18Q1275.docx

M6700118Q1275

Section SF 1449 - CONTINUATION SHEET

Samsung ED75E

FFP

Similar or equal to the Samsung ED75E.

FOB: Destination

MILSTRIP: M5016918SUIN001

PURCHASE REQUEST NUMBER: M5016918SUIN001

NET AMT

Tilting Mount

Similar or equal to : Crimson AV Universal tilting mount for 46 to 65+ flat panel FOB: Destination

NET AMT

H4000B - 1366 x 768 - 60 Hz Clear Motion Rate - DTS Studio Sound

Similar or equal to the Samsung UN28H4000BFXZA.

FOB: Destination

NET AMT

Crimson AV Wall Mount

Similiar Or Equal To: Crimson

Adjustable tilt wall mount with Universal hole pattern to fit a wide selection of flat panel screens.Smooth tilt adjustments of 15deg; forward and 5deg; back with a locking knob for a variety of viewing angles. the screen and turn the pre-assembled securing screw to lock in place. Open wall plate design provides easy access to wiring. PRC: 7050 FOB: Destination

NET AMT

Samsung Television

Similar or equal to the Samsung DC55E Series.

FOB: Destination

NET AMT

Articulating mount

Articulating mount for 32"; to 55" flat panel screens FOB: Destination

NET AMT

Digital processor

Similar or equal to the Biamp Tesira al

FOB: Destination

NET AMT

DisplayPort/HDMI A/V cable

10ft DisplayPort to HDMI Digital A/V Cable - DisplayPort/HDMI for Projector, Monitor, Audio/Video Device, HDTV - 10 ft - 1 x DisplayPort Male Digital Audio/Video - 1 x HDMI Male Digital Audio/Video - Black Connects any computer with DisplayPort to projector, monitor, or display with HDMI port. T FOB: Destination

NET AMT

Ethernet cable

6ft High Speed HDMI UltraHD 4K with Ethernet Thin Flexible Cable FOB: Destination

NET AMT

Adapter cable

15ft 24AWG CL2 High Speed HDMI to DVI Adapter Cable with Net Jacket, Black FOB: Destination

NET AMT

High Performance Cable

6ft High Performance UltraThin VGA/QXGA HDTV/HD15 Tri-Shield Fully-Wired Cable with Panel-Mountable Connectors FOB: Destination

NET AMT

Cat5e Cable

Cat5e 24AWG UTP Ethernet Network Patch Cable, 7ft Gray FOB: Destination

NET AMT

Cat5e Cable

Cat5e 24AWG UTP Ethernet Network Patch Cable, 10ft Black FOB: Destination

NET AMT

Stereo Cable

6ft 3.5mm Stereo Plug/Plug M/M Cable - Black FOB: Destination

NET AMT

Equipment Rack

Similar or Equal to: Middle Atlantic Products Rack Utility - 19" FOB: Destination

NET AMT

Custom Frame

Custom Loaded Frame with I/O Cards installed FOB: Destination

NET AMT

Touch Screen

Similar or equal to the Crestron TS-1542-tilt-B-S.

FOB: Destination

NET AMT

Control System

Similar or equal to the Crestron CP-3

FOB: Destination

NET AMT

DM-TX-4K-100-C-1G-B-T

DM-TX-4K-100-C-1G-B-T

FOB: Destination

NET AMT

Receiver

Similar or equal to the Crestron DM-RMC-4k-100-c

FOB: Destination

NET AMT

Transmitter

Wall Plate DigitalMedia 8G+ Transmitter 200, Black Textured FOB: Destination

NET AMT

Receiver

Similar or equal to the Crestron DM-RMC-200-c

FOB: Destination

NET AMT

Power Supply

16-Port PoDM Power Supply for DM 8G+ I/O Cards FOB: Destination

NET AMT

Rackmount

Rackmount 3 step sequencer with uninterruptible Power Supply 1250 Watts FOB: Destination

NET AMT

16 Port Switch

16-Port Managed PoE Switch FOB: Destination

NET AMT

Cable Connectors

Connectors for DM-CBL-8G DigitalMedia 8G Cable FOB: Destination

NET AMT

Cable

DigitalMedia 8G Cable, plenum, 1000 ft spool FOB: Destination

NET AMT

Audio Cable

22G STRD SHLD PLEN II Audio Cable FOB: Destination

NET AMT

1P 18G STRD UNSHLD PLEN 3

1P 18G STRD UNSHLD PLEN 3

FOB: Destination

NET AMT

HDTV Tuner

Similar or equal to the Contemporary Research 232-ATSC-4 HDTV.

