FA850420R0002.pdf

AUTHORIZED FOR LOCAL REPRODUCTION STANDARD FORM 1449 (REV.2/2012)

PREVIOUS EDITION IS NOT USABLE Prescribed by GSA - FAR (48 CFR) 53.212

SOLICITATION/CONTRACT/ORDER FOR COMMERCIAL ITEMS

OFFEROR TO COMPLETE BLOCKS 12, 17, 23, 24, & 30 JS

1. REQUISITION NUMBER

FD20602030513

5. SOLICITATION NUMBER

FA8504-20-R-0002

6. SOLICITATION ISSUE DATE

b. TELEPHONE NUMBER (No collect calls)

(478 ) 222 -7344 ext.

2. CONTRACT NO.

7. FOR SOLICITATION

INFORMATION CALL

3. AWARD/EFFECTIVE DATE 4. ORDER NUMBER

a. NAME

Jason E. Morgan

8. OFFER DUE DATE/LOCAL

TIME

19NOV2019 4:00PM

12. DISCOUNT TERMS11. DELIVERY FOR FOB DEST.

UNLESS BLOCK IS MARKED

SEE SCHEDULE

10. THIS ACQUISITION IS UNRESTRICTED SET ASIDE: % FOR:

SMALL BUSINESS WOMEN-OWNED SMALL BUSINESS

HUBZONE SMALL (WOSB)ELIGIBLE UNDER THE WOMEN-OWNED

BUSINESS SMALL BUSINESS PROGRAM

NAICS CODE:

SERVICE-DISABLED EDWOSB 336413

VETERAN-OWNED SIZE STANDARD

SMALL BUSINESS 8 (A) 1,250 :

13a. THIS CONTRACT IS A

RATED ORDER

UNDER DPAS

(15 CFR 700)

13b. RATING

DO: A1 52.211-14, 52.211-15

14. METHOD OF SOLICITATION

RFQ IFB RFP

9. ISSUED BY CODE

C-130 HERCULES DIVISION, AFLCMC/WLNKA

235 BYRON ST STE 19A

BLDG 300 CML PHN 478 926 6684

ROBINS AFB GA 31098-1670

BUYER: Jason E. Morgan/WLNKB jason.morgan.12@us.af.mil Phone: (478) 222- 7344

15. DELIVER TO CODE

SEE LINE ITEM SCHEDULE

16. ADMINISTERED BY CODE

17a. CONTRACTOR/OFFEROR FACILITY

CODE CODE

18a. PAYMENT WILL BE MADE BY CODE

17b. CHECK IF REMITTANCE IS DIFFERENT AND PUT SUCH ADDRESS IN OFFER 18b. SUBMIT INVOICES TO ADDRESS SHOWN IN BLOCK 18a UNLESS BLOCK BELOW IS

CHECKED. SEE ELECTRONIC SUBMISSION OF PAYMENT REQUESTS, CLAUSE 252.232-7003.

FA8504

19.

ITEM NO.

20.

SCHEDULE OF SUPPLIES/SERVICES

21.

QUANTITY

22.

UNIT

23.

UNIT PRICE

24.

AMOUNT

FMS REQUIREMENT

ROUTINE

Subject to the terms and conditions stated herein, the Contractor agrees to hold its offered prices firm for 30 days.

SEE LINE ITEM SCHEDULE

(Attach Additional Sheets as Necessary)

26. AWARD AMOUNT (For Gov’t use only)

$ 180,000,000.00 27a. SOLICITATION INCORPORATES BY REFERENCE FAR 52.212-1, 52.212-4. FAR 52.212-3 AND 52.212-5 ARE ATTACHED. ADDENDA ARE ARE NOT ATTACHED.

27b. CONTRACT/PURCHASE ORDER INCORPORATES BY REFERENCE FAR 52.212-4. FAR 52.212-5 IS ATTACHED. ADDENDA ARE ARE NOT ATTACHED.

