Fiber Optic Materials Procurement Packet Fibe.docx

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Fiber Optic Materials Procurement
Solicitation number
PE-61700-NONST-2026-000000071
Issued by
Calhoun County, Georgia

About this file

This is an Invitation to Bid procurement packet issued by Burke County, Georgia Board of Commissioners for the purchase of fiber optic materials to support the county's Broadband Equity, Access & Deployment (BEAD) program. The procurement solicits sealed bids for fiber optic cable in eleven line items ranging from 24-fiber to 432-fiber configurations (loose tube and ribbon options) totaling approximately 4.8 million feet, and handholes in five size categories totaling 4,332 units across both 15K and 20K load ratings. All materials must comply with Build America, Buy America (BABA) requirements and NTIA standards. Sealed bids must be received by 2:00 PM on May 6, 2026, submitted as one electronic PDF and one sealed hardcopy to the Burke County Manager's Office in Waynesboro, Georgia. Questions must be submitted in writing by COB May 1, 2026. Materials will be delivered in three phased shipments: Phase 1 (40% of total order) in January 2027, Phase 2 (30%) in July 2027, and Phase 3 (30%) in January 2028. The successful bidder will be the lowest responsive and responsible bidder meeting all technical and compliance specifications.

Pricing must be firm and fixed for all three delivery phases, include freight costs (FOB Waynesboro, Georgia), and remain valid for 90 days after submission. Vendors must provide unit pricing for each line item and complete the Burke County FTTP Bidder Pricing Sheet in Excel format. The project is funded through the NTIA BEAD grant program, which requires strict compliance with federal domestic content requirements; however, specific waivers are available for fiber optic cable and components. Vendors must submit comprehensive documentation including manufacturer BABA certification letters for each part number, product datasheets with country and city of manufacture, mechanical specifications, lead times, warranty statements (minimum 5 years), NTIA waivers or de minimis calculations where applicable, and proof of insurance with minimum liability limits of $2 million comprehensive general liability and $3 million excess umbrella liability. Additional mandatory certifications include suspension and debarment certification per 2 CFR Part 180, E-Verify affidavits, anti-lobbying certification, and vendor addendum forms acknowledging all published addenda. Burke County reserves the right to award in whole or in part and reserves the right to reject any or all bids.

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BURKE COUNTY

GEORGIA

BURKE COUNTY BOARD OF COMMISSIONERS

Invitation to Bid Fiber Optic Materials Procurement Packet

EXECUTIVE SUMMARY

Burke County is undertaking a major expansion of its county-wide fiber broadband network as part of its Broadband Equity, Access & Deployment (BEAD) program participation. This procurement seeks vendor pricing for fiber optic cable and handholes required for the County’s multi-year Fiber-To-The-Premise (FTTP) deployment.

This packet includes:

Material line items Fiber specifications Handhole specifications BABA/BEAD compliance requirements Pricing tables Mandatory certifications Vendor addenda Vendors must submit pricing for all listed fiber counts and for both 15K and 20K load-rating handholes. All materials must meet Build America, Buy America (BABA) requirements.

I. PROJECT DESCRIPTION

A. Overview Burke County has been tentatively approved for a Broadband Equity, Access & Deployment (BEAD) grant from the National Telecommunications and Information Administration. The County plans to continue to build a fiber-based 100/10 Gbps broadband network with a minimum symmetrical 100 Mbps / 100 Mbps Fiber-To-The-Premise (FTTP) access to all unserved and underserved locations in Burke County.

The planned service area is the entirety of Burke County, Georgia, with the exception of the City of Waynesboro and those areas which already have broadband service. The zip codes included in the project area are 30830, 30815, 30434, 30805, 30816, 30456, 30441, 30442, and 30426. The census tracts included are 9501, 9501.01, 9501.02, 9502, 9503, 9504, 9505, 9507, 9508, and 9509.

The Burke County Broadband network will be a transformative infrastructure investment for the County and its residents.

II. BID SUMMARY

Burke County is soliciting sealed bids from qualified vendors for the purchase and delivery of fiber optic cable and handholes to support the County’s BEAD-funded broadband deployment. All materials must meet the specifications contained in this packet and must comply with all applicable Federal, State, NTIA, and BABA requirements.