FOB: Destination

NET AMT

Digital Video Recorder

Similar or equal to the Hikvision HX-T7204G2T.

FOB: Destination

NET AMT

Video Conference Equipment

Similar or equal to the Scan Source CTS-SX20N-P40-K9.

FOB: Destination

NET AMT

Camera Mount

Niper/Siper Camera Mount FOB: Destination

NET AMT

HDMI Extender

HDMI Extender over cat5e w/ RS232 Control FOB: Destination

NET AMT

Amplifier

Similar or equal to the Lab Gruppen Lucia 120/2M

FOB: Destination

NET AMT

Full Bandwidth Blind Mount

Tannoy The compact, small footprint CVS 6 is a 150mm (6";) full bandwidth blind mount model, FOB: Destination

NET AMT

Misc. Cables

Misc Cables, Connectors, Hardware FOB: Destination

NET AMT

Programming Labor

Labor - FOB: Destination

NET AMT

Project Management Labor

Labor - Project Management- Training- Manuals FOB: Destination

NET AMT

Rack Labor

Labor - Rack Fabrication FOB: Destination

NET AMT

Installation Labor

Labor - Installation of all Audio and Video equipment FOB: Destination

NET AMT

Shipping and Handling

Shipping and handling FOB: Destination

NET AMT

INSPECTION AND ACCEPTANCE TERMS

Supplies/services will be inspected/accepted at:

DELIVERY INFORMATION

ATTN: FREIGHT PERSONNEL

MCAS FREIGHT SECTION

BLDG 612 BAY 13

MCAS BEAUFORT SC 29904

843-228-7120 FOB: Destination M60169

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SITE VISIT

"All interested vendors will meet at the visitor center located at the front gate for the Marine Corps Air Station Beaufort SC in order to receive a base access pass.

All attendees must contact Ms.Connie Washington at connie.washington@usmc.mil no later than 24 hours prior to required access to confirm that they will be attending. Late attendees will not be accepted.

Vendors should plan to arrive about 15 minutes early in order to make sure everyone can acquire access for this site visit. The site visit will begin at 1 p.m. EST on 27 August 2018. The parking lot entrance will be on your right prior to the gate. You will notneed to enter the base in order to reach the Visitor Center.

You will not be able to obtain a pass without the sponsor present in order to sign for you. Below, you will find information regarding obtaining various base passes.

Temporary Passes . Driver's License . Vehicle Registration . Proof of Insurance

Rental Car Passes . ID card and Driver's License . Rental Agreement

If there is an issue after 9:00 a.m. on the day of the site visit, and you cannot arrive at the designated time please notify Mr. Dennis Morrison at 843-228-7880.

All contractors shall sign the attendance roster prior to departure into the Marine Corps Air Station."

PERFORMANCE WORK STATEMENT

PERFORMANCE WORK STATEMENT:

Quoted Labor to install, program, commission the AV system that will integrate audio and video signals with a custom programmed Crestron control system.

The control system will provide routing for video and audio input sources through an Audio/Video matrix.

The system will also allow for custom user interface controls for access to switching routes (input/output sources) to various displays in the room.

Included in integration will be one provided Video Teleconference system with camera control and dialing from the user interface panel.

BASE ACCESS

CONTRACTOR'S UNAUTHORIZED WORK PERFORMANCE. The contractor shall not perform work that deviates from contract requirements and specifications. If the contractor deviates from contract requirements and specifications without approval of the CONTRACT ADMINISTRATOR/OFFICER, such deviation shall be at the risk of the contractor and any cost related thereto shall be borne by the contractor.

1. In order to gain access to Marine Corps Air Station(MCAS)Beaufort and Laurel Bay Housing Area non-Federal Government and non-DoD issued ID cardholders require identity proofing and vetting to determine fitness and eligibility for access. Specifically, a check of records through the National Crime Information Center (NCIC) Interstate Identification Index (III) is the installation’s minimum background check for access to MCAS Beaufort and Laurel Bay Housing Area to include entrance of visitors.

2. MCAS Beaufort and Laurel Bay Housing Area apply the following non-Federal Government cardholder criteria to determine the authorized type of access control credentials:

a. Contractors: RAPIDGate or 30-Day Pass followed by 4-DayPass*

b. Sub-Contractors: RAPIDGate or 30-Day Pass followed by 4-Day Pass*

c. Vendors: RAPIDGate or 30-Day Pass followed by 4-Day Pass*

d. Suppliers: RAPIDGate or 30-Day Pass followed by 4-Day Pass*

e. Service Providers: RAPIDGate or 30-Day Pass followed by 4-Day Pass*

f. Delivery Personnel: RAPIDGate or 30-Day Pass followed by 4-Day Pass*

g. Public-Private Venture (PPV) Housing and Installation Volunteers: Local Population Credential will be produced by the Security Manager Office. (The following are examples of Installation Volunteers: (Red Cross, Community College Instructors and Students, Family Readiness Volunteers, Wounded Warrior Volunteers, Commissary Baggers and any other organization approved by the Commanding Officer, MCAS Beaufort).

