FA5606-17-R-0001.docx

FA5606-17-R-0001

Section SF 1449 - CONTINUATION SHEET

Special Needs Coordinator

FFP

Special Needs Identification and Assignment Coordinator (SNIAC) This action is IAW Continuing Resolution Authority (CRA) disbursing procedures. This requirement is included or provided in the installation financial plan for FY 17.

Period of Performance: 01 February 2017 - 31 January 2018 Government POC:

Kimberly Rosado 452-9341 FOB: Destination

PURCHASE REQUEST NUMBER: F3W4016253A001

SIGNAL CODE: A

NET AMT

FFP

Special Needs Identification and Assignment Coordinator (SNIAC) Period of Performance: 01 February 2018 - 31 January 2019 FOB: Destination

NET AMT

FFP

Special Needs Identification and Assignment Coordinator (SNIAC) Period of Performance: 01 February 2019 - 31 January 2020

NET AMT

FFP

Special Needs Identification and Assignment Coordinator (SNIAC) Period of Performance: 01 February 2020 - 31 January 2021

NET AMT

FFP

Special Needs Identification and Assignment Coordinator (SNIAC) Period of Performance: 01 February 2021 - 31 January 2022

NET AMT

INSPECTION AND ACCEPTANCE TERMS

Supplies/services will be inspected/accepted at:

DELIVERY INFORMATION

31-JAN-2018

GEB. 550

FLUGPLATZ SPANGDAHLEM

KIMBERLY ROSADO

54529 SPANGDAHLEM

GERMANY

452-3491

F3W401

31-JAN-2019

F3W401

31-JAN-2020

F3W401

31-JAN-2021

F3W401

31-JAN-2022

F3W401

CLAUSES INCORPORATED BY REFERENCE

ADDENDUM TO 52.212-1

ADDENDUM TO FAR 52.212-1 INSTRUCTIONS TO OFFERORS–COMMERCIAL ITEMS

To be considered for award, the offer must be received at this location at or before the exact date and time specified in Block 8 of the Standard Form 1449 and must include the following:

1. Proposal Preparation Instructions:

a. To assure timely and equitable evaluation of proposals, offerors must follow the instructions contained herein. Proposals must be complete, self-sufficient, and respond directly to the requirements of this solicitation. A complete proposal consists of a technical proposal, written past performance and executed proposal documents. Offerors must include prices for CLINs in the pricing schedule (on the SF 1449), of the solicitation for the basic period, and all option periods.

1. Proposals shall not contain classified information.

1. Alternate proposals will not be accepted.

1. In accordance with FAR SubPart 4.8 (Government Contract Files), the Government will retain one copy of all unsuccessful proposals. Unless the Offeror requests otherwise, the Government will destroy extra copies of unsuccessful proposals.

1. Only one award will be made as a result of this solicitation.

1. The Government intends to award a contract without discussions with respective offerors. The Government, however, reserves the right to conduct discussions if deemed in its best interest.

1. Offerors are cautioned to submit sufficient information and in the format specified in this addendum. Offerors may be asked to clarify certain aspects of their proposal or respond to adverse past performance information to which the offeror has not previously had an opportunity to respond. Communication conducted to resolve minor or clerical errors will not constitute discussions and the Government reserves the right to award a contract without the opportunity for proposal revision.

b. All extensions of the unit prices shown will be subject to verification by the Government. In case of variation between the unit price and the extension, the unit prices will be considered to be the offer.

c. Failure to furnish a complete proposal may result in the proposal being determined non-responsive by the Government and cause for rejection of the entire offer. Proposal shall be submitted digitally by e-mail or, if too large in size, on a CD/DVD prior to the time set for proposal closing to:

52CONS/LGCB

ATTN: Katrin Aubart, Anja Weber-Sabo Bldg. 128, 2nd Floor Arnold Blvd.

Unit 3562 54529 Flugplatz Spangdahlem Germany

Email: katrin.aubart.de@us.af.mil; anja.weber-sabo.1.de@us.af.mil; 52CONS.LGCB.BaseSupport@us.af.mil

HANDCARRIED PROPOSALS MUST BE RECEIVED AND DATE STAMPED BY A MEMBER OF THE 52d CONTRACTING SQUADRON NO LATER THAN 15 Dec 2016, 10:00 a.m. Central European Time.

EMAILED PROPOSALS MUST BE DELIVERED TO THE POINTS OF CONTACT LISTED ABOVE NO LATER THAN 15 Dec 2016, 10:00 a.m. Central European Time. IT IS THE OFFEROR’S RESPONSIBILITY TO ENSURE EMAILS ARE OF A SIZE THAT ALLOWS FOR DELIVERY. Acceptable document types are .pdf, .doc and .xls. Other document types may be stripped by the Government’s server and may not be received by this office.