Bids must include:

· Completed pricing tables

· Completed compliance certifications

· Delivery schedule

· Warranty information

· Any required addenda Burke County reserves the right to award the bid in whole or in part, or to reject any or all bids.

III. PROPOSAL AND SUBMISSION INFORMATION

A. Submission Deadline All sealed bids must be received no later than 2:00 PM on May 6, 2026. Late submissions will not be accepted.

B. Submission Format Vendors must submit:

· One (1) electronic PDF

· One (1) sealed hard‑copy submission

· All required attachments

· All pricing tables fully completed

· Burke County FTTP Bidder Pricing Sheet (Excel Format) Submissions must be sealed and clearly labeled marked on the outside of the envelope:

“Burke County Fiber Optic Materials Bid – [Vendor Name]” Submissions must be delivered to:

Burke County Board of Commissioners Burke County Manager’s Office PO Box 89 602 N. Liberty Street Waynesboro, GA 30830 C. Questions and Clarifications All questions must be submitted in writing to: Adam Flakes a.flakes@burkecounty-ga.gov Questions must be received no later than COB May 1, 2026.

D. Bid Evaluation Criteria Bids will be evaluated based on:

· BABA documentation completeness pass/fail

· Technical Compliance with specifications

· BABA and BEAD compliance

· Lead time and delivery schedule

· Pricing unit price and total cost

· Vendor qualifications

· Completeness of required attachments

· Manufacturer warranty and reputation

· Recordkeeping and audit readiness E. Delivery Requirements Vendors must provide:

· Estimated delivery schedule

· Lead times for all fiber counts

· Lead times for handholes

· Notification of supply‑chain constraints

IV. GENERAL REQUIREMENTS

· Late bids will not be accepted.

· Bids will be publicly opened and read aloud at the next scheduled bid opening following the due date.

· Burke County reserves the right to reject any and all bids, waive informalities or technicalities, and accept the bid deemed to be in the best interest of the County.

· The successful bidder must comply with all applicable federal, state, and local regulations.

· Award will be made to the lowest responsive and responsible bidder.

· Vendors must provide pricing for all listed fiber counts.

· Vendors must provide pricing for both 15K and 20K load-rated handholes.

· Vendors must review all specifications, provide accurate pricing, ensure compliance, and deliver materials on time.

· Pricing must be firm, fixed, include freight, and remain valid for 90 days after submission.

· All materials must be new, unused, and fully compliant with BABA requirements.

· If the material doesn’t meet the minimum standards, substitutions must be pre-approved by Burke County. Unapproved substitutions will result in rejection.

· Delivery must occur within Delivery Schedule Requirements unless otherwise prior approved.

· Vendor Must Sign Mandatory BABA Compliance Statement

· Vendor Suspension/debarment certification per 2 CFR Part 180

· Proof of insurance and bonding capacity (if required).

· E‑Verify affidavit A. Acceptance, Inspection, Testing, and Title

· Delivery Terms: FOB Waynesboro Georgia or designated warehouse.

· Inspection: County may inspect materials on arrival; non‑conforming items may be rejected.

· Acceptance Testing: County may require OTDR testing and visual inspection for fiber cable; handhole inspection and ASTM D635 verification.

· Title & Risk of Loss: Title passes to Burke County upon acceptance.

· Record Retention: Vendor must retain BABA/BEAD compliance records and test reports for 3 years after project completion.

B. Warranty, Remedies, and Indemnity

· Warranty: Minimum 5 years manufacturer warranty on materials unless otherwise specified.

· Remedies: Replace defective materials at vendor expense including shipping and labor.

· Indemnity: Vendor indemnifies Burke County for failures to comply with BABA or false certifications.

V. Build America, Buy America (BABA) REQUIREMENTS A. Federal Requirements

· All iron, steel, manufactured products, and construction materials must be produced in the U.S.

· Manufactured products must meet the 55% domestic content rule.

· No BEAD funds may be used for covered communications equipment (47 U.S.C. §1608).