28. CONTRACTOR IS REQUIRED TO SIGN THIS DOCUMENT AND RETURN COPIES TO ISSUING

OFFICE. CONTRACTOR AGREES TO FURNISH AND DELIVER ALL ITEMS SET FORTH OR OTHERWISE IDENTIFIED ABOVE AND ON ANY ADDITIONAL SHEETS SUBJECT TO THE TERMS AND CONDITIONS

SPECIFIED HEREIN.

29. AWARD OF CONTRACT: REF. OFFER DATED - - . YOUR OFFER ON

SOLICITATION (BLOCK 5), INCLUDING ANY ADDITIONS OR CHANGES WHICH ARE

SET FORTH HEREIN, IS ACCEPTED AS TO ITEMS:

30a. SIGNATURE OF OFFEROR/CONTRACTOR 31a. UNITED STATES OF AMERICA (SIGNATURE OF CONTRACTING OFFICER)

30b. NAME AND TITLE OF SIGNER (Type or print) 30c. DATE SIGNED 31b. NAME OF CONTRACTING OFFICER (Type or print) 31c. DATE SIGNED

X X

X X

X

25. ACCOUNTING AND APPROPRIATION DATA SEE FUNDS SCHEDULE

X

SCD:C

Total

X

STANDARD FORM 1449 (REV. 2/2012) BACK

COMPUTER GENERATED 12/3/2019, 8:02 AM

32a. QUANTITY IN COLUMN 21 HAS BEEN

RECEIVED INSPECTED ACCEPTED, AND CONFORMS TO THE CONTRACT, EXCEPT AS NOTED:

32b. SIGNATURE OF AUTHORIZED GOV’T REPRESENTATIVE

41a. I CERTIFY THIS ACCOUNT IS CORRECT AND PROPER FOR PAYMENT

41b. SIGNATURE AND TITLE OF CERTIFYING OFFICER

32c. DATE

41c. DATE

33. SHIP NUMBER 34. VOUCHER NUMBER 35. AMOUNT VERIFIED

CORRECT FOR

PARTIAL FINAL

37. CHECK NUMBER36. PAYMENT

COMPLETE PARTIAL FINAL

38. S/R ACCOUNT NUMBER 39. S/R VOUCHER NUMBER 40. PAID BY

42a. RECEIVED BY (Print)

42b. RECEIVED AT (Location)

42c. DATE REC’D (YY/MM/DD) 42d. TOTAL CONTAINERS

19.

ITEM NO.

20.

SCHEDULE OF SUPPLIES/SERVICES

21.

QUANTITY

22.

UNIT

23.

UNIT PRICE

24.

AMOUNT

SEE LINE ITEM SCHEDULE

(Attach Additional Sheets as Necessary)

32d. PRINTED NAME AND TITLE OF AUTHORIZED GOVERNMENT REPRESENTATIVE

32e. MAILING ADDRESS OF AUTHORIZED GOVERNMENT REPRESENTATIVE 32f. TELEPHONE NUMBER OF AUTHORIZED GOVERNMENT REPRESENTATIVE

32g. E-MAIL OF AUTHORIZED GOVERNMENT REPRESENTATIVE

FA8504-20-R-0002

SUPPLIES OR SERVICES AND PRICES/COSTS

B.1 General:

B.2 Contract Type:

B.3 Ordering Periods:

CLINs Ordering Period Date(s)

B.4 Anticipated Contract Structure and Pricing:

B.5 Ordering Authority:

NP2000 Propeller LRU ‐ Repair

Item No.

Quantity U/I Unit Price Amount

Limitations of Liability:

NP2000 Propeller LRU ‐ Repair

Inspection:

Acceptance:

Inspection/Acceptance Report:

Quality Assurance:

Type / Ship To Quantity (U/I) To be cited on individual orders issued hereunder

_ Req No / Pri

Required Delivery

Proposed Delivery

NP2000 Propeller LRU ‐ Repair and Modify

Item No.

Quantity U/I Unit Price

Limitations of Liability:

Inspection:

Acceptance:

Inspection/Acceptance Report:

Quality Assurance:

Type / Ship To Quantity (U/I) To be cited on individual orders issued hereunder

_ Req No / Pri

Required Delivery

Proposed Delivery

Beyond Economical Repair

Item No.