3. Contractor Common Access Card (CAC) Eligibility: Contractor personnel authorized CAC’s are exempt from RAPIDGate enrollment.

4. Contractor personnel who are ineligible for a CAC will be required to either obtain a 30-Day pass followed by a 4-Day pass* or enroll in the RAPIDGate Program. RAPIDGate is a voluntary program due to associated costs. For further information concerning contractor access, please contact the Security Manager Office at 843-228-7090. For information concerning enrolling in RAPIDGate please visit their website at www.rapidgate.com.

NOTE: The Government will not be responsible for any access delays. Delays that may result from inadequate planning are contractor responsibility. Any and all costs associated with RAPIDGate are the sole responsibility of the contractor.

* Contractors will be issued a one-time pass for 30 days. Upon expiration of the 30 day pass, they will only be issued a 4 day pass every 4 days thereafter, for the duration of the contract.

CLAUSES INCORPORATED BY REFERENCE

CLAUSES INCORPORATED BY FULL TEXT

5212-2 EVALUATION--COMMERCIAL ITEMS (OCT 2014) (Tailored)

(a) The Government will award a contract resulting from this solicitation to the responsible offeror whose offer conforming to the solicitation will be most advantageous to the Government, price and other factors considered. The following factors shall be used to evaluate offers:

LOWEST PRICE TECHNICALLY ACCEPTABLE (LPTA)

The proposed acquisition is for a 100% small business set-aside for NAICS code 334310 Audio and Video Equipment Manufacturing and the small business size standard is 750 employees. Offerors must be registered in the System for Award Management (SAM) database. Information on registering in SAM may be obtained by calling (866) 606-8220 or via the internet at http://www.sam.gov. The provision at 52.212-1, Instructions to Offerors - Commercial Items applies to this acquisition.

Quotes will be evaluated and ranked according to price, from lowest to highest. The Government reserves the right to evaluate only the technical quote of the lowest price quote. Other technical quotes may not be evaluated unless the Government determines the lowest price quote to be unacceptable or non-responsive. In the event that Government determines the lowest price quote to be unacceptable, the next lowest price quote will be evaluated. This process will continue until a technically acceptable quote is found.

Technical acceptability will be based on the demonstrated ability to meet the technical requirements as stated below. A mere statement that the vendor “will meet the Government’s requirements” is insufficient; the vendor must demonstrate how it will meet the requirement. Lowest Price Technically Acceptable (LPTA) will be evaluated on: (1) Price; (2) Technical; and (3) Delivery

Descriptive literature outlining the specifications of the items quoted to include drawings. The manufacturer’s name and manufacturer’s complete part numbers of all items quoted shall be submitted in the quote.

To ensure technical compliance with the requirements, vendor quotes shall include the following information:

1. Vendor Specifications. The manufacturer’s name and manufacturer’s complete part numbers of items shall be submitted in the quote.

1. Vendor’s quote shall include an active Cage Code and Federal Tax Identification number. Vendors are required to be registered with SAM database and have an active cage code at the time of award.

1. Delivery Information. Clearly state if the quoter can meet the requested delivery as stated in each CLIN. If not, then state the best delivery date.

(b) A written notice of award or acceptance of an offer, mailed or otherwise furnished to the successful offeror within the time for acceptance specified in the offer, shall result in a binding contract without further action by either party. Before the offer's specified expiration time, the Government may accept an offer (or part of an offer), whether or not there are negotiations after its receipt, unless a written notice of withdrawal is received before award.

PREPARATION OF QUOTE: Quotes submitted shall include the following:

SUBMISSION OF QUOTES: Quotes related to this RFQ shall be received by the Contracting Department within the date and time specified in Block 8 on the first page of this solicitation, to be considered for award. The information submitted shall be clear and legible. Quotes may be submitted via email to connie.washington@usmc.mil; (PREFERRED METHOD) or via hand delivery/courier to Supply Officer, Marine Corps Air Station, Bldg. 612, Beaufort, SC 29904. It is solely the Contractor’s responsibility to ensure proposals are received within the required timeframe. (End of Provision)

52.212-3 OFFEROR REPRESENTATIONS AND CERTIFICATIONS--COMMERCIAL ITEMS (NOV 2017) ALTERNATE I (OCT 2014)

The offeror shall complete only paragraphs (b) of this provision if the Offeror has completed the annual representations and certification electronically via the System for Award Management (SAM) Web site located at https://www.sam.gov/portal . If the Offeror has not completed the annual representations and certifications electronically, the Offeror shall complete only paragraphs (c) through (u) of this provision.

(a) Definitions. As used in this provision-- “Economically disadvantaged women-owned small business (EDWOSB) concern” means a small business concern that is at least 51 percent directly and unconditionally owned by, and the management and daily business operations of which are controlled by, one or more women who are citizens of the United States and who are economically disadvantaged in accordance with 13 CFR part 127. It automatically qualifies as a women-owned small business eligible under the WOSB Program.

“Forced or indentured child labor” means all work or service—

(1) Exacted from any person under the age of 18 under the menace of any penalty for its nonperformance and for which the worker does not offer himself voluntarily; or

(2) Performed by any person under the age of 18 pursuant to a contract the enforcement of which can be accomplished by process or penalties.

“Highest-level owner” means the entity that owns or controls an immediate owner of the offeror, or that owns or controls one or more entities that control an immediate owner of the offeror. No entity owns or exercises control of the highest level owner.

“Immediate owner” means an entity, other than the offeror, that has direct control of the offeror. Indicators of control include, but are not limited to, one or more of the following: Ownership or interlocking management, identity of interests among family members, shared facilities and equipment, and the common use of employees.

“Inverted domestic corporation,” means a foreign incorporated entity that meets the definition of an inverted domestic corporation under 6 U.S.C. 395(b), applied in accordance with the rules and definitions of 6 U.S.C. 395(c).

“Manufactured end product” means any end product in product and service codes (PSCs) 1000-9999, except—

(1) PSC 5510, Lumber and Related Basic Wood Materials;

(2) Product or Service Group (PSG) 87, Agricultural Supplies;

(3) PSG 88, Live Animals;

(4) PSG 89, Subsistence;

(5) PSC 9410, Crude Grades of Plant Materials;

(6) PSC 9430, Miscellaneous Crude Animal Products, Inedible;

(7) PSC 9440, Miscellaneous Crude Agricultural and Forestry Products;

(8) PSC 9610, Ores;

(9) PSC 9620, Minerals, Natural and Synthetic; and

(10) PSC 9630, Additive Metal Materials.

“Place of manufacture” means the place where an end product is assembled out of components, or otherwise made or processed from raw materials into the finished product that is to be provided to the Government. If a product is disassembled and reassembled, the place of reassembly is not the place of manufacture.

“Restricted business operations” means business operations in Sudan that include power production activities, mineral extraction activities, oil-related activities, or the production of military equipment, as those terms are defined in the Sudan Accountability and Divestment Act of 2007 (Pub. L. 110-174). Restricted business operations do not include business operations that the person (as that term is defined in Section 2 of the Sudan Accountability and Divestment Act of 2007) conducting the business can demonstrate—

(1) Are conducted under contract directly and exclusively with the regional government of southern Sudan;

(2) Are conducted pursuant to specific authorization from the Office of Foreign Assets Control in the Department of the Treasury, or are expressly exempted under Federal law from the requirement to be conducted under such authorization;

(3) Consist of providing goods or services to marginalized populations of Sudan;

(4) Consist of providing goods or services to an internationally recognized peacekeeping force or humanitarian organization;

(5) Consist of providing goods or services that are used only to promote health or education; or

(6) Have been voluntarily suspended.

“Sensitive technology”—

(1) Means hardware, software, telecommunications equipment, or any other technology that is to be used specifically—

(i) To restrict the free flow of unbiased information in Iran; or

(ii) To disrupt, monitor, or otherwise restrict speech of the people of Iran; and

(2) Does not include information or informational materials the export of which the President does not have the authority to regulate or prohibit pursuant to section 203(b)(3) of the International Emergency Economic Powers Act (50 U.S.C. 1702(b)(3)).

“Service-disabled veteran-owned small business concern”—

(1) Means a small business concern—

(i) Not less than 51 percent of which is owned by one or more service-disabled veterans or, in the case of any publicly owned business, not less than 51 percent of the stock of which is owned by one or more service-disabled veterans; and

(ii) The management and daily business operations of which are controlled by one or more service-disabled veterans or, in the case of a service-disabled veteran with permanent and severe disability, the spouse or permanent caregiver of such veteran.

(2) Service-disabled veteran means a veteran, as defined in 38 U.S.C. 101(2), with a disability that is service-connected, as defined in 38 U.S.C. 101(16).