· No BEAD funds may be used for PRC‑manufactured fiber or optical transmission equipment unless a waiver is granted.

B. NTIA BEAD BABA Waiver Waiver Covers (Partially):

· Fiber‑optic cable and components

· Broadband electronics (with specific domestic manufacturing steps)

· Plastics and polymers used in fiber cable

· Enclosures (cabinets, vaults, pedestals, terminals) Waiver Does NOT Cover:

· Iron and steel

· Items not explicitly waived

· Any stricter Georgia requirements C. Vendor Documentation Required

· BABA certification letter (part‑number specific)

· NTIA self‑certification listing (if applicable)

· Manufacturing location details

· Reporting of waived electronics VI. Required Bid Attachments (Per Part Number)

· Manufacturer BABA certification letter (NTIA format preferred).

· Product datasheet for each part number.

· Country and city of manufacture for each manufacturing step.

· Mechanical specification sheet (OD, weight, tensile, bend radius).

· Lead time (calendar days) and warranty statement.

· NTIA waiver or de minimis calculation (if applicable).

VII. Fiber Optic Cable Specification A. Transmission Performance Requirements Ribbon Cable Minimums

· Fiber Category: G.652.D

· Fiber Code: Single‑mode OS2

· Wavelengths: 1310 / 1383 / 1550 nm

· Maximum Attenuation: 0.35 / 0.35 / 0.25 dB/km

· Construction: Single jacket, Single Armored

· Length Markings: Feet (FT)

· Gel Status: Gel‑Free

· Must support mass‑splicing (12‑fiber ribbons or separable 24/36 ribbons).

· Mass fusion splice‑ready Loose Tube Minimums

· Cable Type: Loose Tube with 2.5 mm buffer tubes

· Fiber Placement: 12 fibers per buffer tube

· Fiber Category: G.652.D

· Fiber Code: Single‑mode OS2

· Wavelengths: 1310 / 1383 / 1550 nm

· Maximum Attenuation: 0.40 / 0.40 / 0.30 dB/km

· Construction: Single jacket, Single Armored

· Central strength member

· Length Markings: Feet (FT)

· Gel Status: Gel‑Free B. Mechanical & Construction Requirements For All Fiber Types

· Short‑term tensile: ≥ 2700 N (600 lbf)

· Long‑term tensile: ≥ 890 N (200 lbf)

· Temperature Range:

· Storage: −40°C to 70°C

· Installation: −30°C to 70°C

· Operation: −40°C to 70°C

· Jacket: UV‑resistant black polyethylene

· Bend radius: Vendor must provide installation and operational minimums.

· Water blocking : Gel‑free, water‑swellable tapes

· Outdoor‑rated jacket

· 1,000–2,000 lb. pulling tension

· rodent‑resistant and BABA compliant.

· TIA/EIA color coding

· Jacket must include manufacturer name, fiber count, type, year, and sequential footage.

B. Ribbon Fiber Preference and Acceptable Loose Tube Alternatives Burke County prefers ribbonized fiber optic cable for all higher‑count fiber segments, specifically:

· 96‑fiber

· 144‑fiber

· 288‑fiber

· 432‑fiber Ribbonized fiber is preferred due to its suitability for mass‑fusion splicing, reduced splice time, and improved operational efficiency.

However, due to national supply constraints and potential manufacturing backlogs, vendors must:

· Bid ribbonized fiber as the primary option, and

· Provide a compliant loose‑tube alternative for each of the above fiber counts in case ribbonized fiber cannot be delivered in time to meet project deadlines.

Loose‑tube alternatives must meet all technical requirements in this packet, including attenuation, construction, gel‑free design, and BABA/BEAD compliance.

Vendors must clearly indicate:

· Lead times for both ribbon and loose‑tube options

· Any known supply chain constraints

· Whether ribbonized fiber can meet the County’s phased delivery schedule Burke County reserves the right to select ribbon or loose‑tube construction based on availability and project schedule requirements.