Quantity U/I Unit Price Amount

Beyond Economical Repair

Limitations of Liability:

Inspection:

Acceptance:

Inspection/Acceptance Report:

Quality Assurance:

Type / Ship To Quantity (U/I) To be cited on individual orders issued hereunder

_ Req No / Pri

Required Delivery

Proposed Delivery

Over and Above

Item No.

Quantity U/I Unit Price Amount

Limitations of Liability:

Inspection:

Acceptance:

Inspection/Acceptance Report:

Quality Assurance:

Type / Ship To Quantity (U/I) To be cited on individual orders issued hereunder

_ Req No / Pri

Required Delivery

Proposed Delivery

Over and Above

Engineering Services

Item No.

Quantity U/I Unit Price

Limitations of Liability:

Inspection:

Acceptance:

Inspection/Acceptance Report:

Quality Assurance:

Type / Ship To Quantity (U/I) To be cited on individual orders issued hereunder

_ Req No / Pri

Required Delivery

Proposed Delivery

Travel

Item No.

Quantity U/I Est Unit Cost Total Estimated Cost

Limitations of Liability:

Inspection:

Acceptance:

Inspection/Acceptance Report:

Quality Assurance:

Travel

Type / Ship To Quantity (U/I) To be cited on individual orders issued hereunder

_ Req No / Pri

Required Delivery

Proposed Delivery

DATA ‐ CDRLS

Item No.

Quantity U/I Unit Price

CDRL TITLE DOCUMENT ID PWS REF

Limitations of Liability:

Inspection:

Acceptance:

Inspection/Acceptance Report:

Exhibit:

Quality Assurance:

Type / Ship To Quantity (U/I) To be cited on individual orders issued hereunder

_ Req No / Pri

Required Delivery

Proposed Delivery

SHIP TO / PLACE OF PERFORMANCE

TYPE/CODE:

MARK FOR: (See Individual Line Item) REQUISITION NUMBER: (See Individual Line Item) REQUISITION PRIORITY: (See Individual Line Item)

AWARD NUMBER:

CONTRACT CLAUSES

252.203‐7000 REQUIREMENTS RELATING TO COMPENSATION OF FORMER DOD OFFICIALS

252.203-7003 AGENCY OFFICE OF THE INSPECTOR GENERAL (DEC 2012)

(IAW DFARS 203.1004(a), DFARS 212.301(f)(iii))

252.205-7000 PROVISION OF INFORMATION TO COOPERATIVE AGREEMENT HOLDERS

(DEC 1991)

(IAW DFARS 205.470, DFARS 212.301(f)(x))

252.211-7003 ITEM UNIQUE IDENTIFICATION AND VALUATION (MAR 2016)

(IAW DFARS 211.274-6(a)(1), DFARS 212.301(f)(xii)) Definitions

Unique item identifier.

52.212-5 CONTRACT TERMS AND CONDITIONS REQUIRED TO IMPLEMENT STATUTES OR

EXECUTIVE ORDERS--COMMERCIAL ITEMS (OCT 2019)

(IAW FAR 12.301(b)(4))

52.203‐19

[Contracting Officer check as appropriate.] X 52.203‐6

Alternate I

X 52.203‐13, 52.203‐15

X 52.204‐10

52.204‐14

52.204‐15, X 52.209‐6

X 52.209‐9, 52.219‐3

Alternate I

52.219‐4

Alternate I

52.219‐6

Alternate I

Alternate II

52.219‐7

Alternate I

Alternate II

X 52.219‐8

X 52.219‐9

Alternate I

Alternate II

Alternate III

Alternate IV

52.219‐13

52.219‐14

X 52.219‐16

52.219‐27

X 52.219‐28

52.219‐29, 52.219‐30, X 52.222‐3

52.222‐19

X 52.222‐21

X 52.222‐26

Alternate I

X 52.222‐35

Alternate I

X 52.222‐36

Alternate I

X 52.222‐37

X 52.222‐40

X 52.222‐50

Alternate I

52.222‐54

52.223‐9

Alternate I

52.223‐11

52.223‐12

52.223‐13

Alternate I

52.223‐14

Alternate I

52.223‐15

52.223‐16

Alternate I

X 52.223‐18

X 52.223‐20

52.223‐21

X 52.224‐3

Alternate I

52.225‐1

52.225‐3

Alternate I

Alternate II

Alternate III

52.225‐5 et seq.

X 52.225‐13

52.225‐26

52.226‐4

52.226‐5

52.232‐29

52.232‐30

52.232‐33

52.232‐34

52.232‐36

52.239‐1

X 52.242‐5

52.247‐64

Alternate I

Alternate II

[Contracting Officer check as appropriate.] 52.222‐17

X 52.222‐41 X 52.222‐42

52.222‐43

X 52.222‐44

52.222‐51

52.222‐53

X 52.222‐55 X 52.222‐62 52.226‐6

52.237‐11

Comptroller General Examination of Record

52.203‐13

52.203‐19

52.204‐23

X

252.219-7003 SMALL BUSINESS SUBCONTRACTING PLAN (DoD CONTRACTS) (MAY 2019) (IAW DFARS 219.708(b)(1)(A), DFARS 219.708(b)(1)(A)(1))

252.219-7003 SMALL BUSINESS SUBCONTRACTING PLAN (DoD CONTRACTS)--ALTERNATE I

(MAY 2019)

(IAW DFARS 219.708(b)(1)(A)(2), DFARS 219.708(b)(1)(A)(1))

252.219-7004 SMALL BUSINESS SUBCONTRACTING PLAN (TEST PROGRAM) (MAY 2019)

(IAW DFARS 219.708(b)(1)(B))

252.223-7008 PROHIBITION OF HEXAVALENT CHROMIUM (JUN 2013)

(IAW DFARS 223.7306, DFARS 212.301(f)(xxi))

252.225-7012 PREFERENCE FOR CERTAIN DOMESTIC COMMODITIES (DEC 2017)

(IAW DFARS 225.7002-3(a))

252.226-7001 UTILIZATION OF INDIAN ORGANIZATIONS, INDIAN-OWNED ECONOMIC

ENTERPRISES, AND NATIVE HAWAIIAN SMALL BUSINESS CONCERNS

(APR 2019)

(IAW DFARS 226.104)

252.232-7009 MANDATORY PAYMENT BY GOVERNMENTWIDE COMMERCIAL PURCHASE CARD

(MAY 2018)

(IAW DFARS 232.1110)

252.232-7010 LEVIES ON CONTRACT PAYMENTS (DEC 2006)

(IAW DFARS 232.7102)

252.237-7010 PROHIBITION ON INTERROGATION OF DETAINEES BY CONTRACTOR

PERSONNEL (JUN 2013)

(IAW DFARS 237.173-5)

252.243-7002 REQUESTS FOR EQUITABLE ADJUSTMENT (DEC 2012)

(IAW DFARS 243.205-71)

252.244-7000 SUBCONTRACTS FOR COMMERCIAL ITEMS AND COMMERCIAL COMPONENTS

(DOD CONTRACTS) (JUN 2013)

(IAW DFARS 244.403)

252.246-7007 CONTRACTOR COUNTERFEIT ELECTRONIC PART DETECTION AND AVOIDANCE

SYSTEM (AUG 2016)

(IAW DFARS 246.870-3(a))

252.246-7008 SOURCES OF ELECTRONIC PARTS (MAY 2018)

(IAW DFARS 246-870-3(b))

252.247-7023 TRANSPORTATION OF SUPPLIES BY SEA--BASIC (FEB 2019)

(IAW DFARS 247.574(b))

252.201-7000 CONTRACTING OFFICER'S REPRESENTATIVE (DEC 1991)

(IAW DFARS 201.602-70)

52.203-3 GRATUITIES (APR 1984)

(IAW FAR 3.202)