“Small business concern” means a concern, including its affiliates, that is independently owned and operated, not dominant in the field of operation in which it is bidding on Government contracts, and qualified as a small business under the criteria in 13 CFR Part 121 and size standards in this solicitation.

“Small disadvantaged business concern, consistent with 13 CFR 124.1002,” means a small business concern under the size standard applicable to the acquisition, that--

(1) Is at least 51 percent unconditionally and directly owned (as defined at 13 CFR 124.105) by--

(i) One or more socially disadvantaged (as defined at 13 CFR 124.103) and economically disadvantaged (as defined at 13 CFR 124.104) individuals who are citizens of the United States; and

(ii) Each individual claiming economic disadvantage has a net worth not exceeding $750,000 after taking into account the applicable exclusions set forth at 13 CFR 124.104(c)(2); and

(2) The management and daily business operations of which are controlled (as defined at 13.CFR 124.106) by individuals, who meet the criteria in paragraphs (1)(i) and (ii) of this definition.

“Subsidiary” means an entity in which more than 50 percent of the entity is owned—

(1) Directly by a parent corporation; or

(2) Through another subsidiary of a parent corporation.

“Veteran-owned small business concern” means a small business concern—

(1) Not less than 51 percent of which is owned by one or more veterans(as defined at 38 U.S.C. 101(2)) or, in the case of any publicly owned business, not less than 51 percent of the stock of which is owned by one or more veterans; and

(2) The management and daily business operations of which are controlled by one or more veterans.

“Women-owned business concern” means a concern which is at least 51 percent owned by one or more women; or in the case of any publicly owned business, at least 51 percent of the its stock is owned by one or more women; and whose management and daily business operations are controlled by one or more women.

“Women-owned small business concern” means a small business concern --

(1) That is at least 51 percent owned by one or more women or, in the case of any publicly owned business, at least 51 percent of the stock of which is owned by one or more women; and

(2) Whose management and daily business operations are controlled by one or more women.

“Women-owned small business (WOSB) concern eligible under the WOSB Program (in accordance with 13 CFR part 127),” means a small business concern that is at least 51 percent directly and unconditionally owned by, and the management and daily business operations of which are controlled by, one or more women who are citizens of the United States.

(b)

(1) Annual Representations and Certifications. Any changes provided by the offeror in paragraph (b)(2) of this provision do not automatically change the representations and certifications posted on the SAMwebsite.

(2) The offeror has completed the annual representations and certifications electronically via the SAM website accessed through https://www.acquisition.gov. After reviewing the SAM database information, the offeror verifies by submission of this offer that the representation and certifications currently posted electronically at FAR 52.212-3, Offeror Representations and Certifications—Commercial Items, have been entered or updated in the last 12 months, are current, accurate, complete, and applicable to this solicitation (including the business size standard applicable to the NAICS code referenced for this solicitation), as of the date of this offer and are incorporated in this offer by reference (see FAR 4.1201), except for paragraphs ___ . [Offeror to identify the applicable paragraphs at (c) through (u) of this provision that the offeror has completed for the purposes of this solicitation only, if any. These amended representation(s) and/or certification(s) are also incorporated in this offer and are current, accurate, and complete as of the date of this offer. Any changes provided by the offeror are applicable to this solicitation only, and do not result in an update to the representations and certifications posted electronically on SAM.]

(c) Offerors must complete the following representations when the resulting contract is to be performed in the United States or its outlying areas. Check all that apply.

(1) Small business concern. The offeror represents as part of its offer that it [ ___ ] is, [ ___ ] is not a small business concern.

(2) Veteran-owned small business concern. [Complete only if the offeror represented itself as a small business concern in paragraph (c)(1) of this provision.] The offeror represents as part of its offer that it [ ___ ] is, [ ___ ] is not a veteran-owned small business concern.

(3) Service-disabled veteran-owned small business concern. [Complete only if the offeror represented itself as a veteran-owned small business concern in paragraph (c)(2) of this provision.] The offeror represents as part of its offer that it [ ___ ] is, [ ___ ] is not a service-disabled veteran-owned small business concern.

(4) Small disadvantaged business concern. [Complete only if the offeror represented itself as a small business concern in paragraph (c)(1) of this provision.]The offeror represents that it [ ___ ] is, [ ___ ] is not, a small disadvantaged business concern as defined in 13 CFR 124.1002.

(5) Women-owned small business concern. [Complete only if the offeror represented itself as a small business concern in paragraph (c)(1) of this provision.]The offeror represents that it [ ___ ] is, [ ___ ] is not a women-owned small business concern.

Note: Complete paragraphs (c)(8) and (c)(9) only if this solicitation is expected to exceed the simplified acquisition threshold.

(6) WOSB concern eligible under the WOSB Program. [Complete only if the offeror represented itself as a women-owned small business concern in paragraph (c)(5) of this provision.] The offeror represents that—

(i) It [ ___ ] is, [ ___ ] is not a WOSB concern eligible under the WOSB Program, has provided all the required documents to the WOSB Repository, and no change in circumstances or adverse decisions have been issued that affects its eligibility; and

(ii) It [ ___ ] is, [ ___ ] is not a joint venture that complies with the requirements of 13 CFR part 127, and the representation in paragraph (c)(6)(i) of this provision is accurate for each WOSB concern eligible under the WOSB Program participating in the joint venture. [The offeror shall enter the name or names of the WOSB concern eligible under the WOSB Program and other small businesses that are participating in the joint venture: ___ .] Each WOSB concern eligible under the WOSB Program participating in the joint venture shall submit a separate signed copy of the WOSB representation.

(7) Economically disadvantaged women-owned small business (EDWOSB) concern. [Complete only if the offeror represented itself as a WOSB concern eligible under the WOSB Program in (c)(6) of this provision.] The offeror represents that—

(i) It [ ___ ] is, [ ___ ] is not an EDWOSB concern, has provided all the required documents to the WOSB Repository, and no change in circumstances or adverse decisions have been issued that affects its eligibility; and

(ii) It [ ___ ] is, [ ___ ] is not a joint venture that complies with the requirements of 13 CFR part 127, and the representation in paragraph (c)(7)(i) of this provision is accurate for each EDWOSB concern participating in the joint venture. [The offeror shall enter the name or names of the EDWOSB concern and other small businesses that are participating in the joint venture: ___ .] Each EDWOSB concern participating in the joint venture shall submit a separate signed copy of the EDWOSB representation.

(8) Women-owned business concern (other than small business concern). [Complete only if the offeror is a women-owned business concern and did not represent itself as a small business concern in paragraph (c)(1) of this provision.] The offeror represents that it [ ___ ] is, a women-owned business concern.

(9) Tie bid priority for labor surplus area concerns. If this is an invitation for bid, small business offerors may identify the labor surplus areas in which costs to be incurred on account of manufacturing or production (by offeror or first-tier subcontractors) amount to more than 50 percent of the contract price:

(10) HUBZone small business concern. [Complete only if the offeror represented itself as a small business concern in paragraph (c)(1) of this provision.] The offeror represents, as part of its offer, that--

(i) It [ ___ ] is, [ ___ ] is not a HUBZone small business concern listed, on the date of this representation, on the List of Qualified HUBZone Small Business Concerns maintained by the Small Business Administration, and no material changes in ownership and control, principal office, or HUBZone employee percentage have occurred since it was certified in accordance with 13 CFR part 126; and

(ii) It [ ___ ] is, [ ___ ] is not a HUBZone joint venture that complies with the requirements of 13 CFR part 126, and the representation in paragraph (c)(10)(i) of this provision is accurate for each HUBZone small business concern participating in the HUBZone joint venture. [The offeror shall enter the names of each of the HUBZone small business concerns participating in the HUBZone joint venture: ___ .] Each HUBZone small business concern participating in the HUBZone joint venture shall submit a separate signed copy of the HUBZone representation.

(11) (Complete if the offeror has represented itself as disadvantaged in paragraph (c)(4) of this provision.)

[The offeror shall check the category in which its ownership falls]:

___ Black American.

___ Hispanic American.

___ Native American (American Indians, Eskimos, Aleuts, or Native Hawaiians).

___ Asian-Pacific American (persons with origins from Burma, Thailand, Malaysia, Indonesia, Singapore, Brunei, Japan, China, Taiwan, Laos, Cambodia (Kampuchea), Vietnam, Korea, The Philippines, Republic of Palau, Republic of the Marshall Islands, Federated States of Micronesia, the Commonwealth of the Northern Mariana Islands, Guam, Samoa, Macao, Hong Kong, Fiji, Tonga, Kiribati, Tuvalu, or Nauru).

___ Subcontinent Asian (Asian-Indian) American (persons with origins from India, Pakistan, Bangladesh, Sri Lanka, Bhutan, the Maldives Islands, or Nepal).

___ Individual/concern, other than one of the preceding.

(d) Representations required to implement provisions of Executive Order 11246 --

(1) Previous contracts and compliance. The offeror represents that --

(i) It [ ___ ] has, [ ___ ] has not, participated in a previous contract or subcontract subject to the Equal Opportunity clause of this solicitation; and

(ii) It [ ___ ] has, [ ___ ] has not, filed all required compliance reports.

(2) Affirmative Action Compliance. The offeror represents that --

(i) It [ ___ ] has developed and has on file, [ ___ ] has not developed and does not have on file, at each establishment, affirmative action programs required by rules and regulations of the Secretary of Labor (41 CFR parts 60-1 and 60-2), or

(ii) It [ ___ ] has not previously had contracts subject to the written affirmative action programs requirement of the rules and regulations of the Secretary of Labor.

(e) Certification Regarding Payments to Influence Federal Transactions (31 U.S.C. 1352). (Applies only if the contract is expected to exceed $150,000.) By submission of its offer, the offeror certifies to the best of its knowledge and belief that no Federal appropriated funds have been paid or will be paid to any person for influencing or attempting to influence an officer or employee of any agency, a Member of Congress, an officer or employee of Congress or an employee of a Member of Congress on his or her behalf in connection with the award of any resultant contract. If any registrants under the Lobbying Disclosure Act of 1995 have made a lobbying contact on behalf of the offeror with respect to this contract, the offeror shall complete and submit, with its offer, OMB Standard Form LLL, Disclosure of Lobbying Activities, to provide the name of the registrants. The offeror need not report regularly employed officers or employees of the offeror to whom payments of reasonable compensation were made.

(f) Buy American Certificate. (Applies only if the clause at Federal Acquisition Regulation (FAR) 52.225-1, Buy American – Supplies, is included in this solicitation.)

(1) The offeror certifies that each end product, except those listed in paragraph (f)(2) of this provision, is a domestic end product and that for other than COTS items, the offeror has considered components of unknown origin to have been mined, produced, or manufactured outside the United States. The offeror shall list as foreign end products those end products manufactured in the United States that do not qualify as domestic end products, i.e., an end product that is not a COTS item and does not meet the component test in paragraph (2) of the definition of “domestic end product.” The terms “commercially available off-the-shelf (COTS) item,” “component,” “domestic end product,” “end product,” “foreign end product,” and “United States” are defined in the clause of this solicitation entitled “Buy American—Supplies.”

(2) Foreign End Products:

[List as necessary]

(3) The Government will evaluate offers in accordance with the policies and procedures of FAR Part 25.

(g)

(1) Buy American -- Free Trade Agreements -- Israeli Trade Act Certificate. (Applies only if the clause at FAR 52.225-3, Buy American -- Free Trade Agreements -- Israeli Trade Act, is included in this solicitation.)

(i) The offeror certifies that each end product, except those listed in paragraph (g)(1)(ii) or (g)(1)(iii) of this provision, is a domestic end product and that for other than COTS items, the offeror has considered components of unknown origin to have been mined, produced, or manufactured outside the United States. The terms “Bahrainian, Moroccan, Omani, Panamanian, or Peruvian end product,” “commercially available off-the-shelf (COTS) item,” “component,” “domestic end product,” “end product,” “foreign end product,” “Free Trade Agreement country,” “Free Trade Agreement country end product,” “Israeli end product,” and “United States” are defined in the clause of this solicitation entitled “Buy American--Free Trade Agreements--Israeli Trade Act.”

(ii) The offeror certifies that the following supplies are Free Trade Agreement country end products (other than Bahrainian, Moroccan, Omani, Panamanian, or Peruvian end products) or Israeli end products as defined in the clause of this solicitation entitled “Buy American—Free Trade Agreements—Israeli Trade Act”:

Free Trade Agreement Country End Products (Other than Bahrainian, Moroccan, Omani, Panamanian, or Peruvian End Products) or Israeli End Products:

(iii) The offeror shall list those supplies that are foreign end products (other than those listed in paragraph (g)(1)(ii) or this provision) as defined in the clause of this solicitation entitled “Buy American—Free Trade Agreements—Israeli Trade Act.” The offeror shall list as other foreign end products those end products manufactured in the United States that do not qualify as domestic end products, i.e., an end product that is not a COTS item and does not meet the component test in paragraph (2) of the definition of “domestic end product.”

Other Foreign End Products:

(iv) The Government will evaluate offers in accordance with the policies and procedures of FAR Part 25.