N O T I C E Offerors are cautioned that Spangdahlem Air Base has stringent visitor control procedures requiring individuals not affiliated with the installation to obtain a visitor pass and be cleared by the Government point of contact to be visited prior to entrance. IT IS POSSIBLE THAT THE POINT OF CONTACT MAY NOT BE AVAILABLE TO CLEAR OFFERORS FOR ENTRANCE WHICH MAY PROHIBIT SUBMISSION OF HANDCARRIED OFFERS; CONSEQUENTLY, OFFERORS ELECTING TO HANDCARRY THEIR PROPOSALS FOR SUBMITTAL JUST PRIOR TO PROPOSAL CLOSING TIME DO SO AT THEIR OWN RISK.

2. Submission of Offers:

Submit signed and dated proposal stating the solicitation number – also with the solicitation number annotated on the outer envelope in case of handcarried delivery.

Offeror’s shall submit the following information as part of their proposal.

a. COVER LETTER: Include a Summary of the Proposal contents and identify the offeror’s primary and alternate point of contact for all proposal-related matters.

b. ORIGINAL STANDARD FORM 1449: complete Blocks 17a (Company Stamp) and 30a (Signature);

Block 30b ( Name and Title of Signer); Block 30c (Date Signed); Block 12 (Optional).

c. SF 1449 CONTINUATION:

Price: List all Pricing Information on the complete Schedule of Services.

Technical: See Technical Evaluation Subfactors 1 through Subfactor 4 of Addendum to 52.212-2

Past Performance: The offeror shall provide information on no more than three (3) contracts. Criteria:

3. Offerors shall submit ONLY documentation relevant to subject Request for Proposal.

CLAUSES INCORPORATED BY FULL TEXT

52.212-2 EVALUATION--COMMERCIAL ITEMS (OCT 2014)

(a) The Government will award a contract resulting from this solicitation to the responsible offeror whose offer conforming to the solicitation is determined to be most advantageous – representing the best value - to the Government, price and other factors considered. The following three factors shall be used to evaluate offers.

1.) Price;

2.) Technical;

3.) Past Performance;

(b) 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).

(c) 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)

ADDENDUM TO 52.212-2

ADDENDUM TO FAR 52.212-2 EVALUATION – COMMERCIAL ITEMS

1. EVALUATION FACTORS FOR AWARD

The following three factors shall be used to evaluate offers:

(1) FACTOR 1 - Price Offerors will be evaluated on the Total Evaluated Price (TEP) resulting from the total amounts of CLINs 0001 through 4001 plus 50% of the price(s) proposed for the last option period in accordance with FAR Clause 52.217-8 Extention of Services. Unbalanced prices may serve as a basis for rejection of the proposal. The price evaluation will document the reasonableness of the total evaluated price.

Arithmetic Discrepancies: For the purpose of initial evaluation of offers, the following will be utilized in resolving arithmetic discrepancies found on the face of the pricing schedule as submitted by the offeror.

Reasonableness: Price analysis will be used to determine reasonableness of prices. The techniques and procedures described under FAR 13.106-2, as determined appropriate, will be the primary means of assessing proposals in determining the reasonableness.

(2) FACTOR 2 – Technical

Sub-Factor 1 Special Qualifications

The contractor shall process one of the following qualifications for either Medical Social Worker – Special Needs Coordinator (SNC) or Clinical Nurse - Special Needs Coordinator (SNC) IAW Air Force Medical Services (AFMS) Commodity Council Clinical Acquisition Support Services (CLASS) Direct Patient Care Approved Position Descriptions Version 2.8, dated 28 August 2015.

1. Medical Social Worker – Special Needs Coordinator (SNC):

Education: Masters of Social Work (MSW) degree from an accredited graduate school of social work.

License: Not applicable for Medical Social Worker.

1. Clinical Nurse - Special Needs Coordinator (SNC):

Education: Shall be a graduate of associates (ADN) or baccalaureate degree (BSN) program in nursing accredited by a national nursing accrediting agency recognized by the US Department of Education.

License: Maintain an active, valid, current, and unrestricted license (with no limitations, stipulations or pending adverse actions) to practice nursing as a registered nurse in any US state/jurisdiction.

Sub-Factor 2 Quality Control Plan

Offeror shall provide a Commercial Quality Control Plan to ensure the requirements of the contract are provided as specified; consisting of the following:

A complete portfolio of the company, listing key personnel, describing the inspection system/checklists and other pertinent tools to measure the quality of services rendered.