252.203-7002 REQUIREMENT TO INFORM EMPLOYEES OF WHISTLEBLOWER RIGHTS

(SEP 2013)

(IAW DFARS 203.970)

52.204-18 COMMERCIAL AND GOVERNMENT ENTITY CODE MAINTENANCE (JUL 2016)

(IAW FAR 4.1804(c), FAR 12.301(d))

52.204-19 INCORPORATION BY REFERENCE OF REPRESENTATIONS AND CERTIFICATIONS

(DEC 2014)

(IAW FAR 4.1202(b))

52.204-21 BASIC SAFEGUARDING OF COVERED CONTRACTOR INFORMATION SYSTEMS

(JUN 2016)

(IAW FAR 4.1903)

52.204-23 PROHIBITION ON CONTRACTING FOR HARDWARE, SOFTWARE, AND SERVICES

DEVELOPED OR PROVIDED BY KASPERSKY LAB AND OTHER COVERED

ENTITIES (JUL 2018)

(IAW FAR 4.2004)

52.204-25 PROHIBITION ON CONTRACTING FOR CERTAIN TELECOMMUNICATIONS AND

VIDEO SURVEILLANCE SERVICES OR EQUIPMENT (AUG 2019)

(IAW 4.2105(b))

252.204-7004 Level I Antiterrorism Awareness Training for Contractors (FEB 2019)

(IAW IAW 204.7203)

252.204-7004 BASIC AGREEMENT APPLICABILITY (FEB 2019)

252.204-7012 SAFEGUARDING COVERED DEFENSE INFORMATION AND CYBER INCIDENT

REPORTING (OCT 2016)

(IAW DFARS 204.7304(c))

252.204-7015 NOTICE OF AUTHORIZED DISCLOSURE OF INFORMATION FOR LITIGATION

SUPPORT (MAY 2016)

(IAW DFARS 204.7403(c), DFARS 212.301(f)(ix))

52.211-8 TIME OF DELIVERY (JUN 1997)

(IAW FAR 11.404(a)(2))

252.211-7007 REPORTING OF GOVERNMENT-FURNISHED PROPERTY (AUG 2012)

(IAW DFARS 211.274-6(b), DFARS 212.301(f)(iv))

52.212-4 CONTRACT TERMS AND CONDITIONS--COMMERCIAL ITEMS (OCT 2018)

(IAW FAR 12.301(b)(3))

52.216-11 COST CONTRACT--NO FEE (APR 1984)

(IAW FAR 16.307(e)(1))

52.216-19 ORDER LIMITATIONS (OCT 1995)

(IAW FAR 16.506(b))

Minimum order $ 150,000.00

Maximum order i.e

52.216-22 INDEFINITE QUANTITY (OCT 1995)

(IAW FAR 16.506(e))

29‐JUN‐2025

52.216-32 TASK-ORDER AND DELIVERY-ORDER OMBUDSMAN (SEP 2019)

(IAW 16.506(j))

Timothy R. Inman 478 222 4097 000 000 0000 timothy.inman@us.af.mil e.g., 252.216-7006 ORDERING (SEP 2019)

(IAW DFARS 216.506(a))

30‐JUN‐2020 through 29‐JUN‐2025

52.217-8 OPTION TO EXTEND SERVICES (NOV 1999)

(IAW FAR 17.208(f))

252.217-7028 OVER AND ABOVE WORK (DEC 1991)

(IAW DFARS 217.7702)

THE FOLLOWING IS FILL‐IN DATA FOR CLAUSE 52.212‐5 PARA (b)(22):

52.219‐28 POST‐AWARD SMALL BUSINESS PROGRAM REREPRESENTATION

[ ] is, [ ] is not _____________

Contractor to sign and date and insert authorized signer's name and title

52.222-1 NOTICE TO THE GOVERNMENT OF LABOR DISPUTES (FEB 1997)

(IAW FAR 22.103-5(a), AFFARS 5322.101-1)

52.222-2 PAYMENT FOR OVERTIME PREMIUMS (JUL 1990)

(IAW FAR 22.103-5(b))

