11-t-0426.doc

Section A - Solicitation/Contract Form

CLAUSES INCORPORATED BY FULL TEXT

Blanks:

TIN (tax ID): ________________

CAGE: ________________

DUNS: __________________

Vendor Point of Contact: ______________________Phone: ____________________

Vendor email: ______________________

Naval Medical Center Portsmouth POC: Dam Neck Lab

Vendors quoted price shall be inclusive of all cost including shipping, materials, and equipment rentals etc.

Payment Monthly, Quarterly, Annually (please circle) in Arrears Note: vendor will be required to provide billing electronically via the WAWF Electronic Invoicing method. For additional information, a review of the following web sites may be required: https://wawf.eb.mil http://wawftraining (email) wawf@nmlc.med.navy.mil Vendor to reference N00183-11-T-0426 on all inquires.

Government reserves the right to:

(1) award based on an "All or Nothing Evaluation".

(2) award a “Best Value” requirement. Vendors with superior past performance histories may be given 1st consideration.

PROMPT PAYMENT

For Prompt Payment Act Purposes, this contract is:

Subject to the 7-calender day constructive acceptance period.

The intent of this solicitation is to support GSA E-Buy RFQ: 597114. In the event that any part of this solicitation is deemed “open market” and award based on the results of RFQ: 597114 will be issued without further competition.

Section B - Supplies or Services and Prices

Cost per Test Agreement

FFP

for the Period 1 Oct 11 - 30 Sep 12

FOB: Destination

MILSTRIP: N4610612RQLC058

PURCHASE REQUEST NUMBER: N4610612RQLC058

NET AMT

0001AA

Cost per Test Agreement for 1 ea. AcT Diff 5 Part # 6605705

Manufacturer: Beckman Coulter

Est test volume: 30 test / day

FOB: Destination

NET AMT

0001AB

Cat # 8547169 Diluent 20L

Manufacturer: Beckman Coulter

Ship schedule; 5 boxes / quarter (Oct, Jan, Apr & Jul)

FOB: Destination

NET AMT

0001AC

Cat # 8547168 HGB Lyse 400 ml

Manufacturer: Beckman Coulter

Ship schedule; 5 boxes / Oct & Mar

7 boxes Aug

FOB: Destination

NET AMT

0001AD

Cat # 8547170 WBC Lyse 1L

Manufacturer: Beckman Coulter

Ship schedule; 5 boxes / Oct, Dec, Feb, Apr & Jul

6 boxes Jul

FOB: Destination

NET AMT

0001AE

Cat # 8547171 Diff Fix 1L

Manufacturer: Beckman Coulter

Ship schedule; 5 boxes / Oct, Mar & Aug

FOB: Destination

NET AMT

0001AF

Cat # 8547167 DiffRinse 1L

Manufacturer: Beckman Coulter

Ship schedule; 5 boxes / Oct, jan & Apr

7 boxes / Jul

FOB: Destination

NET AMT

0001AG

Cat # 7547198 Control Plus

Manufacturer: Beckman Coulter

Ship schedule; 1 box / month

FOB: Destination

NET AMT

0001AH

Cat # 7547175 Cal Kit 2ml

Manufacturer: Beckman Coulter

Ship schedule; 1 pack / Dec & Jun

FOB: Destination

NET AMT

FFP

for the Period 1 Oct 12 - 30 Sep 13

FOB: Destination

NET AMT

0002AA

FFP

for 1 ea. AcT Diff 5 Part # 6605705

Manufacturer: Beckman Coulter

Est test volume: 30 test / day

FOB: Destination

NET AMT

0002AB

FFP

Manufacturer: Beckman Coulter

Ship schedule; 5 boxes / quarter (Oct, Jan, Apr & Jul)

