A23 RPP_IBP Consortium_Attachment 3 Affirmation of Business Status Certification_DRAFT.docx

ATTACHMENT 3: AFFIRMATION OF BUSINESS STATUS CERTIFICATION

Every significant participating entity shall complete the following table and provide a signature representing its certification.

Legal Entity Name

Proposed NAICS Code

Industry Size Standard (Small/Large/Foreign)

UEI Number

CAGE Code

Tax Identification

Address 1

Address 2

City/State/Zip

POC Name/Title

POC Phone/e-mail

The Entity named above represents that it is (check one of the following boxes):

A Nontraditional Defense Contractor (NDC) – As defined in 10 U.S.C. § 3014, is an entity that is not currently performing and has not performed, for at least the one-year period preceding the solicitation of sources by DoD for the procurement or transaction, any contract or subcontract for the DoD that is subject to full coverage under the cost accounting standards prescribed pursuant to section 1502 of title 41 and the regulations implementing such section.

A Nonprofit Research Institution (NRI) – As defined in 40 C.F.R. § 262.200, is an organization that conducts research as its primary function and files as a non-profit organization under the tax code of 26 U.S.C. 501(c)(3). Additionally, it means an organization owned and operated exclusively for scientific or educational purposes, no part of the net earnings of which, inures to the benefit of any private shareholder or individual; and includes federally funded research and development centers, as identified by the National Scientific Foundation.

A Small Business Contractor (SB) – As defined in 15 U.S.C. § 632, small business concern is an enterprise that is deemed to be one that is independently owned and operated, and is not dominant in its field of operation based on the appropriate standards, utilizing the number of employees, dollar volume of business, net worth, net income, a combination thereof, or other appropriate factors.

A Traditional Defense Contractor (TDC) – A TDC is an entity that does not meet the definition of a NDC, as defined in 10 U.S.C. § 3014.

The undersigned hereby certifies that the representations made herein are accurate and true regarding the entity identified above. I authorize my electronic signature to carry the same weight and legal effect as my written signature.

Signature

Name

Title

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