*Overtime Premium $

THE FOLLOWING IS FILL‐IN DATA FOR CLAUSE 52.212‐5 PARA (c)(2):

52.222‐42 STATEMENT OF EQUIVALENT RATES FOR FEDERAL HIRES

This Statement is for Information Only:

It is not a Wage Determination

252.223-7006 PROHIBITION ON STORAGE, TREATMENT, AND DISPOSAL OF TOXIC OR

HAZARDOUS MATERIALS--BASIC (SEP 2014)

(IAW DFARS 223.7106)

5352.223-9001 HEALTH AND SAFETY ON GOVERNMENT INSTALLATIONS (NOV 2012)

(IAW AFFARS 5323.9001)

252.225-7013 DUTY-FREE ENTRY (MAY 2016)

(IAW DFARS 225.1101(4))

252.225-7048 EXPORT-CONTROLLED ITEMS (JUN 2013)

(IAW DFARS 225.7901-4)

252.225-7052 RESTRICTION ON THE ACQUISITION OF CERTAIN MAGNETS AND TUNGSTEN

(APR 2019)

(IAW DFARS 225.7018-5)

52.228-7 INSURANCE--LIABILITY TO THIRD PERSONS (MAR 1996)

(IAW FAR 28.311-1)

52.229-4 FEDERAL, STATE, AND LOCAL TAXES (STATE AND LOCAL ADJUSTMENTS)

(FEB 2013)

(IAW FAR 29.401-3(b))

52.230-6 ADMINISTRATION OF COST ACCOUNTING STANDARDS (JUN 2010)

(IAW FAR 30.201-4(d)(1))

52.232-20 LIMITATION OF COST (APR 1984)

(IAW FAR 32.706-2(a))

52.232-39 UNENFORCEABILITY OF UNAUTHORIZED OBLIGATIONS (JUN 2013)

(IAW FAR 32.706-3)

52.232-40 PROVIDING ACCELERATED PAYMENTS TO SMALL BUSINESS

SUBCONTRACTORS (DEC 2013)

(IAW FAR 32.009-2)

52.242-1 NOTICE OF INTENT TO DISALLOW COSTS (APR 1984)

(IAW FAR 42.802)

52.242-4 CERTIFICATION OF FINAL INDIRECT COSTS (JAN 1997)

(IAW FAR 42.703-2(f))

CERTIFICATE OF FINAL INDIRECT COSTS

identify proposal and date identify period covered by rate

252.242-7004 MATERIAL MANAGEMENT AND ACCOUNTING SYSTEM (MAY 2011)

(IAW DFARS 242.7204)

52.243-1 CHANGES--FIXED-PRICE (AUG 1987)

(IAW FAR 43.205(a)(1))

52.243-2 CHANGES--COST-REIMBURSEMENT (AUG 1987)

(IAW FAR 43.205(b)(1))

52.243-2 CHANGES--COST-REIMBURSEMENT -- ALTERNATE I (APR 1984)

(IAW FAR 43.205(b)(2))

52.243-2 CHANGES--COST-REIMBURSEMENT -- ALTERNATE II (APR 1984)

(IAW FAR 43.205(b)(3))

252.243-7001 PRICING OF CONTRACT MODIFICATIONS (DEC 1991)

(IAW DFARS 243.205-70)

52.245-1 GOVERNMENT PROPERTY (JAN 2017)

(IAW FAR 45.107(a), DFARS 237.7003(c), DFARS 245.107)

52.245-9 USE AND CHARGES (APR 2012)

(IAW FAR 45.107(c))

252.245-7001 TAGGING, LABELING, AND MARKING OF GOVERNMENT-FURNISHED PROPERTY

(APR 2012)

(IAW DFARS 245.107(2))

252.245-7002 REPORTING LOSS OF GOVERNMENT PROPERTY (DEC 2017)

(IAW DFARS 245.107(3))

252.245-7003 CONTRACTOR PROPERTY MANAGEMENT SYSTEM ADMINISTRATION (APR 2012)

(IAW DFARS 245.107(4))