Sub-Factor 3 Experience

1. Medical Social Worker – Special Needs Coordinator (SNC):

Demonstrates a minimum of two (2) years full-time experience in care coordination, discharge planning or case management in a medical setting within the last four (4) years.

1. Clinical Nurse – Special Needs Coordinator (SNC):

Minimum of 3 years for ADN/ 2 years for BSN full-time experience in nursing and care coordination.

Sub-Factor 4 Certification

Offeror shall maintain competency in Basic Life Support (BLS) certification.

Offerors will be evaluated on written documentation provided in accordance with Addendum to FAR 52.212-1, Instructions to Offerors – Commercial, and listed as subfactors above. Technical acceptability is based on successfully meeting this requirement. The focus of the technical rating is to identify if the contractor has an adequate approach and understanding of the requirement. Each outlined subfactor will be rated “Acceptable” or “Unacceptable” as follows:

TECHNICAL CRITERIA RATINGS

Offerors must receive “Acceptable” rating for each subfactor to receive an overall “Acceptable” rating in the technical evaluation. In the event one or more subfactors receive an “Unacceptable” rating, the proposal will receive an overall “Unacceptable” rating in the technical evaluation. In order to receive an “Acceptable” rating, the offeror must provide proof that all requirements will be met.

(3) FACTOR 3 – Past Performance

Past Performance will be evaluated on how well the offeror performed on recent and relevant work. Past performance references of a joint venture partner, key subcontractor, or instances where the offeror performed as a key personnel or a key subcontractor will be accepted. The rating is based upon offeror-provided references, or information obtained by the Government from any other sources of past performance information within the past five (5) years. A past performance questionnaire will be utilized to determine the offeror’s rating on past projects with Government or other sources. The information, as well as any other information known by or made available to the Contracting Officer, will be used by the Government in the following manner to determine if the offeror has a satisfactory past performance record. Offeror must receive an “Acceptable” rating to receive an award, as follows:

PAST PERFORMANCE RATINGS

Note: Contractors without a record of relevant past performance information will not be penalized in any manner.

Relevant past performance is defined as work where the same or similar projects as defined in the Performance Work Statement (PWS) have been completed. Contracts listed may include those entered into with the Federal Government or private/commercial entities, whereby Federal Government contracts take precedence. In the case of an offeror without a record of relevant past performance or for whom information on past performance is not available or so sparse that no meaningful past performance rating can be reasonably assigned, the offeror may not be evaluated favorably or unfavorably on past performance. Therefore, the offeror shall be determined to have unknown past performance. In the context of acceptability/unacceptability, “Unknown” shall be considered “Acceptable.”

The Offeror shall provide no more than 3 relevant projects or contracts that include the following information:

Government Agency/Company who awarded the contract Contract Number Description of Supplies/Services Contract Value (base and all options) Period of Performance (including all options) Place of Performance Contract Type Current POC with current email address and phone number

Upon completion of the past performance questionnaire please e-mail the signed document to katrin.aubart.de@us.af.mil and anja.weber-sabo.1.de@us.af.mil prior to 15 Dec 2016, 10:00 a.m.

2. CONTRACTOR RESPONSIBILITY

Prior to award, a responsibility determination will be made as described in FAR Part 9.

3. AWARD PROCESS

The Government intends to award to the lowest priced offeror with an acceptable technical and past performance rating; the Government may award without discussions, reserving the right to hold discussions if deemed necessary by the CO.

The evaluation process is as follows:

PP QUESTIONNAIRE

PAST AND PRESENT PERFORMANCE QUESTIONNAIRE

FA5606-17-R-0001

Special Needs Integrator and Assignment Coordinator (SNIAC)

SECTION A: CONTRACTOR INFORMATION:

(TO BE COMPLETED BY THE CONTRACTOR/OFFEROR BEING EVALUATED)

A. Contractor’s Name and Address: _____________________________________________________________

B. Point of Contact: ________________________________________________________

C. Phone Number (with area code): _________________________________________________________________________

D. Contract Number (If Applicable): __________________________________________

E. Brief description of services: ______________________________________________

F. Contract Type (If Applicable): |_| Firm-Fixed-Price |_| Indefinite-Delivery/Indefinite Quantity Task Order |_| Cost-Reimbursement

G. Award Date: Scheduled Completion Date: ___________________

H. Period Performance: ______________________________ Current/Final Completion Date: ________________

I. Award Amount: Current/Final Project Amount: _________________

J. Contractor being evaluated performed as the |_| Prime Contractor |_| Subcontractor |_| Supplier on this contract/order.

