Federal_Requirements_Bid_Forms.pdf

Federal Requirements Bid Forms TOC Page i of i June 3, 2022

FEDERAL REQUIREMENTS CERTIFICATION FORMS

Table of Contents

FR-4 Buy American Certification Form

FR-11

FR-12

FR-16

FR-18

FR-19

FR-24

Debarment and Suspension Form

Assurance of Disadvantaged Business Enterprises (DBE) Participation Form

Bidder’s Statement on Previous Contracts Subject to EEO Clause Form

Certification Regarding Lobbying Form

Prohibition of Segregated Facilities Form

Tax Delinquency and Felony Convictions Form

FR-26 Trade Restriction Clause Form

After reading and reviewing the applicable related Federal clauses in Contract Documents, Federal Requirements, please complete the following Certification Forms and submit with bid. Failure to do so may result in the bid being found Nonresponsive.

Federal Requirements Bid Forms FR-4 Page 1 of 11

FEDERAL REQUIREMENTS

FR – 4 CERTIFICATION FORM

Certificate of Buy American Compliance for Manufactured Products

As a matter of bid responsiveness, the bidder or offeror must complete, sign, date, and submit this certification statement with their proposal. The bidder or offeror must indicate how they intend to comply with 49 USC § 50101 by selecting one on the following certification statements. These statements are mutually exclusive.

Bidder must select one or the other (not both) by inserting a checkmark () or the letter “X”.

Bidder or offeror hereby certifies that it will comply with 49 USC § 50101 by:

a) Only installing steel and manufactured products produced in the United States;

b) Installing manufactured products for which the Federal Aviation Administration (FAA) has issued a waiver as indicated by inclusion on the current FAA Nationwide Buy American Waivers Issued listing; or

c) Installing products listed as an Excepted Article, Material or Supply in Federal Acquisition Regulation Subpart 25.108.

By selecting this certification statement, the bidder or offeror agrees:

1. To provide to the Owner evidence that documents the source and origin of the steel and manufactured product.

2. To faithfully comply with providing U.S. domestic product.

3. To furnish U.S. domestic product for any waiver request that the FAA rejects

4. To refrain from seeking a waiver request after establishment of the contract, unless extenuating circumstances emerge that the FAA determines justified.

The bidder or offeror hereby certifies it cannot comply with the 100 percent Buy American Preferences of 49 USC § 50101(a) but may qualify for either a Type 3 or Type 4 waiver under 49 USC § 50101(b).

By selecting this certification statement, the apparent bidder or offeror with the apparent low bid agrees:

1. To the submit to the Owner within 15 calendar days of the bid opening, a formal waiver request and required documentation that supports the type of waiver being requested.

2. That failure to submit the required documentation within the specified timeframe is cause for a non-responsive determination may result in rejection of the proposal.

3. To faithfully comply with providing U.S. domestic products at or above the approved U.S.

domestic content percentage as approved by the FAA.

4. To refrain from seeking a waiver request after establishment of the contract, unless extenuating circumstances emerge that the FAA determines justified.

Required Documentation

Type 3 Waiver – The cost of the item components and subcomponents produced in the United States is more that 60 percent of the cost of all components and subcomponents of the “item”. The required documentation for a Type 3 waiver is:

a) Listing of all product components and subcomponents that are not comprised of 100 percent U.S. domestic content (Excludes products listed on the FAA Nationwide Buy American Waivers Issued listing and products excluded by Federal Acquisition

b) Regulation Subpart 25.108; products of unknown origin must be considered as non-domestic products in their entirety).

c) Cost of non-domestic components and subcomponents, excluding labor costs associated with final assembly at place of manufacture.

Federal Requirements Bid Forms FR-4 Page 2 of 11

d) Percentage of non-domestic component and subcomponent cost as compared to total “item” component and subcomponent costs, excluding labor costs associated with final assembly at place of manufacture.

