FY22-29460_SECTION 889 COMPLI- FORM_04262022.pdf

Merchant Name

Merchant’s Authorized Representative

Authorized Representative Signature and Date

If vendor indicates WILL or DOES, then review will be required by a Contracting Officer prior to purchase.

Contracting Officer Approval

I have reviewed and determined procurement through this vendor is authorized.

Signature

Solicitation or PRT #:

Buyer Name:

Representation.

The Merchant represents that—

52.204-26 COVERED TELECOMMUNICATIONS EQUIPMENT OR SERVICES--REPRESENTATION (OCT 2020)

(a) Definitions. As used in this provision, “covered telecommunications equipment or services” and "reasonable inquiry" have the meaning provided in the clause 52.204-25, Prohibition on Contracting for Certain Telecommunications and Video Surveillance Services or Equipment.

(b) Procedures. The Offeror shall review the list of excluded parties in the System for Award Management (SAM) (https://www.sam.gov) for entities excluded from receiving federal awards for “covered telecommunications equipment or services”.

(c) Representations.

(1) The Offeror represents that it [ ___ ] does, [ ___ ] does not provide covered telecommunications equipment or services as a part of its offered products or services to the Government in the performance of any contract, subcontract, or other contractual instrument.

(2) After conducting a reasonable inquiry for purposes of this representation, the offeror represents that it [ ___ ] does, [ ___ ] does not use covered telecommunications equipment or services, or any equipment, system, or service that uses covered telecommunications equipment or services.

(End of provision)

Section 889 Form Compliance Form

N63394-22-R-0019

Karla Facio