Document 14 - Attachment 7 - Award Approval Request.pdf

Attachment 7 Award Approval Request

For Solicitation Number Solicitation: HSHQE3-12-R-00001

This award approval request shall be completed only if an offeror represents under Homeland Security Acquisition Regulation (HSAR) clause 3052.209-76, Prohibition on Federal Protective Service guard services contracts with business concerns owned, controlled, or operated by an individual convicted of a felony, that it IS a business concern owned, controlled or operated by an individual convicted of a felony.

1. Name and Address of the business concern submitting the proposal:

2. Basis for Award Request (Please check applicable basis and provide a detailed explanation):

o Subject felony is not a serious felony as defined by (HSAR) 48 CFR 3009.171-5 o Individual does not or no longer owns, control or operate the business concern o Commission of a serious felony no longer calls into question the individual or business concern’s integrity or business ethics and that an award would be consistent with the mission of FPS

3. Name and Date of Birth of Individual Convicted of a Felony

4. Full Description of Roles and Interests (indicate what the individual owns, controls, or operates, or may own, control or operate the business concern):

5. Date Sentenced:

6. Statute/Charge:

7. Docket/Case Number:

8. Court/Jurisdiction:

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9. Nature and Circumstances Surrounding the Conviction:

10. Protective Measures (taken by the individual to or business concern to reduce or eliminate the risk of further misconduct):

11. Responsibility and Restitution (actions the individual has taken to accept responsibility and make restitution for past misconduct resulting in the felony conviction):

Pursuant to HSAR 3052.209-76(e)(2), the offeror shall provide the following statement to any individual whose information will be submitted with this award request.

Privacy Notice. The collection of this information is authorized by the Federal Protective Service Guard Contracting Reform Act of 2008 (Pub.L 110-356) and Department of Homeland Security (DHS) implementing regulations at Homeland Security Acquisition Regulation (HSAR) 48 CFR 3009.171. This information is being collected to determine whether an individual that owns, controls, or operates the business concern submitting this offer has been convicted of a felony that would disqualify the offeror from receiving an award. This information will be used by and disclosed to DHS personnel and contractors or other agents who require this information to determine whether an award request should be approved or denied. Additionally, DHS may share this personal information with the U.S. Justice Department and other Federal and State agencies for collection, enforcement, investigatory, or litigation purposes, or as otherwise authorized. Submission of this information by the individual is voluntary, however, failure to provide it may result in denial of an award to the offeror. Individuals who wish to correct inaccurate information in or to remove their information from an offer that has been submitted should contact the business concern submitting the offer and request correction. Should individuals seek to correct inaccurate information or remove their information from an offer that has been submitted in response to a solicitation for FPS guard services prior to contract award, an authorized representative of the business concern submitting the offer must contact the contracting officer of record and request that the firm’s offer be formally withdrawn or submit a correction to the award request. After contract award, it is recommended that an authorized representative of the business concern that submitted the inaccurate or erroneous information contact the contracting officer of record. The contracting officer will handle such requests on a case by case basis.

I hereby deny this award approval request:

(Contracting Officer Signature) Date:

(Print Name)

I hereby recommend approval of this award request:

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(Contracting Officer Signature) Date:

I hereby approve this award request to permit award of a contract for Federal Protective Service Protective Security Officer services to a business concern owned, controlled, or operated by an individual convicted of a felony.

(HCA Signature) Date: