HQ003425BOTA1 Amd 1_Attach 2 ABSC.docx
DOCX document 32 KB Posted
- Solicitation number
- HQ003425BOTA1_Amd_1_CFA1
- Issued by
-
DOD Washington Headquarters Service
About this file
This is an Affirmation of Business Status Certification form required for submission under the HQ003425BOTA1 Other Transaction Agreement (OTA) amendment. The form serves as a template for companies to provide statutory certifications regarding their business classification and participant contributions to prototype projects funded under 10 U.S.C. 4022.
Contractors must complete the certification by providing company registration details (legal name, SAM status, UEI, CAGE code, and physical address) and designating their business classification as either a Nontraditional Defense Contractor, Nonprofit Research Institution, Small Business, or Traditional Defense Contractor. For companies classified as Traditional Defense Contractors, the form notes that they must provide at least one-third of the total prototype project cost unless the Agreement Officer pursues alternative requirements under 10 U.S.C. 4022(d)(1)(D). Additionally, all significant participants in the project must be identified with detailed descriptions of their specific contributions and the significance of those contributions to the overall project objectives. The form requires certification by an authorized company representative with electronic signature authority. This is a template document designed for submission with responses to the Advanced Manufacturing, Prototypes and Materials (AMPAM) Capability Focus Area 1 solicitation managed by the Office of the Undersecretary of War Research and Engineering Manufacturing Technology program.
View the file
Other files
| File | Type | Posted |
|---|---|---|
| HQ003425BOTA1 Amd1_Attach 1 WP.docx | DOCX document | |
| HQ003425BOTA1 Amd 1_CFA1.docx | DOCX document |
On GovTribe
Work with this file
- Download the original file
- Contacts named in this file
- Similar government files
- Ask GovTribe AI about this file
Text version
ATTACHMENT 2: AFFIRMATION OF BUSINESS STATUS CERTIFICATION
Authority: To meet the requirements of 10 U.S.C. §4022(d)(1) the COMPANY shall provide the following information with a signature representing its certification.
Legal COMPANY Name:
Doing Business As:
| SAM Registration Status: |
| ☐ Active ☐ Inactive Expiration Date: |
SAM UEI:
CAGE Code:
| COMPANY Physical Address: |
| Street: |
City/State/Zip:
| COMPANY Point of Contact: |
| Name: |
Title:
Phone:
E-mail:
Representation: The COMPANY represents that it is a
Nontraditional Defense Contractor: As defined in 10 U.S.C. §4022(e)(2).
Nonprofit Research Institution: As defined in 40 C.F.R. § 262.200.
Small Business: As defined in 10 U.S.C. §4022(e)(4).
Traditional Defense Contractor[footnoteRef:1]: Does not meet one of the definitions identified above. [1: As required in 10 U.S.C. §4022(d)(1)(C), in the event the requirements of 10 U.S.C. §4022(d)(1)(A) or (B) are not met for the project, the COMPANY shall provide at least one third of the total cost of the prototype project, unless the COMPANY is otherwise notified that the Agreement Officer will pursue the requirements of 10 U.S.C. §4022(d)(1)(D).
Significant Participation[footnoteRef:2]: The COMPANY shall describe participant’s specific contribution(s) and the significance of the contribution to the overall project. [2: The July 2023 Other Transactions Guide states when evaluating the significance of the participant, the Agreements Officer should consider, by way of illustration and not limitation, whether the participant will supply a new key technology, product, or process; supply a novel application or approach to an existing technology, product, or process; provide a material increase in the performance, efficiency, quality, or versatility of a key technology, product, or process; accomplish a significant amount of the prototype project; cause a material reduction in the cost or schedule of the prototype project; or, provide for a material increase in performance of the prototype project.]
| Participant |
| Contribution and Significance to Overall Project |
Name:
What is the significant contribution(s)?
Why/how is the contribution significant?
*Note: Please add new row for each significant participant.
Certification: The undersigned hereby certifies that the representations made herein are accurate and true regarding the COMPANY identified above. I authorize my electronic signature to carry the same weight and legal effect as my written signature.
Name:
Title:
Email:
image1.png image2.png
File details come from the government source that posted it. Updated .