Type 4 Waiver – Total cost of project using U.S. domestic source product exceeds the total project cost using non-domestic product by 25 percent. The required documentation for a Type 4 of waiver is:

a) Detailed cost information for total project using U.S. domestic product

b) Detailed cost information for total project using non-domestic product

False Statements: Per 49 USC § 47126, this certification concerns a matter within the jurisdiction of the Federal Aviation Administration and the making of a false, fictitious or fraudulent certification may render the maker subject to prosecution under Title 18, United States Code.

Date Signature

Company Name Title

FR-4 Buy American Certification

Federal Requirements Bid Forms FR-4 Page 3 of 11

FEDERAL REQUIREMENTS

FR – 11 CERTIFICATION FORM

SUSPENSION AND DEBARMENT REQUIREMENTS FOR

ALL CONTRACTS OVER $25,000

The Proposer/offeror certifies, by this submission of this proposal or acceptance of this contract, that neither it nor its principals is presently debarred, suspended, proposed for debarment, declared ineligible, or voluntarily excluded from participation in this transaction by any Federal department or agency. Proposer further agrees by submitting this proposal that it will include this clause without modification in all lower tier transactions, solicitations, proposals, contracts, and subcontracts. Where the Proposer/offeror/contractor or any lower tier participant is unable to certify to this statement, it shall attach an explanation to this solicitation/proposal.

Date

Authorized Signature

Print Name

Title of Signer

Company Name

Company Address

Authority, State, Zip Code

NOTE: Failure to complete the blanks may be grounds for rejecting the Proposal.

FR-11 Suspension & Debarment Certification

Federal Requirements Bid Forms FR-12 Page 4 of 11

FEDERAL REQUIREMENTS

FR – 12 CERTIFICATION FORM

ASSURANCE OF DISADVANTAGED BUSINESS ENTERPRISE PARTICIPATION

(To meet the mandated requirements of the United States Department of Transportation, 49 CFR Part 23, the assurance below shall be signed by the Bidder and submitted with the Technical Proposal.)

Bidder's Assurance of Compliance with Title 49, CFR Part 23 Relating To Disadvantaged Business Enterprise Participation.

The Proposer hereby gives assurance pursuant to the requirements of Title 49 CFR Part 23 that bidder has made a reasonable effort to meet the goals for Disadvantaged Business Enterprise participation specified for the contract for which this Proposal is submitted and that bidder, if the contract is awarded to Proposer, will have the DBE participation as indicated below.

Proposer further gives assurance that bidder will submit the documentation required by said Regulations and the contract specifications, including the Listing of Disadvantaged Business Enterprises with which the Proposer will subcontract if the contract is awarded and if Proposer is unable to meet the contract goals for DBE participation, of the steps Proposer has taken to obtain DBE participation.

The DBE goal for this project is 13%.

The bidder / offeror is committed to a minimum of % DBE utilization on this contract.

Date

Authorized Signature

Print Name

Title of Signer

Company Name

Company Address

Authority, State, Zip Code

* Proposer shall insert the percentage for the DBE participation even if the percentage is less than the contract goal.

FR 12 Assurance of DBE Participation

Federal Requirements Bid Forms FR-12 Page 5 of 11

FEDERAL REQUIREMENTS

FR – 16 CERTIFICATION FORM

BIDDER’S STATEMENT ON PREVIOUS CONTRACTS SUBJECT TO EEO CLAUSE

The Proposer shall complete the following statement by checking the appropriate boxes.

The Proposer has □ has not □ participated in a previous contract subject to the equal opportunity clause prescribed by Executive Order 11246, as amended, of September 24, 1965.

The Proposer has □ has not □ submitted all compliance reports in connection with any such contract due under the applicable filing requirements; and that representations indicating submission of required compliance reports signed by proposed subcontractors will be obtained prior to award of subcontracts.

If the Proposer has participated in a previous contract subject to the equal opportunity clause and has not submitted compliance reports due under applicable filing requirements, the Proposer shall submit a compliance report on Standard Form 100, "Employee Information Report EEO-I" prior to award of the contract.

Date

Authorized Signature

Print Name

Title of Signer

Company Name

Company Address

Authority, State, Zip Code

NOTE: Failure to complete the blanks may be grounds for rejecting the Proposal.