B. Fiber Optic Cable Material Line Items

Line Item
Fiber Count
Footage (ft)
Type
Corning BABA Part Number
BFO 24L
24
1,570,000
Loose Tube
024EUC-T4F00D20-US
BFO 48L
48
897,000
Loose Tube
048EUC-T4F00D20-US
BFO 72L
72
15,000
Loose Tube
072EUC-T4F00D20-US
BFO 96L
96
525,000
Loose Tube
096EUC-T4101D20-US
BFO 144L
144
495,000
Loose Tube
144EUC-T4101D20-US
BFO 288L
288
145,000
Loose Tube
288EUC-T4101D20-US
BFO 432L
432
25,000
Loose Tube
432EUC-T4101D20-US
BFO 96R
96
525,000
Ribbon
096EUC-T4101D20-US
BFO 144R
144
495,000
Ribbon
144EUC-T4101D20-US
BFO 288R
288
145,000
Ribbon
288EUC-T4101D20-US
BFO 432R
432
25,000
Ribbon
432EUC-T4101D20-US

Please note that the Corning part numbers are reference examples only. Vendors may provide equivalent materials that meet or exceed all specifications.

VIII. Handhole Specifications A. Technical Requirements

· Preferred Chip and Crack Resistant: Unique material blend resists chipping and cracking, unlike polymer concrete but will accept polymer concrete bids.

· Fire Resistant: Must meet ASTM D635 flame propagation requirements.

· Load Rating: Minimum H‑20 vehicular load rating.

· Lid: Lockable, gasketed, tamper‑resistant.

· Conduit Entries: Preformed knockouts.

· Warranty: Minimum 5 years.

· Documentation Required:

· Datasheet

· ASTM D635 test report

· Material certification

· BABA/BEAD compliance documentation B. Handhole Material Line Items

Handhole Size (W×L×D)
Quantity
Load Rating
Notes
17×30×24
2,942
20K / 15K
24×36×24
1,159
20K / 15K
30×48×30
165
20K / 15K
Split Lid
36×60×36
24
20K / 15K
Split Lid
36×60 LCC
42
20K / 15K
Lid Conversion Cabinet (LCC) – includes hole for lid conversion cabinet

IX. Delivery Schedule Requirements (Three‑Phase Delivery) All fiber optic cable and handhole materials shall be delivered in three phased shipments:

Phase 1 — 40% of Total Order

· Delivery Date: January 2027

· Must include 40% of total footage and quantities for each part number.

Phase 2 — 30% of Total Order

· Delivery Date: July 2027

· Six months after Phase 1.

Phase 3 — 30% of Total Order

· Delivery Date: January 2028

· Six months after Phase 2.

Vendor Requirements

· Provide complete documentation with each shipment.

· Notify Burke County 30 days prior to each shipment.

· Replace any non‑delivered or non‑conforming materials at vendor expense.

Delivery Location Waynesboro Georgia or designated warehouse

X. Pricing Structure A. Pricing Stability Declaration Bidders must indicate whether pricing will remain fixed for all three delivery phases.

Option A — Firm, Fixed Pricing Bidder certifies that all unit prices will remain unchanged for all deliveries.

Option B — Pricing Subject to Increase Bidder anticipates potential price increases and provides a maximum escalation cap (%):

Maximum price increase cap (%): ______________________ Any increase must:

· Not exceed the stated cap

· Be supported by manufacturer documentation

· Be approved by Burke County XI. Submission Attachment Checklist Vendors must include:

[ ] Completed pricing tables [ ] BABA manufacture certification letters for each item [ ] BABA Material Compliance Statement [ ] Product Datasheets [ ] Warranty Documentation [ ] Delivery Schedule [ ] Handhole ASTM D635 documentation [ ] Vendor Addendum Form [ ] Suspension/debarment certification [ ] E‑Verify affidavit [ ] NTIA waiver (if applicable) [ ] Vendor Addendum Form [ ] All Published Addenda [ ] Anti-Lobbying Certification [ ] Burke County FTTP Bidder Pricing Sheet (Excel Format)

Bid Summary Project: Burke County Broadband Material Bid (Fiber Optic Cable & Handholes) Bidder (Company): __________________________ Contact Person: __________________________ Phone / Email: __________________________ Date of Bid: __________________________ Bid Valid For: ______ days

Bid Submission Checklist (vendor to complete and attach) [ ] Completed bid summary form and signed Mandatory Compliance Statement [ ] Line‑item pricing table (electronic spreadsheet + printed) [ ] Manufacturer self‑certification letters per part number (NTIA format preferred) [ ] Product datasheets and country/city of manufacture details [ ] Performance test reports and representative OTDR traces at delivery [ ] Fiber Mechanical spec sheets and armor details (if applicable) [ ] Handhole ASTM D635 test report and material certification (if applicable) [ ] Lead time (calendar days) and warranty statement [ ] Proof of insurance and bonding capacity (if required) [ ] Suspension/debarment certification per 2 CFR Part 180 [ ] E‑Verify affidavit [ ] NTIA waiver or de minimis calculation if applicable [ ] Vendor Addendum Form [ ] All Published Addenda [ ] Anti-Lobbying Certification [ ] Burke County FTTP Bidder Pricing Sheet (Excel Format)

Bid Mandatory Compliance Statement (Vendor must sign) Vendor certifies that:

· All materials offered meet BABA requirements (iron & steel, manufactured products, construction materials) unless an NTIA waiver is provided and attached.

· Vendor will retain and provide manufacturer self‑certification letters, country‑of‑origin documentation, and any waiver documentation for three (3) years after project completion and will make records available to Burke County or NTIA upon request.

· Vendor agrees to comply with all GTA, NTIA, and BEAD program requirements.

Authorized signature: _______________________ Date: __________

Pricing Tables Bidders must also complete the Burke County Bidding Template (Excel format) and submit it along with this bid response.

A. Fiber Optical Cable Pricing Template Including Shipping Cost (One Row Per Part Number)

Line Item
Part Number
Unit Price (USD)
Manufacturer
Mfg Location (City, State)
BABA

Cert (Y/N) Lead Time (Days)

BFO 24L

BFO 48L

BFO 72L

BFO 96L

BFO 144L

BFO 288L

BFO 432L

BFO 96R

BFO 144R

BFO 288R

BFO 432R

B. Handhole Pricing Template Including Shipping Cost (One Row Per Part Number)

Size

Part Number
Unit Price (USD)
Manufacturer
Mfg Location (City, State)
BABA

Cert (Y/N) Lead Time (Days)

17×30×24

24×36×24

30×48×30

36×60×36

36×60 LCC

Vendor Addendum Form Vendor acknowledges receipt of all addenda.

Addendum #
Date
Initials
#1
______
______
#2
______
______
#3
______
______
#4
______
______

Vendor Information, Certification, Signature.

Vendor Certification Form Vendor certifies:

· Bid is accurate and complete

· All materials meet specifications

· All addenda acknowledged

· Pricing valid for 90 days

· Delivery timelines will be met Signature, title, date, optional notary.

Required One Page Bid Addendum (per part number) Vendor Name: ____________________ Part Number: ____________________ Part Number Description: ____________________ Manufacturer: ____________________ Manufacturing Location: ____________________ OTDR Trace Attached when delivered (if applicable) : Y / N BABA Certification Attached: Y / N NTIA Waiver Attached: Y / N Lead Time: ______ days Unit Price including delivery cost: ______ Signature: ____________________ Date: ____________________

Suspension And Debarment Certification Form (Per 2 CFR Part 180 and 2 CFR 200.214) The vendor submitting this bid certifies, to the best of its knowledge and belief, that:

1. The vendor and its principals are not presently debarred, suspended, proposed for debarment, declared ineligible, or voluntarily excluded from participation in covered transactions as defined under 2 CFR Part 180 and 2 CFR 200.214.

2. The vendor and its principals have not, within the preceding three (3) years:

· 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 public transaction;

· Violated federal or state antitrust statutes;

· Committed embezzlement, theft, forgery, bribery, falsification or destruction of records, making false statements, or receiving stolen property.

3. The vendor and its principals are not presently indicted or otherwise criminally or civilly charged by a governmental entity with any of the offenses listed above.

4. The vendor and its principals have not, within the past three (3) years, had one or more public transactions terminated for cause or default.

5. The vendor agrees to immediately notify Burke County if it or any of its principals become subject to a suspension, debarment, or similar ineligibility determination during the performance of this contract.

Vendor Certification By signing below, the vendor certifies that this Suspension and Debarment Certification is true and accurate and understands that false statements may result in termination of award or other remedies available to Burke County and the Federal Government.

Vendor Name: ___________________________________________ Authorized Representative: ________________________________ Title: _________________________________________________ Signature: _____________________________________________ Date: _________________________________________________ Printed Name and Title of Authorized Officer or Agent

SUBSCRIBED AND SWORN BEFORE ME

ON THIS THE ______ DAY OF ______________,202__.

NOTARY PUBLIC

My Commission Expires:

Notes and Guidance

· Vendor certifications must be part‑number specific and retained for audits.

· Substitutions: If proposing an equivalent part number, include cross‑reference, full test data, and BABA/BEAD certification for the substitute.

· Noncompliance may result in rejection, replacement at vendor expense, contract termination, and indemnity obligations.

Certification I certify to Burke County and to any construction or permanent lender of the project that the information and responses provided on this questionnaire are true, accurate and complete. Burke County or any construction or permanent lender of the project may contact any entity or reference listed in this questionnaire. Each entity or reference may make any information concerning the contractor available to Burke County or to any lender of Burke County.

Dated ___________________2026 .

PROPOSER:

By:

Title:

Sworn to and subscribed before me this __________ day of _______, 2026.

Notary Public

My Commission expires:

STATE OF GEORGIA

BURKE COUNTY

LIABILITY INSURANCE

The limits of liability for the insurance required by the General Conditions shall not be less than the following amounts:

A Workers Compensation

StateStatutory
Applicable Federal (e. g. Longshoreman’s):Statutory
B. Employer’s Liability$1 Million

Comprehensive General Liability (including Contractual Liability, Premises – Operations; Independent contractor’s Protective; Products Liability – Completed Operations; Broad Form Property Damage:

1. General Aggregate (Except Products – Completed Operations)$2 Million
2. Products – Completed Operations Aggregate$1 Million
3. Personal and Advertising Injury (per Person/Organization)$1 Million
4. Each Occurrence (Bodily Injury)$50,000.00
5. Each Occurrence (Property Damage)$50,000.00
Excess or Umbrella Liability$3 Million
a. General Aggregate$3 Million
b. Each Occurrence$3 Million

NOTICE TO BIDDER: Certificates of Insurance shall be submitted with the Contractor’s Bid.

E-VERIFY

Contractor Affidavit under O.C.G.A. § 13-10-91(b)(1)

By executing this affidavit, the undersigned contractor verifies its compliance with O.C.G.A. § 13-10-91, stating affirmatively that the individual, firm or corporation which is engaged in the physical performance of services on behalf of (name of public employer) has registered with, is authorized to use and uses the federal work authorization program commonly known as E-Verify, or any subsequent replacement program, in accordance with the applicable provisions and deadlines established in O.C.G.A. § 13-10-91. Furthermore, the undersigned contractor will continue to use the federal work authorization program throughout the contract period and the undersigned contractor will contract for the physical performance of services in satisfaction of such contract only with subcontractors who present an affidavit to the contractor with the information required by O.C.G.A. § 13-10-91(b). Contractor hereby attests that its federal work authorization user identification number and date of authorization are as follows:

Federal Work Authorization User Identification Number Date of Authorization Name of Contractor Name of Project Name of Public Employer I hereby declare under penalty of perjury that the foregoing is true and correct.

Executed on ______, ___, 202__ in _____(city), ______(state).

Signature of Authorized Officer or Agent Printed Name and Title of Authorized Officer or Agent

SUBSCRIBED AND SWORN BEFORE ME

ON THIS THE ______ DAY OF ______________,202__.