FOB: Destination

NET AMT

0002AC

FFP

Manufacturer: Beckman Coulter

Ship schedule; 5 boxes / Oct & Mar

7 boxes Aug

FOB: Destination

NET AMT

0002AD

FFP

Manufacturer: Beckman Coulter

Ship schedule; 5 boxes / Oct, Dec, Feb, Apr & Jul

6 boxes Jul

FOB: Destination

NET AMT

0002AE

FFP

Manufacturer: Beckman Coulter

Ship schedule; 5 boxes / Oct, Mar & Aug

FOB: Destination

NET AMT

0002AF

FFP

Manufacturer: Beckman Coulter

Ship schedule; 5 boxes / Oct, jan & Apr

7 boxes / Jul

FOB: Destination

NET AMT

0002AG

FFP

Manufacturer: Beckman Coulter

Ship schedule; 1 box / month

FOB: Destination

NET AMT

0002AH

FFP

Manufacturer: Beckman Coulter

Ship schedule; 1 pack / Dec & Jun

FOB: Destination

NET AMT

FFP

for the Period 1 Oct 13 - 30 Sep 14

FOB: Destination

NET AMT

0003AA

FFP

for 1 ea. AcT Diff 5 Part # 6605705

Manufacturer: Beckman Coulter

Est test volume: 30 test / day

FOB: Destination

NET AMT

0003AB

FFP

Manufacturer: Beckman Coulter

Ship schedule; 5 boxes / quarter (Oct, Jan, Apr & Jul)

FOB: Destination

NET AMT

0003AC

FFP

Manufacturer: Beckman Coulter

Ship schedule; 5 boxes / Oct & Mar

7 boxes Aug

FOB: Destination

NET AMT

0003AD

FFP

Manufacturer: Beckman Coulter

Ship schedule; 5 boxes / Oct, Dec, Feb, Apr & Jul

6 boxes Jul

FOB: Destination

NET AMT

0003AE

FFP

Manufacturer: Beckman Coulter

Ship schedule; 5 boxes / Oct, Mar & Aug

FOB: Destination

NET AMT

0003AF

FFP

Manufacturer: Beckman Coulter

Ship schedule; 5 boxes / Oct, jan & Apr

7 boxes / Jul

FOB: Destination

NET AMT

0003AG

FFP

Manufacturer: Beckman Coulter

Ship schedule; 1 box / month

FOB: Destination

NET AMT

0003AH

FFP

Manufacturer: Beckman Coulter

Ship schedule; 1 pack / Dec & Jun

FOB: Destination

NET AMT

FFP

for the Period 1 Oct 14 - 30 Sep 15

FOB: Destination

NET AMT

0004AA

FFP

for 1 ea. AcT Diff 5 Part # 6605705

Manufacturer: Beckman Coulter

Est test volume: 30 test / day

FOB: Destination

NET AMT

0004AB

FFP

Manufacturer: Beckman Coulter

Ship schedule; 5 boxes / quarter (Oct, Jan, Apr & Jul)

FOB: Destination

NET AMT

0004AC

FFP

Manufacturer: Beckman Coulter

Ship schedule; 5 boxes / Oct & Mar

7 boxes Aug

FOB: Destination

NET AMT

0004AD

FFP

Manufacturer: Beckman Coulter

Ship schedule; 5 boxes / Oct, Dec, Feb, Apr & Jul

6 boxes Jul

FOB: Destination

NET AMT

0004AE

FFP

Manufacturer: Beckman Coulter

Ship schedule; 5 boxes / Oct, Mar & Aug

FOB: Destination

NET AMT

0004AF

FFP

Manufacturer: Beckman Coulter

Ship schedule; 5 boxes / Oct, jan & Apr

7 boxes / Jul

FOB: Destination

NET AMT

0004AG

FFP

Manufacturer: Beckman Coulter

Ship schedule; 1 box / month

FOB: Destination

NET AMT

0004AH

FFP

Manufacturer: Beckman Coulter

Ship schedule; 1 pack / Dec & Jun

FOB: Destination

NET AMT

FFP

for the Period 1 Oct 15 - 30 Sep 16

FOB: Destination

NET AMT

0005AA

FFP

for 1 ea. AcT Diff 5 Part # 6605705

Manufacturer: Beckman Coulter

Est test volume: 30 test / day

FOB: Destination

NET AMT

0005AB

FFP

Manufacturer: Beckman Coulter

Ship schedule; 5 boxes / quarter (Oct, Jan, Apr & Jul)

FOB: Destination

NET AMT

0005AC

FFP

Manufacturer: Beckman Coulter

Ship schedule; 5 boxes / Oct & Mar

7 boxes Aug

FOB: Destination

NET AMT

0005AD

FFP

Manufacturer: Beckman Coulter

Ship schedule; 5 boxes / Oct, Dec, Feb, Apr & Jul

6 boxes Jul

FOB: Destination

NET AMT

0005AE

FFP

Manufacturer: Beckman Coulter

Ship schedule; 5 boxes / Oct, Mar & Aug

FOB: Destination

NET AMT

0005AF

FFP

Manufacturer: Beckman Coulter

Ship schedule; 5 boxes / Oct, jan & Apr

7 boxes / Jul

FOB: Destination

NET AMT

0005AG

FFP

Manufacturer: Beckman Coulter

Ship schedule; 1 box / month

FOB: Destination

NET AMT

0005AH

FFP

Manufacturer: Beckman Coulter

Ship schedule; 1 pack / Dec & Jun

FOB: Destination

NET AMT

CLAUSES INCORPORATED BY REFERENCE

Section C - Descriptions and Specifications

Statement of Work

Vendor to supply items listed in Section B, in a packaged ready to use condition.

· Vendor to supply a Cost per Test agreement for 1 Beckman Coulter ACT Diff 5 Analyzer. The estimated test volume will be 30 test / day

· Vendor to supply all required reagents, equipment and maintenance of supplied equipment.

· Equipment to be maintained per original equipment manufacturers recommendations. Vendor to supply unlimited service calls as required and an annual preventative maintenance inspection. NMCP will be responsible for daily maintenance to include cleaning and batch calibration as required. Vendor shall maintain all service records for supplied equipment. Vendor to provide the Government with maintenance history within 3 business days of request.

· Vendor to warrant that all supplied items are free of manufactures defects. Vendor shall repair / replace any unsatisfactory items at vendor’s expense.

· Vendor price shall be inclusive of all cost including lease of equipment, maintenance of equipment, reagents, shipping and handling

· Reagents shall be “Dropped Shipped” on a regular basis. Items shall be shipped so that they arrive on the 1st business day of each month /quarter (see Section B for shipping schedule).

· All items are to have a minimum 18-month shelf life from date of receipt and shall have the same lot numbers.

· Shipped items requiring special handling (fragile, refrigeration etc) must be clearly marked (with instructions) on the out shipping container

· All supplied items are to be certified for use within Beckman Coulter equipment.

· All items received are to be certified for use (where applicable) in US based hospitals.

Section E - Inspection and Acceptance

INSPECTION AND ACCEPTANCE TERMS

Supplies/services will be inspected/accepted at:

Section F - Deliveries or Performance

DELIVERY INFORMATION

30-SEP-2012

FOB: Destination

30-SEP-2012

SUPPLY DEPT

1885 TERRIER AVENUE

SUITE 100

VIRGINIA BEACH VA 23454

757-953-3886

N46106

30-SEP-2012

N46106

30-SEP-2012

N46106

30-SEP-2012

N46106

30-SEP-2012

N46106

30-SEP-2012

N46106

30-SEP-2012

N46106

30-SEP-2012

N46106

30-SEP-2013

30-SEP-2013

SUPPLY DEPT

1885 TERRIER AVENUE

SUITE 100

VIRGINIA BEACH VA 23454

757-953-3886

N46106

30-SEP-2013

N46106

30-SEP-2013

N46106

30-SEP-2013

N46106

30-SEP-2013

N46106

30-SEP-2013

N46106

30-SEP-2013

N46106

30-SEP-2013

N46106

30-SEP-2014

30-SEP-2014

SUPPLY DEPT

1885 TERRIER AVENUE

SUITE 100

VIRGINIA BEACH VA 23454

757-953-3886

N46106

30-SEP-2014

N46106

30-SEP-2014

N46106

30-SEP-2014

N46106

30-SEP-2014

N46106

30-SEP-2014

N46106

30-SEP-2014

N46106

30-SEP-2014

N46106

30-SEP-2015

30-SEP-2015

SUPPLY DEPT

1885 TERRIER AVENUE

SUITE 100

VIRGINIA BEACH VA 23454

757-953-3886

N46106

30-SEP-2015

N46106

30-SEP-2015

N46106

30-SEP-2015

N46106

30-SEP-2015

N46106

30-SEP-2015

N46106

30-SEP-2015

N46106

30-SEP-2015

N46106

30-SEP-2016

30-SEP-2016

SUPPLY DEPT

1885 TERRIER AVENUE

SUITE 100

VIRGINIA BEACH VA 23454

757-953-3886

N46106

30-SEP-2016

N46106

30-SEP-2016

N46106

30-SEP-2016

N46106

30-SEP-2016

N46106

30-SEP-2016

N46106

30-SEP-2016

N46106

30-SEP-2016

N46106

CLAUSES INCORPORATED BY REFERENCE

Section G - Contract Administration Data

INVOICING INSTRUCTIONS AND PAYMENT FOR SERVICES

Invoices for services rendered under this Contract shall be submitted electronically through Wide Area Work Flow – Receipt and Acceptance (WAWF):

The vendor shall self-register at the web site https://wawf.eb.mil. Vendor training is available on the internet at http://wawftraining.com.

Select the 2-in-1 Invoice within WAWF as the invoice type. The 2-in-1 Invoice prepares the Material Inspection and Receiving Report, DD Form 250, and invoice in one document.

Back up documentation (such as service tickets, etc.) can be included and attached to the invoice in WAWF.

Attachments created in any Microsoft Office product are attachable to the invoice in WAWF.

The following information regarding Naval Medical Center Portsmouth is provided for completion of the invoice in WAWF:

Issuing Office DODAAC: N00183

Admin DODAAC: N00183

Acceptor DODAAC: N00183

LPO DODAAC: N00183

Pay DODAAC: HQ0248

The contractor shall submit invoices for payment per contract terms.

The Government shall process invoices for payment per contract terms.

For more information on Wide Area Workflow, please contact the Wide Area Workflow Implementation Team at wawf@med.navy.mil.

Section H - Special Contract Requirements

CLAUSES INCORPORATED BY FULL TEXT

Department of Defense Business Associate Agreement Introduction

In accordance with DoD 6025.18-R “Department of Defense Health Information Privacy Regulation,” January 24, 2003, the Contractor meets the definition of Business Associate. Therefore, a Business Associate Agreement is required to comply with both the Health Insurance Portability and Accountability Act (HIPAA) Privacy and Security regulations. This clause serves as that agreement whereby the Contractor agrees to abide by all applicable HIPAA Privacy and Security requirements regarding health information as defined in this clause, and in DoD 6025.18-R and DoD 8580.02-R, as amended. Additional requirements will be addressed when implemented.

(a) Definitions. As used in this clause generally refer to the Code of

Federal Regulations (CFR) definition unless a more specific provision exists in DoD 6025.18-R or DoD 8580.02-R.

Individual has the same meaning as the term “individual” in 45 CFR

160.103 and shall include a person who qualifies as a personal representative in accordance with 45 CFR 164.502(g).

Privacy Rule means the Standards for Privacy of Individually Identifiable Health Information at 45 CFR part 160 and part 164, subparts A and E.

Protected Health Information has the same meaning as the term

“protected health information” in 45 CFR 160.103, limited to the information created or received by the Contractor from or on behalf of the Government pursuant to the Contract.

Electronic Protected Health Information has the same meaning as the term “electronic protected health information” in 45 CFR 160.103.

Required by Law has the same meaning as the term “required by law” in 45 CFR 164.103.

Secretary means the Secretary of the Department of Health and Human Services or his/her designee.