FR-16 Bidder’s Statement on Previous Contracts Subject to EEO Clause

Federal Requirements Bid Forms FR-18 Page 6 of 11

FEDERAL REQUIREMENTS

FR – 18 CERTIFICATION FORM

CERTIFICATION REGARDING LOBBYING

The Bidder or Offeror certifies by signing and submitting this bid or proposal, to the best of his or her knowledge and belief, that:

(1) No Federal appropriated funds have been paid or will be paid, by or on behalf of the Bidder or Offeror, to any person for influencing or attempting to influence an officer or employee of an agency, a Member of Congress, an officer or employee of Congress, or an employee of a Member of Congress in connection with the awarding of any Federal contract, the making of any Federal grant, the making of any Federal loan, the entering into of any cooperative agreement, and the extension, continuation, renewal, amendment, or modification of any Federal contract, grant, loan, or cooperative agreement.

(2) If any funds other than 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 in connection with this Federal contract, grant, loan, or cooperative agreement, the undersigned shall complete and submit Standard Form-LLL, “Disclosure Form to Report Lobbying,” in accordance with its instructions.

(3) The undersigned shall require that the language of this certification be included in the award documents for all sub-awards at all tiers (including subcontracts, subgrants, and contracts under grants, loans, and cooperative agreements) and that all sub-recipients shall certify and disclose accordingly.

Date

Authorized Signature

Print Name

Title of Signer

Company Name

Company Address

Authority, State, Zip Code

FR-18 Certification Regarding Lobbying

A12: Federal Requirements Bid Forms Issued for Bid

FR-19 Page 7 of 11 June 3, 2022

PROHIBITION of SEGREGATED FACILITIES

(a) The Contractor agrees that it does not and will not maintain or provide for its employees any segregated facilities at any of its establishments, and that it does not and will not permit its employees to perform their services at any location under its control where segregated facilities are maintained. The Contractor agrees that a breach of this clause is a violation of the Equal Opportunity clause in this contract.

(b) “Segregated facilities,” as used in this clause, means any waiting rooms, work areas, restrooms and wash rooms, restaurants and other eating areas, time clocks, locker rooms and other storage or dressing areas, parking lots, drinking fountains, recreation or entertainment areas, transportation, and housing facilities provided for employees, that are segregated by explicit directive or are in fact segregated on the basis of race, color, religion, sex, or national origin because of written or oral policies or employee custom. The term does not include separate or single-user rest rooms or necessary dressing or sleeping areas provided to assure privacy between the sexes.

(c) The Contractor shall include this clause in every subcontract and purchase order that is subject to the Equal

Opportunity clause of this contract.

Date Signature and Title

IRS Employer Identification Number

FR-19 Prohibition of Segregated Facilities

FEDERAL REQUIREMENTS

FR – 24 CERTIFICATION FORM

Federal Requirements Bid Forms Issued for Bid

FR-24 Page 8 of 11 June 3, 2022

CERTIFICATION OF OFFERER/BIDDER REGARDING TAX DELINQUENCY

AND FELONY CONVICTIONS

The applicant must complete the following two certification statements. The applicant must indicate its current status as it relates to tax delinquency and felony conviction by inserting a checkmark () in the space following the applicable response. The applicant agrees that, if awarded a contract resulting from this solicitation, it will incorporate this provision for certification in all lower tier subcontracts.

Certifications

1. The applicant represents that it is is not a corporation that has any unpaid Federal tax liability that has been assessed, for which all judicial and administrative remedies have been exhausted or have lapsed, and that is not being paid in a timely manner pursuant to an agreement with the authority responsible for collecting the tax liability.

2. The applicant represents that it is is not is not a corporation that was convicted of a criminal violation under any Federal law within the preceding 24 months.

Note

If an applicant responds in the affirmative to either of the above representations, the applicant is ineligible to receive an award unless the sponsor has received notification from the agency suspension and debarment official (SDO) that the SDO has considered suspension or debarment and determined that further action is not required to protect the Government’s interests. The applicant therefore must provide information to the owner about its tax liability or conviction to the Owner, who will then notify the FAA Airports District Office, which will then notify the agency’s SDO to facilitate completion of the required considerations before award decisions are made.