252.245-7004 REPORTING, REUTILIZATION, AND DISPOSAL (DEC 2017)

(IAW DFARS 245.107(5))

INSPECTION AND ACCEPTANCE (SEP 1999)

(IAW FAR 46.401(b), FAR 46.503)

[CONTRACTOR FILL‐IN]

See schedule for items with the following code(s) listed below :

Inspection Code and Address:

Item No(s): X007

52.251-1 GOVERNMENT SUPPLY SOURCES (APR 2012)

(IAW FAR 51.107)

252.251-7000 ORDERING FROM GOVERNMENT SUPPLY SOURCES (AUG 2012)

(IAW DFARS 251.107)

Contractor's Billing Address

Government Remittance Address

00000‐0000

52.252-6 AUTHORIZED DEVIATIONS IN CLAUSES (APR 1984)

(IAW FAR 52.107(f))

Defense Federal Acquisition Regulation Supplement Chapter 2

LIST OF DOCUMENTS, EXHIBITS OR ATTACHMENTS

SOLICITATION PROVISIONS

REPRESENTATIONS, INSTRUCTIONS AND EVALUATIONS

52.212-3 OFFEROR REPRESENTATIONS AND CERTIFICATIONS--COMMERCIAL ITEMS

(OCT 2018)

(IAW FAR 12.301(b)(2))

Annual Representations and Certifications

[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.]

[ ] is, [ ] is not [ ] is, [ ] is not [ ] is, [ ] is not [ ] is, [ ] is not [ ] is, [ ] is not

Note

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.]

[ ] is, [ ] is not

[ ] is, [ ] is not

[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: ______________.]

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.]

[ ] is, [ ] is not

[ ] is, [ ] is not

The offeror shall enter the name or names of the EDWOSB concern and other small businesses that are participating in the joint venture: ______________].

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.] [ ] is

Tie bid priority for labor surplus area concerns.

HUBZone small business concern. [Complete only if the offeror represented itself as a small business concern in paragraph (c)(1) of this provision.]

[ ] is, [ ] is not

[ ] is, [ ] is not

[The offeror shall enter the names of each of the HUBZone small business concerns participating in the HUBZone joint venture: ____________.]

Representations required to implement provisions of Executive Order 11246‐‐

[ ] has, [ ] has not

[ ] has, [ ] has not Affirmative Action Compliance.

[ ] has [ ] has not [ ] has not

Buy American Certificate i.e

Buy American‐‐Free Trade Agreement—Israeli Trade Act Certificate.

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

i.e

Other Foreign End Products:

Buy American‐‐Free Trade Agreements‐‐Israeli Trade Act Certificate, Alternate I.

Canadian End Products:

Buy American‐‐Free Trade Agreements‐‐Israeli Trade Act Certificate, Alternate II.

Canadian or Israeli End Products:

Buy Americant—Free Trade Agreements—Israeli Trade Act Certificate, Alternate III.

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

Trade Agreements Certificate.

Other End Products:

Certification Regarding Responsibility Matters (Executive Order 12689).

[ ] Are, [ ] are not

[ ] Have, [ ] have not

[ ] Are, [ ] are not

[ ] Have, [ ] have not

The tax liability is finally determined

The taxpayer is delinquent in making payment

Examples

Certification Regarding Knowledge of Child Labor for Listed End Products (Executive Order 13126). [The Contracting Officer must list in paragraph (j)(1) any end products being acquired under this solicitation that are included in the List of Products Requiring Contractor Certification as to Forced or Indentured Child Labor; unless excluded at 22.1503(b).]

Listed End Products.

(2) Certification. [If the Contracting Officer has identified end products and countries of origin in paragraph (j)(1) of this provision, then the offeror must certify to either (j)(2)(i) or (j)(2)(ii) by checking the appropriate block.]

Place of Manufacture.

Certificates regarding exemptions from the application of the Service Contract Labor Standards

[ ] [ ] does [ ]

Taxpayer Identification Number (TIN) (26 U.S.C. 6109, 31 U.S.C. 7701)

Taxpayer Identification Number

Type of organization.