NOTARY PUBLIC

My Commission Expires:

BURKE COUNTY, GEORGIA

FIBER-TO-THE-PREMISES (FTTP) MATERIALS BID PACKET

ANTI-LOBBYING CERTIFICATION

A. PURPOSE & AUTHORITY

This certification is required by the Byrd Anti-Lobbying Amendment (31 U.S.C. § 1352) for all contracts, grants, loans, and cooperative agreements exceeding $100,000 in federal funds. Vendors submitting bids in response to this solicitation must complete, sign, and return this certification as part of their bid packet. Failure to submit this certification may result in bid disqualification.

B. CERTIFICATION REGARDING LOBBYING

The undersigned certifies, 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 undersigned, 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 the awarding of any Federal contract, the making of any Federal grant, the entering into of any cooperative agreement, and the extension, continuation, renewal, amendment, or modification of any Federal contract, grant, loan, or cooperative agreement.

1. 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 of Lobbying Activities,” in accordance with its instructions.

1. 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, sub-grants, and contracts under grants, loans, and cooperative agreements) and that all sub-recipients shall certify and disclose accordingly.

This certification is a material representation of fact upon which reliance was placed when this transaction was made or entered into. Submission of this certification is a prerequisite for making or entering into this transaction imposed by 31 U.S.C. § 1352. Any person who fails to file the required certification shall be subject to a civil penalty of not less than $10,000 and not more than $100,000 for each such failure.

C. DISCLOSURE OF NON-FEDERAL LOBBYING ACTIVITIES

If the Vendor has used or intends to use non-federal funds for lobbying activities in connection with this solicitation, the Vendor must complete the following disclosure. If no such activities have occurred or are planned, indicate “N/A” in each field below.

Type of Federal Action (check one): ☐ Contract ☐ Grant ☐ Cooperative Agreement ☐ Loan ☐ Loan Guarantee ☐ Loan Insurance Status of Federal Action (check one): ☐ Bid / Offer / Application ☐ Initial Award ☐ Post-Award Report Type (check one): ☐ Initial Filing ☐ Material Change If Material Change — Year: ________________ Quarter: ________________ Date of Last Report: ________________ Name and Address of Reporting Entity: ___________________________________________________________ ☐ Prime ☐ Subawardee Tier (if known): ________________ Congressional District (if known): ___________________________________________________________ Federal Department / Agency: ___________________________________________________________ Federal Program Name / Description: ___________________________________________________________ CFDA Number (if applicable): ___________________________________________________________ Federal Action Number (if known): ___________________________________________________________ Award Amount (if known): $ ___________________________________________________________ Name and Address of Lobbying Registrant: ___________________________________________________________ Individuals Performing Lobbying Services: ___________________________________________________________

D. VENDOR INFORMATION

Vendor / Company Name: ___________________________________________________________ Street Address: ___________________________________________________________ City, State, ZIP Code: ___________________________________________________________ Federal Employer Identification Number (FEIN): ___________________________________________________________ DUNS / UEI Number: ___________________________________________________________ Contact Person: ___________________________________________________________ Telephone: ___________________________________________________________ Email Address: ___________________________________________________________

E. CERTIFICATION AND SIGNATURE

By signing below, the authorized representative of the Vendor certifies that the information provided in this document is true, complete, and accurate to the best of their knowledge, and acknowledges the penalties for non-compliance as stated herein.

Signature of Authorized Representative: ___________________________________________________________ Printed Name: ___________________________________________________________ Title: ___________________________________________________________ Date: ___________________________________________________________

F. NOTARY ACKNOWLEDGMENT

(Optional — Required if specified by the Issuing Authority)

STATE OF ___________________________________________________________

COUNTY OF ___________________________________________________________

Sworn to and subscribed before me this _____________ day of ___________________________, 20_________.

Notary Public My Commission Expires: ___________________________________________________________

[SEAL]

G. PAPERWORK REDUCTION ACT STATEMENT

This information collection is authorized by 31 U.S.C. § 1352. The valid OMB Control Number for this information collection is 0348-0046. Public reporting burden for this collection of information is estimated to average 10 minutes per response, including time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding the burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to the Office of Management and Budget, Paperwork Reduction Project (0348-0046), Washington, DC 20503.

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