Term Definitions

Felony conviction: Felony conviction means a conviction within the preceding twenty-four (24) months of a felony criminal violation under any Federal law and includes conviction of an offense defined in a section of the U.S. code that specifically classifies the offense as a felony and conviction of an offense that is classified as a felony under 18 U.S.C. § 3559.

Tax Delinquency: A tax delinquency is any unpaid Federal tax liability that has been assessed, for which all judicial and administrative remedies have been exhausted, or have lapsed, and that is not being paid in a timely manner pursuant to an agreement with the authority responsible for collecting the tax liability.

Continued Next Page…

FR-24 Tax Delinquency and Felony Convictions

FR – 24 CERTIFICATION FORM

Federal Requirements Bid Forms Issued for Bid

FR-24 Page 9 of 11 June 3, 2022

CERTIFICATION OF OFFER BIDDER REGARDING TAX

DELINQUENCY AND FELONY CONVICTIONS

(Contractors/Subcontractors) (Continued)

Date

Authorized Signature

Print Name

Title of Signer

Company Name

Company Address

FR -24 Tax Delinquency and Felony Convictions

FR – 26 CERTIFICATION FORM

Federal Requirements Bid Forms Issued for Bid

FR-26 Page 10 of 11 June 3, 2022

TRADE RESTRICTION CLAUSE

The contractor or subcontractor, by submission of an offer and/or execution of contract, certifies that it:

a. is not owned or controlled by one or more citizens or nationals of a foreign country included in the list of countries that discriminate against U.S. firms published by the Office of the United States Trade Representative (USTR);

b. has not knowingly entered into any contract or subcontract for this project with a person that is a citizen or a national of a foreign country on said list, or is owned or controlled directly or indirectly by one or more citizens or nationals of a foreign country on said list;

c. has not procured any product nor subcontracted for the supply of any product for use on the project that is produced in a foreign country on said list.

Unless the restrictions of this clause are waived by the Secretary of Transportation in accordance with, no contract shall be awarded to a contractor or subcontractor who is unable to certify to the above. If the contractor knowingly procures or subcontracts for 49 CFR 30.17the supply of any product or service of a foreign country on the said list for use on the project, the Federal Aviation Administration may direct, through the sponsor, cancellation of the contract at no cost to the Government.

Further, the contractor agrees that, if awarded a contract resulting from this solicitation, it will incorporate this provision for certification without modification in each contract and in all lower tier subcontracts. The contractor may rely on the certification of a prospective subcontractor unless it has knowledge that the certification is erroneous.

The contractor shall provide immediate written notice to the sponsor if the contractor learns that its certification or that of a subcontractor was erroneous when submitted or has become erroneous by reason of changed circumstances. The subcontractor agrees to provide immediate written notice to the contractor, if at any time it learns that its certification was erroneous by reason of changed circumstances.

This certification is a material representation of fact upon which reliance was placed when making the award. If it is later determined that the contractor or subcontractor knowingly rendered an erroneous certification, the Federal Aviation Administration may direct, through the sponsor, cancellation of the contract or subcontract for default at no cost to the Government.

(Continued)

FR-26 Trade Restriction Clause

FR – 26 CERTIFICATION FORM

Federal Requirements Bid Forms Issued for Bid

FR-26 Page 11 of 11 June 3, 2022

TRADE RESTRICTION CLAUSE

(Continued)

Nothing contained in the foregoing shall be construed to require establishment of a system of records in order to render, in good faith, the certification required by this provision. The knowledge and information of a contractor is not required to exceed that which is normally possessed by a prudent person in the ordinary course of business dealings.

This certification concerns a matter within the jurisdiction of an agency of the United States of America and the making of a false, fictitious, or fraudulent certification may render the maker subject to prosecution under Title 18, United States Code, Section 1001.

Date

Authorized Signature

Print Name

Title of Signer

Company Name

Company Address

FR-26 Trade Restriction Clause