Common parent.

Restricted business operations in Sudan

Prohibition on Contracting with Inverted Domestic Corporations.

Representation

Ownership or Control of Offeror

Representation by Corporations Regarding Delinquent Tax Liability or a Felony Conviction under any Federal Law.

is [ ] is not [ ] is [ ] is not [ ]

Predecessor of Offeror.

[ ] is [ ] is not

Representation regarding compliance with labor laws (Executive Order 13673

Offeror [ ] does [ ] does not

Note to paragraph (s):

[ ] does, [ ] does not

[ ] does, [ ] does not

52.212-3 OFFEROR REPRESENTATIONS AND CERTIFICATIONS--COMMERCIAL ITEMS --

ALTERNATE I (OCT 2014)

(IAW FAR 12.301(b)(2))

[The offeror shall check the category in which its ownership falls]:

ADDENDUM TO PROVISION 52.212‐1

52.203-18 PROHIBITION ON CONTRACTING WITH ENTITIES THAT REQUIRE CERTAIN

INTERNAL CONFIDENTIALITY AGREEMENTS OR

STATEMENTS--REPRESENTATION (JAN 2017)

(IAW FAR 3.909-3 (a))

252.203-7005 REPRESENTATION RELATING TO COMPENSATION OF FORMER DOD OFFICIALS

(NOV 2011)

(IAW DFARS 203.171-4(b), DFARS 212.301(f)(iv))

52.204-16 COMMERCIAL AND GOVERNMENT ENTITY CODE REPORTING (JUL 2016)

(IAW FAR 4.1804(a), FAR 12.301(d))

52.204-22 ALTERNATIVE LINE ITEM PROPOSAL (JAN 2017)

(IAW FAR 4.1008)

52.204-24 REPRESENTATION REGARDING CERTAIN TELECOMMUNICATIONS AND VIDEO

SURVEILLANCE SERVICES OR EQUIPMENT (AUG 2019)

(IAW 4.2105(a))

252.204-7008 COMPLIANCE WITH SAFEGUARDING COVERED DEFENSE INFORMATION

CONTROLS (OCT 2016)

(IAW DFARS 204.7304(a))

52.209-7 INFORMATION REGARDING RESPONSIBILITY MATTERS (OCT 2018)

(IAW FAR 9.104-7(b))

[_] has [_] does not have

52.209-11 REPRESENTATION BY CORPORATIONS REGARDING DELINQUENT TAX LIABILITY

OR A FELONY CONVICTION UNDER ANY FEDERAL LAW (FEB 2016)

(IAW FAR 9.104-7(d)) is [ ] is not [ ] is [ ] is not [ ]

52.212-1 INSTRUCTIONS TO OFFERORS--COMMERCIAL ITEMS (DEVIATION 2018-O0018)

(AUG 2018)

(IAW DARS TRACKING # 2018-O0018)

252.215-7013 SUPPLIES AND SERVICES PROVIDED BY NONTRADITIONAL DEFENSE

CONTRACTORS (JAN 2018)

(IAW DFARS 215.408(6))

52.222-46 EVALUATION OF COMPENSATION FOR PROFESSIONAL EMPLOYEES (FEB 1993)

(IAW FAR 22.1103)

52.225-25 PROHIBITION ON CONTRACTING WITH ENTITIES ENGAGING IN CERTAIN

ACTIVITIES OR TRANSACTIONS RELATING TO IRAN--REPRESENTATION AND

CERTIFICATIONS (AUG 2018)

(IAW FAR 25.1103(e))

252.225-7050 DISCLOSURE OF OWNERSHIP OR CONTROL BY THE GOVERNMENT OF A

COUNTRY THAT IS A STATE SPONSOR OF TERRORISM (DEC 2018)

(IAW DFARS 225.771-5)

52.227-6 ROYALTY INFORMATION (APR 1984)

(IAW FAR 27.202-5(a)(1))

NOTE: Refer to FAR clause 52.204‐8 para c(2)(ix)(A)