K. Authorization is hereby granted to provide the information requested in SECTION B of this Questionnaire.

(Signature)

SECTION B: RESPONDENT INFORMATION

(TO BE COMPLETED BY THE RESPONDENT/SOURCE THAT IS EVALUATING)

EVALUATED BY:

(Date) (Phone

SECTION C. PERFORMANCE INFORMATION: Please check the appropriate column.

Contractor’s Name: _________________________ Contract Number: ________________________

Place an “X” in the appropriate column.

Remarks:________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

CLAUSES INCORPORATED BY FULL TEXT

52.212-3 OFFEROR REPRESENTATIONS AND CERTIFICATIONS--COMMERCIAL ITEMS (JUL 2016)

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

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

“Economically disadvantaged women-owned small business (EDWOSB) Concern” means a small business concern that is at least 51 percent directly and unconditionally owned by, and the management and daily business operations of which are controlled by, one or more women who are citizens of the United States and who are economically disadvantaged in accordance with 13 CFR part 127. It automatically qualifies as a women-owned small business eligible under the WOSB Program.

"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.

Highest-level owner means the entity that owns or controls an immediate owner of the offeror, or that owns or controls one or more entities that control an immediate owner of the offeror. No entity owns or exercises control of the highest level owner.

Immediate owner means an entity, other than the offeror, that has direct control of the offeror. Indicators of control include, but are not limited to, one or more of the following: Ownership or interlocking management, identity of interests among family members, shared facilities and equipment, and the common use of employees.

Inverted domestic corporation means a foreign incorporated entity that meets the definition of an inverted domestic corporation under 6 U.S.C. 395(b), applied in accordance with the rules and definitions of 6 U.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.

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.

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

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.

Small disadvantaged business concern, consistent with 13 CFR 124.1002, means a small business concern under the size standard applicable to the acquisition, that--

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

(i) One or more socially disadvantaged (as defined at 13 CFR 124.103) and economically disadvantaged (as defined at 13 CFR 124.104) individuals who are citizens of the United States; and

(ii) Each individual claiming economic disadvantage has a net worth not exceeding $750,000 after taking into account the applicable exclusions set forth at 13 CFR 124.104(c)(2); and

(2) The management and daily business operations of which are controlled (as defined at 13.CFR 124.106) by individuals, who meet the criteria in paragraphs (1)(i) and (ii) of this definition.

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 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 or a 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.

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 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.

"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 small business (WOSB) concern eligible under the WOSB Program (in accordance with 13 CFR part 127)”, means a small business concern that is at least 51 percent directly and unconditionally owned by, and the management and daily business operations of which are controlled by, one or more women who are citizens of the United States.

(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 (r) 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 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 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 [ ___ ] is, [ ___ ] 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 [ ___ ] is, [ ___ ] 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 [ ___ ] is, [ ___ ] 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) HUBZone 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--

(i) It [ ___ ] is, [ ___ ] is not a HUBZone small business concern listed, on the date of this representation, on the List of Qualified HUBZone Small Business Concerns maintained by the Small Business Administration, and no material changes in ownership and control, principal office, or HUBZone employee percentage have occurred since it was certified in accordance with 13 CFR Part 126; and

(ii) It [ ___ ] is, [ ___ ] is not a HUBZone joint venture that complies with the requirements of 13 CFR Part 126, and the representation in paragraph (c)(10)(i) of this provision is accurate for each HUBZone small business concern participating in the HUBZone joint venture. [The offeror shall enter the names of each of the HUBZone small business concerns participating in the HUBZone joint venture: ___ .] Each HUBZone small business concern participating in the HUBZone joint venture shall submit a separate signed copy of the HUBZone representation.

(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 $150,000.) 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 Certificate. (Applies only if the clause at Federal Acquisition Regulation (FAR) 52.225-1, Buy American --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--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--Free Trade Agreements--Israeli Trade Act Certificate. (Applies only if the clause at FAR 52.225-3, Buy American--Free Trade Agreements--Israeli Trade Act, is included in this solicitation.)

(i) 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--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--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) of this provision) as defined in the clause of this solicitation entitled "Buy American-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 -Free Trade Agreements-Israeli Trade Act":

Canadian End Products:

Line Item No.

(3) Buy American-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-Free Trade Agreements-Israeli Trade Act":

Canadian or Israeli End Products:

(4) Buy American--Free Trade Agreements--Israeli Trade Act Certificate, Alternate III. If Alternate III 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 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 --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 statute. 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;

(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) [ ___ ] Have, [ ___ ] have not, within a three-year period preceding this offer, been notified of any delinquent Federal taxes in an amount that exceeds $3,500 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…