitation, substitute the following paragraph (g)(1)(ii) for paragraph (g)(1)(ii) of the basic provision:

(g)(1)(ii) The offeror certifies that the following supplies are Free Trade Agreement country end products (other than Bahrainian, Korean, Moroccan, Omani, Panamanian, or Peruvian end products) or Israeli end products as defined in the clause of this solicitation entitled ``Buy American Act--Free Trade Agreements--Israeli Trade Act'':

Free Trade Agreement Country End Products (Other than Bahrainian, Korean, Moroccan, Omani, Panamanian, or Peruvian End Products) or Israeli End Products:

(5) Trade Agreements Certificate. (Applies only if the clause at FAR 52.225-5, Trade Agreements, is included in this solicitation.)

(i) The offeror certifies that each end product, except those listed in paragraph (g)(5)(ii) of this provision, is a U.S.-made or designated country end product, as defined in the clause of this solicitation entitled ``Trade Agreements''.

(ii) The offeror shall list as other end products those end products that are not U.S.-made or designated country end products.

Other End Products:

(iii) The Government will evaluate offers in accordance with the policies and procedures of FAR Part 25. For line items covered by the WTO GPA, the Government will evaluate offers of U.S.-made or designated country end products without regard to the restrictions of the Buy American Act. The Government will consider for award only offers of U.S.-made or designated country end products unless the Contracting Officer determines that there are no offers for such products or that the offers for such products are insufficient to fulfill the requirements of the solicitation.

(h) Certification Regarding Responsibility Matters (Executive Order 12689). (Applies only if the contract value is expected to exceed the simplified acquisition threshold.) The offeror certifies, to the best of its knowledge and belief, that the offeror and/or any of its principals—

(1) ( ___ ) Are, ( ___ ) are not presently debarred, suspended, proposed for debarment, or declared ineligible for the award of contracts by any Federal agency; and

(2) ( ___ ) Have, ( ___ ) have not, within a three-year period preceding this offer, been convicted of or had a civil judgment rendered against them for: Commission of fraud or a criminal offense in connection with obtaining, attempting to obtain, or performing a Federal, state or local government contract or subcontract; violation of Federal or state antitrust statutes relating to the submission of offers; or Commission of embezzlement, theft, forgery, bribery, falsification or destruction of records, making false statements, tax evasion, violating Federal criminal tax laws, or receiving stolen property; and

(3) ( ___ ) Are, ( ___ ) are not presently indicted for, or otherwise criminally or civilly charged by a Government entity with, commission of any of these offenses enumerated in paragraph (h)(2) of this clause; and

(4) [ ___ ballot] Have, [ ___ ballot] have not, within a three-year period preceding this offer, been notified of any delinquent Federal taxes in an amount that exceeds $3,000 for which the liability remains unsatisfied.

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

(A) The tax liability is finally determined. The liability is finally determined if it has been assessed. A liability is not finally determined if there is a pending administrative or judicial challenge. In the case of a judicial challenge to the liability, the liability is not finally determined until all judicial appeal rights have been exhausted.

(B) The taxpayer is delinquent in making payment. A taxpayer is delinquent if the taxpayer has failed to pay the tax liability when full payment was due and required. A taxpayer is not delinquent in cases where enforced collection action is precluded.

(ii) Examples.

(A) The taxpayer has received a statutory notice of deficiency, under I.R.C. Sec. 6212, which entitles the taxpayer to seek Tax Court review of a proposed tax deficiency. This is not a delinquent tax because it is not a final tax liability. Should the taxpayer seek Tax Court review, this will not be a final tax liability until the taxpayer has exercised all judicial appeal rights.

(B) The IRS has filed a notice of Federal tax lien with respect to an assessed tax liability, and the taxpayer has been issued a notice under I.R.C. Sec. 6320 entitling the taxpayer to request a hearing with the IRS Office of Appeals contesting the lien filing, and to further appeal to the Tax Court if the IRS determines to sustain the lien filing. In the course of the hearing, the taxpayer is entitled to contest the underlying tax liability because the taxpayer has had no prior opportunity to contest the liability. This is not a delinquent tax because it is not a final tax liability. Should the taxpayer seek tax court review, this will not be a final tax liability until the taxpayer has exercised all judicial appeal rights.

(C) The taxpayer has entered into an installment agreement pursuant to I.R.C. Sec. 6159. The taxpayer is making timely payments and is in full compliance with the agreement terms. The taxpayer is not delinquent because the taxpayer is not currently required to make full payment.

(D) The taxpayer has filed for bankruptcy protection. The taxpayer is not delinquent because enforced collection action is stayed under 11 U.S.C. 362 (the Bankruptcy Code).

(i) Certification Regarding Knowledge of Child Labor for Listed End Products (Executive Order 13126). (The Contracting Officer must list in paragraph (i)(1) any end products being acquired under this solicitation that are included in the List of Products Requiring Contractor Certification as to…