Security Rule means the Health Insurance Reform: Security Standards at

45 CFR part 160, 162 and part 164, subpart C.

Terms used, but not otherwise defined, in this Clause shall have the same meaning as those terms in 45 CFR 160.103, 164.501 and 164.304.

(b) The Contractor shall not use or further disclose Protected Health

Information other than as permitted or required by the Contract or as Required by Law.

(c) The Contractor shall use appropriate safeguards to prevent use or disclosure of the Protected Health Information other than as provided for by this Contract.

(d) The Contractor agrees to use administrative, physical, and technical safeguards that reasonably and appropriately protect the confidentiality, integrity, and availability of the electronic protected health information that it creates, receives, maintains, or transmits in the execution of this Contract.

(e) The Contractor agrees to mitigate, to the extent practicable, any harmful effect that is known to the Contractor of a use or disclosure of Protected Health Information by the Contractor in violation of the requirements of this Clause.

(f) The Contractor shall report to the Government any security incident involving protected health information of which it becomes aware.

(g) The Contractor shall report to the Government any use or disclosure of the Protected Health Information not provided for by this Contract of which the Contractor becomes aware.

(h) The Contractor shall ensure that any agent, including a subcontractor, to whom it provides Protected Health Information received from, or created or received by the Contractor, on behalf of the Government, agrees to the same restrictions and conditions that apply through this Contract to the Contractor with respect to such information.

(i) The Contractor shall ensure that any agent, including a subcontractor, to whom it provides electronic Protected Health Information, agrees to implement reasonable and appropriate safeguards to protect it.

(j) The Contractor shall provide access, at the request of the Government, and in the time and manner reasonably designated by the Government to Protected Health Information in a Designated Record Set, to the Government or, as directed by the Government, to an Individual in order to meet the requirements under 45 CFR 164.524.

(k) The Contractor shall make any amendment(s) to Protected Health

Information in a Designated Record Set that the Government directs or agrees to pursuant to 45 CFR 164.526 at the request of the Government, and in the time and manner reasonably designated by the Government.

(l) The Contractor shall make internal practices, books, and records relating to the use and disclosure of Protected Health Information received from, or created or received by the Contractor, on behalf of the Government, available to the Government, or at the request of the Government to the Secretary, in a time and manner reasonably designated by the Government or the Secretary, for purposes of the Secretary determining the Government’s compliance with the Privacy Rule.

(m) The Contractor shall document such disclosures of Protected

Health Information and information related to such disclosures as would be required for the Government to respond to a request by an Individual for an accounting of disclosures of Protected Health Information in accordance with 45 CFR 164.528.

(n) The Contractor shall provide to the Government or an Individual, in time and manner reasonably designated by the Government, information collected in accordance with this Clause of the Contract, to permit the Government to respond to a request by an Individual for an accounting of disclosures of Protected Health Information in accordance with 45 CFR 164.528.

General Use and Disclosure Provisions

Except as otherwise limited in this Clause, the Contractor may use or disclose Protected Health Information on behalf of, or to provide services to, the

Government for treatment, payment, or healthcare operations purposes, in accordance with the specific use and disclosure provisions below, if such use or disclosure of Protected Health Information would not violate the HIPAA Privacy Rule, the HIPAA Security Rule, DoD 6025.18-R or DoD 8580.02-R if done by the Government.

Specific Use and Disclosure Provisions

(a) Except as otherwise limited in this Clause, the Contractor may use

Protected Health Information for the proper management and administration of the Contractor or to carry out the legal responsibilities of the Contractor.

(b) Except as otherwise limited in this Clause, the Contractor may disclose Protected Health Information for the proper management and administration of the Contractor, provided that disclosures are required by law, or the Contractor obtains reasonable assurances from the person to whom the information is disclosed that it will remain confidential and used or further disclosed only as required by law or for the purpose for which it was disclosed to the person, and the person notifies the Contractor of any instances of which it is aware in which the confidentiality of the information has been breached.

(c) Except as otherwise limited in this Clause, the Contractor may use

Protected Health Information to provide Data Aggregation services to the

Government as permitted by 45 CFR 164.504(e)(2)(i)(B).

(d) Contractor may use Protected Health Information to report violations of law to appropriate Federal and State authorities, consistent with 45 CFR 164.502(j)(1).

Obligations of the Government

Provisions for the Government to Inform the Contractor of Privacy Practices and Restrictions

(a) The Government shall provide the Contractor with the notice of privacy practices that the Government produces in accordance with 45 CFR 164.520.

(b) The Government shall provide the Contractor with any changes in, or revocation of, permission by Individual to use or disclose Protected Health

Information, if such changes affect the Contractor’s permitted or required uses and disclosures.

(c) The Government shall notify the Contractor of any restriction to the use or disclosure of Protected Health Information that the Government has agreed to in accordance with 45 CFR 164.522.

Permissible Requests by the Government

The Government shall not request the Contractor to use or disclose

Protected Health Information in any manner that would not be permissible under the HIPAA Privacy Rule, the HIPAA Security Rule, or any applicable Government regulations (including without limitation, DoD 6025.18-R and DoD 8580.02-R) if done by the Government, except for providing Data Aggregation services to the Government and for management and administrative activities of the Contractor as otherwise permitted by this clause.

Termination

(a) Termination. A breach by the Contractor of this clause, may subject the

Contractor to termination under any applicable default or termination provision of this Contract.

(b) Effect of Termination.

(1) If this contract has records management requirements, the records subject to the Clause should be handled in accordance with the records management requirements. If this contract does not have records management requirements, the records should be handled in accordance with paragraphs (2) and (3) below

(2) If this contract does not have records management requirements, except as provided in paragraph (3) of this section, upon termination of this Contract, for any reason, the Contractor shall return or destroy all Protected Health Information received from the Government, or created or received by the Contractor on behalf of the Government. This provision shall apply to Protected Health Information that is in the possession of subcontractors or agents of the Contractor. The Contractor shall retain no copies of the Protected Health Information.

(3) If this contract does not have records management provisions and the Contractor determines that returning or destroying the Protected Health

Information is infeasible, the Contractor shall provide to the Government notification of the conditions that make return or destruction infeasible. Upon mutual agreement of the Government and the Contractor that return or destruction of Protected Health Information is infeasible, the Contractor shall extend the protections of this Contract to such Protected Health Information and limit further uses and disclosures of such Protected Health Information to those purposes that make the return or destruction infeasible, for so long as the Contractor maintains such Protected Health Information.

Miscellaneous

(a) Regulatory References. A reference in this Clause to a section in DoD 6025.18-R, DoD 8580.02-R, Privacy Rule or Security Rule means the section currently in effect or as amended, and for which compliance is required.

(b) Survival. The respective rights and obligations of Business Associate under the “Effect of Termination” provision of this Clause shall survive the termination of this Contract.

(c) Interpretation. Any ambiguity in this Clause shall be resolved in favor of a meaning that permits the Government to comply with DoD 6025.18-R, DoD 8580.02-R, the HIPAA Privacy Rule or the HIPAA Security Rule.

INFORMATION ONLY: This document has been designated for posting to the Navy Electronic Commerce Online (NECO) at http://www.neco.navy.mil

Section I - Contract Clauses

CLAUSES INCORPORATED BY REFERENCE

52.217-8 OPTION TO EXTEND SERVICES (NOV 1999)

The Government may require continued performance of any services within the limits and at the rates specified in the contract. These rates may be adjusted only as a result of revisions to prevailing labor rates provided by the Secretary of Labor. The option provision may be exercised more than once, but the total extension of performance hereunder shall not exceed 6 months. The Contracting Officer may exercise the option by written notice to the Contractor within 10 days

(End of clause)

52.217-9 OPTION TO EXTEND THE TERM OF THE CONTRACT (MAR 2000)

(a) The Government may extend the term of this contract by written notice to the Contractor within 10 days; provided that the Government gives the Contractor a preliminary written notice of its intent to extend at least 10 days before the contract expires. The preliminary notice does not commit the Government to an extension.