(2) Buy American—Free Trade Agreements—Israeli Trade Act Certificate, Alternate I. If Alternate I to the clause at FAR 52.225-3 is included in this solicitation, substitute the following paragraph (g)(1)(ii) for paragraph (g)(1)(ii) of the basic provision:

(g)(1)(ii) The offeror certifies that the following supplies are Canadian end products as defined in the clause of this solicitation entitled “Buy American—Free Trade Agreements—Israeli Trade Act”:

Canadian End Products:

Line Item No.:

[List as necessary]

(3) Buy American—Free Trade Agreements—Israeli Trade Act Certificate, Alternate II. If Alternate II to the clause at FAR 52.225-3 is included in this solicitation, substitute the following paragraph (g)(1)(ii) for paragraph (g)(1)(ii) of the basic provision:

(g)(1)(ii) The offeror certifies that the following supplies are Canadian end products or Israeli end products as defined in the clause of this solicitation entitled “Buy American--Free Trade Agreements--Israeli Trade Act'':

Canadian or Israeli End Products:

(4) Buy American—Free Trade Agreements—Israeli Trade Act Certificate, Alternate III. If Alternate III to the clause at 52.225-3 is included in this solicitation, substitute the following paragraph (g)(1)(ii) for paragraph (g)(1)(ii) of the basic provision:

(g)(1)(ii) The offeror certifies that the following supplies are Free Trade Agreement country end products (other than Bahrainian, Korean, Moroccan, Omani, Panamanian, or Peruvian end products) or Israeli end products as defined in the clause of this solicitation entitled “Buy American—Free Trade Agreements—Israeli Trade Act”:

Free Trade Agreement Country End Products (Other than Bahrainian, Korean, Moroccan, Omani, Panamanian, or Peruvian End Products) or Israeli End Products:

(5) Trade Agreements Certificate. (Applies only if the clause at FAR 52.225-5, Trade Agreements, is included in this solicitation.)

(i) The offeror certifies that each end product, except those listed in paragraph (g)(5)(ii) of this provision, is a U.S.-made or designated country end product as defined in the clause of this solicitation entitled “Trade Agreements.”

(ii) The offeror shall list as other end products those end products that are not U.S.-made or designated country end products.

Other End Products

(iii) The Government will evaluate offers in accordance with the policies and procedures of FAR Part 25. For line items covered by the WTO GPA, the Government will evaluate offers of U.S.-made or designated country end products without regard to the restrictions of the Buy American statute. The Government will consider for award only offers of U.S.-made or designated country end products unless the Contracting Officer determines that there are no offers for such products or that the offers for such products are insufficient to fulfill the requirements of the solicitation.

(h) Certification Regarding Responsibility Matters (Executive Order 12689). (Applies only if the contract value is expected to exceed the simplified acquisition threshold.) The offeror certifies, to the best of its knowledge and belief, that the offeror and/or any of its principals--

(1) [ ___ ] Are, [ ___ ] are not presently debarred, suspended, proposed for debarment, or declared ineligible for the award of contracts by any Federal agency;

(2) [ ___ ] Have, [ ___ ] have not, within a three-year period preceding this offer, been convicted of or had a civil judgment rendered against them for: commission of fraud or a criminal offense in connection with obtaining, attempting to obtain, or performing a Federal, state or local government contract or subcontract; violation of Federal or state antitrust statutes relating to the submission of offers; or commission of embezzlement, theft, forgery, bribery, falsification or destruction of records, making false statements, tax evasion, violating Federal criminal tax laws, or receiving stolen property; and

(3) [ ___ ] Are, [ ___ ] are not presently indicted for, or otherwise criminally or civilly charged by a Government entity with, commission of any of these offenses enumerated in paragraph (h)(2) of this clause; and

(4) [ ___ ] Have, [ ___ ] have not, within a three-year period preceding this offer, been notified of any delinquent Federal taxes in an amount that exceeds $3,500 for which the liability remains unsatisfied.

(i) Taxes are considered delinquent if both of the following criteria apply:

(A) The tax liability is finally determined. The liability is finally determined if it has been assessed. A liability is not finally determined if there is a pending administrative or judicial challenge. In the case of a judicial challenge to the liability, the liability is not finally determined until all judicial appeal rights have been exhausted.

(B) The taxpayer is delinquent in making payment. A taxpayer is delinquent if the taxpayer has failed to pay the tax liability when full payment was due and required. A taxpayer is not delinquent in cases where enforced collection action is precluded.

(ii) Examples.

(A) The taxpayer has received a statutory notice of deficiency, under I.R.C. §6212, which entitles the taxpayer to seek Tax Court review of a proposed tax deficiency. This is not a delinquent tax because it is not a final tax liability. Should the taxpayer seek Tax Court review, this will not be a final tax liability until the taxpayer has exercised all judicial appear rights.

(B) The IRS has filed a notice of Federal tax lien with respect to an assessed tax liability, and the taxpayer has been issued a notice under I.R.C. §6320 entitling the taxpayer to request a hearing with the IRS Office of Appeals Contesting the lien filing, and to further appeal to the Tax Court if the IRS determines to sustain the lien filing.