Attachment 4 Offeror Certifications and Disclosures 20Feb25 Final.pdf

ATTACHMENT 4

OFFEROR CERTIFICATIONS AND DISCLOSURES

The offeror shall complete the certification below. The certification shall be included as an attachment to the offeror's written submission and will not count toward the page limit.

Please note that some sections in the certification may be left blank due to the type of business completing this form (e.g. non-traditional defense contractor).

Please note that in order to be eligible for OTA Award offerors must meet the requirements outlined in 10 U.S.C Section 4022(d)(1). Failure to provide the required may result in your company's removal from the competition. Any Traditional Defense Contractor shall provide their intent on how they intend to meet the requirements of 10 USC 4022 (d)(1)(C).

Offeror Name

Proposed North American Industry Classification System

Industry Size Standard [Check one of the following boxes] Small Large Federally Funded Research &

Development Center

Data Universal Numbering Systems (DUNS) NumberCommercial & Government Entity (CAGE) CodeActive System for Award Management (SAM) Registration

[Check one of the following boxes and insert date] Yes No Expiration Date:

Address 1

Address 2

City/State/Zip Code

Point of Contact (POC) Name/Title

POC Phone/Email

[Check one of the following boxes:]

Nontraditional Defense Contractor (NDC): A NDC is an entity that is not currently performing and has not performed, for at least the one-year period preceding the issuance of this request for white paper, any contract or subcontract for the DoD that is subject to full coverage under the cost accounting standards prescribed pursuant to section

20 Feb 25

Signature (electronic signature is acceptable)

Name

Title

Signature Date

1502 of title 41 of the U.S. Code and the regulations implementing such section. All small businesses are considered NDCs. A small business is a business concern as defined under section 3 of the Small Business Act (15 U.S.C. 632). To be considered a small business for the purposes of this request, a concern must qualify as a small business under the size standard for the North American Industry Classification System (NAICS) code, as described at 13 C.F.R. 121.201 and the proposed NAICS code above.

Traditional Defense Contractor::A traditional defense contractor is an entity that does not meet the definition of a NDC. Any traditional defense contractors must comply with 10 USC 4022 (d)(1)(C) in order to be eligible for award.

This is to certify that the above is accurate, complete, and current as of ________________.

Individual Authorized to Sign

Proposals shall be signed by an authorized individual. The offeror hereby represents that the individual designated below is authorized to bind the corporation, partnership, individual or educational institution.

Evidence of authorization shall be provided by the offeror in accordance with the applicable instructions below. If the offeror is a joint venture, each participant in the joint venture shall submit a separate representation.

CORPORATIONS: The signatory must be an official or person otherwise authorized to bind the corporation. A Corporate representation as shown below, shall be executed in accordance with the instructions, or other evidence must be furnished which satisfactorily shows that the person signing the proposal is empowered to bind the corporation. Corporations may establish the authority of its agents by furnishing a power of attorney with the offer, a corporate resolution, or by causing the following representation to be executed under its corporate seal, provided that the same officer shall not execute both the contract and the representation.

I, _____________________________, represent that I am the ________________________ of the firm named as the offeror herein; that ________________________ signed this contractual instrument on behalf of the corporation and is __________________________ of said corporation; that said contractual instrument was duly signed for and in behalf of said corporation by authority of its governing body; and is within the scope of its corporate powers.

AFFIX CORPORATE SEAL (Note: If a corporation does not have a seal or the offer is being submitted electronically, the offeror may print the word "SEAL".)

___________________________ (Signature)

(2) PARTNERSHIPS: Partnerships shall establish their authority and the authority of their agents by completing the following representation, provided that it is executed by a partner other than the person signing the contractual instrument.

I, _____________________________, represent that I am a partner of the firm of ___________________ consisting of the following partners _____________________________________________________;

that ______________ signed this contractual instrument on behalf of said firm and is __________________________ of said firm; that said contractual instrument was duly signed for and in behalf of said firm by authority of partnership; and is within the scope of its corporate powers.

__________________________ (Signature)

(3) INDIVIDUALS: The signatory must be the owner and the contractual instrument shall be signed as such unless an agent's authority has been established through a power of attorney. Individuals submitting contractual instruments under an agent's signature must furnish a power of attorney to establish the agent's authority.

(4) EDUCATIONAL INSTITUTIONS: The signatory must be an official or person otherwise authorized to bind the educational institution. A representation as shown below, shall be executed in accordance with the instructions, or other evidence must be furnished which satisfactorily shows that the person signing the proposal is empowered to bind the educational institution. Educational institutions may establish authority of their agents by furnishing with H92222-17-R-0005 Page 80 of 97 their offeror a power of attorney, a corporate resolution or by causing the following representation to be executed, provided that the same individual shall not execute both the contract and the representation.

I, _____________________________, represent that I am the ________________________ of the educational institution named as the offeror herein; that ________________________ signed this contractual instrument on behalf of the educational institution and is __________________________ of said educational institution; that said contractual instrument was duly signed for and in behalf of said educational institution by authority of its governing body; and is within the scope of its corporate powers.

___________________________ (Signature)

(b) Once a power of attorney or corporate resolution has been submitted to establish the authority of its agents, provide reference to the Procurement Instrument Identification Number with which it was submitted by including the following statement in lieu of furnishing an additional copy: "Evidence to establish the authority of the agent signing this document was submitted with Document Number (end of clause)