(b) If the Government exercises this option, the extended contract shall be considered to include this option clause.

(c) The total duration of this contract, including the exercise of any options under this clause, shall not exceed 5 years.

(End of clause)

52.252-2 CLAUSES INCORPORATED BY REFERENCE (FEB 1998)

This contract incorporates one or more clauses by reference, with the same force and effect as if they were given in full text. Upon request, the Contracting Officer will make their full text available. Also, the full text of a clause may be accessed electronically at this/these address(es):

http://www.aquisition.gov/far (End of clause)

Section K - Representations, Certifications and Other Statements of Offerors

CLAUSES INCORPORATED BY REFERENCE

52.204-3 TAXPAYER IDENTIFICATION (OCT 1998)

(a) Definitions.

Common parent, as used in this provision, means that corporate entity that owns or controls an affiliated group of corporations that files its Federal income tax returns on a consolidated basis, and of which the offeror is a member.

Taxpayer Identification Number (TIN), as used in this provision, means the number required by the Internal Revenue Service (IRS) to be used by the offeror in reporting income tax and other returns. The TIN may be either a Social Security Number or an Employer Identification Number.

(b) All offerors must submit the information required in paragraphs (d) through (f) of this provision to comply with debt collection requirements of 31 U.S.C. 7701(c) and 3325(d), reporting requirements of 26 U.S.C. 6041, 6041A, and 6050M, and implementing regulations issued by the IRS. If the resulting contract is subject to the payment reporting requirements described in Federal Acquisition Regulation (FAR) 4.904, the failure or refusal by the offeror to furnish the information may result in a 31 percent reduction of payments otherwise due under the contract.

(c) The TIN may be used by the Government to collect and report on any delinquent amounts arising out of the offeror's relationship with the Government (31 U.S.C. 7701(c)(3)). If the resulting contract is subject to the payment reporting requirements described in FAR 4.904, the TIN provided hereunder may be matched with IRS records to verify the accuracy of the offeror's TIN.

(d) Taxpayer Identification Number (TIN).

___ TIN:.--------------------------------------------------------

___ TIN has been applied for.

___ TIN is not required because:

___ Offeror is a nonresident alien, foreign corporation, or foreign partnership that does not have income effectively connected with the conduct of a trade or business in the United States and does not have an office or place of business or a fiscal paying agent in the United States;

___ Offeror is an agency or instrumentality of a foreign government;

___ Offeror is an agency or instrumentality of the Federal Government.

(e) Type of organization.

___ Sole proprietorship;

___ Partnership;

___ Corporate entity (not tax-exempt);

___ Corporate entity (tax-exempt);

___ Government entity (Federal, State, or local);

___ Foreign government;

___ International organization per 26 CFR 1.6049-4;

___ Other--------------------------------------------------------

(f) Common parent.

___ Offeror is not owned or controlled by a common parent as defined in paragraph (a) of this provision.

___ Name and TIN of common parent:

Name-------------------------------------------------------------------

TIN--------------------------------------------------------------------

(End of provision)

Section L - Instructions, Conditions and Notices to Bidders

CLAUSES INCORPORATED BY REFERENCE

52.252-1 SOLICITATION PROVISIONS INCORPORATED BY REFERENCE (FEB 1998)

This solicitation incorporates one or more solicitation provisions by reference, with the same force and effect as if they were given in full text. Upon request, the Contracting Officer will make their full text available. The offeror is cautioned that the listed provisions may include blocks that must be completed by the offeror and submitted with its quotation or offer. In lieu of submitting the full text of those provisions, the offeror may identify the provision by paragraph identifier and provide the appropriate information with its quotation or offer. Also, the full text of a solicitation provision may be accessed electronically at this/these address(es):

http://www.aquisition.gov/far (End of provision

Section M - Evaluation Factors for Award

CLAUSES INCORPORATED BY REFERENCE