N0025316T0305.pdf

SEE ADDENDUM

(No Collect Calls)

N00253-16-T-0305 10-May-2016

b. TELEPHONE NUMBER

360 315-6721

8. OFFER DUE DATE/LOCAL TIME

02:00 PM 23 May 2016

5. SOLICITATION NUMBER 6. SOLICITATION ISSUE DATE

AUTHORIZED FOR LOCAL REPRODUCTION

PREVIOUS EDITION IS NOT USABLE

STANDARD FORM 1449 (REV. 2/2012)

Prescribed by GSA – FAR (48 CFR) 53.212

(TYPE OR PRINT)

(SIGNATURE OF CONTRACTING OFFICER)

ADDENDA ARE

26. TOTAL AWARD AMOUNT (For Gov t. Use Only )

23.

CODE 10. THIS ACQUISITION IS

SUCH ADDRESS IN OFFER

17b. CHECK IF REMITTANCE IS DIFFERENT AND PUT

BELOW IS CHECKED

TELEPHONE NO.

N002539. ISSUED BY

18b. SUBMIT INVOICES TO ADDRESS SHOWN IN BLOCK 18a. UNLESS BLOCK

7. FOR SOLICITATION

INFORMATION CALL:

a. NAME

DIANA L. LASOTA

2. CONTRACT NO. 3. AWARD/EFFECTIVE DATE 4. ORDER NUMBER

(TYPE OR PRINT)

30b. NAME AND TITLE OF SIGNER 30c. DATE SIGNED 31b. NAME OF CONTRACTING OFFICER

30a. SIGNATURE OF OFFEROR/CONTRACTOR 31a.UNITED STATES OF AMERICA

27a. SOLICITATION INCORPORATES BY REFERENCE FAR 52.212-1. 52.212-4. FAR 52.212-3. 52.212-5 ARE ATTACHED.

25. ACCOUNTING AND APPROPRIATION DATA

1. REQUISITION NUMBER

20.

ADDITIONAL SHEETS SUBJECT TO THE TERMS AND CONDITIONS SPECIFIED.

OFFEROR TO COMPLETE BLOCKS 12, 17, 23, 24, AND 30

SOLICITATION/CONTRACT/ORDER FOR COMMERCIAL ITEMS

ARE NOT ATTACHED

27b. CONTRACT/PURCHASE ORDER INCORPORATES BY REFERENCE FAR 52.212-4. FAR 52.212-5 IS ATTACHED. ADDENDA ARE ARE NOT ATTACHED

(BLOCK 5), INCLUDING ANY ADDITIONS OR CHANGES WHICH ARE

SET FORTH HEREIN, IS ACCEPTED AS TO ITEMS:

. YOUR OFFER ON SOLICITATION

28. CONTRACTOR IS REQUIRED TO SIGN THIS DOCUMENT AND RETURN

% FOR:SET ASIDE:UNRESTRICTED OR X

SMALL BUSINESSX

17a.CONTRACTOR/ CODE FACILITY

OFFEROR CODE

NAVAL UNDERSEA WARFARE CENTER

ATTN: DIANA L. LASOTA

DIANA.LASOTA@NAVY.MIL

610 DOWELL ST BLDG 206

KEYPORT WA 98345-7610

18a. PAYMENT WILL BE MADE BY CODE

RATED ORDER UNDER

DPAS (15 CFR 700)

13a. THIS CONTRACT IS AX

13b. RATING

DO-C9

CODE15. DELIVER TO CODE N35266 16. ADMINISTERED BY

12. DISCOUNT TERMS11. DELIVERY FOR FOB DESTINA-

TION UNLESS BLOCK IS

MARKED

SEE SCHEDULE

14. METHOD OF SOLICITATION

RFQ IFB RFPX

NAVAL UNDERSEA WARFARE CENTER

SUPPLY OFFICER

NUWC DETACHMENT PACIFIC

1894 WASP BLVD., BLDG.133

PEARL HARBOR HI 96860

TEL: (808) 472-1738 FAX:

FAX:

TEL: 360 315-6721

SERVICE-DISABLED

VETERAN-OWNED

SMALL BUSINESS

8(A)

HUBZONE SMALL

BUSINESS

SIZE STANDARD:

NAICS:

333995

X

OFFER DATED

29. AWARD OF CONTRACT: REF.

DELIVER ALL ITEMS SET FORTH OR OTHERWISE IDENTIFIED ABOVE AND ON ANY

COPIES TO ISSUING OFFICE. CONTRACTOR AGREES TO FURNISH AND

EMAIL:

TEL:

31c. DATE SIGNED

SEE SCHEDULE

SCHEDULE OF SUPPLIES/ SERVICESITEM NO. QUANTITY UNIT UNIT PRICE AMOUNT

24.22.21.19.

WOMEN-OWNED SMALL BUSINESS (WOSB)

ELIGIBLE UNDER THE WOMEN-OWNED

SMALL BUSINESS PROGRAM

EDWOSB

32g. E-MAIL OF AUTHORIZED GOVERNMENT REPRESENTATIVE

SOLICITATION/CONTRACT/ORDER FOR COMMERCIAL ITEMS

(CONTINUED)

PAGE 2 OF53

ACCEPTED, AND CONFORMS TO THE CONTRACT, EXCEPT AS NOTED: ______________________________________________________

32a. QUANTITY IN COLUMN 21 HAS BEEN

RECEIVED INSPECTED

32b. SIGNATURE OF AUTHORIZED GOVERNMENT

REPRESENTATIVE

32c. DATE 32d. PRINTED NAME AND TITLE OF AUTHORIZED GOVERNMENT

REPRESENTATIVE

32e. MAILING ADDRESS OF AUTHORIZED GOVERNMENT REPRESENTATIVE 32f . TELEPHONE NUMBER OF AUTHORIZED GOVERNMENT REPRESENTATIVE

37. CHECK NUMBER

FINALPARTIALCOMPLETE

36. PAYMENT35. AMOUNT VERIFIED

CORRECT FOR

34. VOUCHER NUMBER

FINAL

33. SHIP NUMBER

PARTIAL

38. S/R ACCOUNT NUMBER 39. S/R VOUCHER NUMBER 40. PAID BY

41a. I CERTIFY THIS ACCOUNT IS CORRECT AND PROPER FOR PAYMENT

41b. SIGNATURE AND TITLE OF CERTIFYING OFFICER 41c. DATE

42a. RECEIVED BY (Print)

42b. RECEIVED AT (Location)

42c. DATE REC'D (YY/MM/DD) 42d. TOTAL CONTAINERS

STANDARD FORM 1449 (REV. 2/2012) BACK

Prescribed by GSA – FAR (48 CFR) 53.212

AUTHORIZED FOR LOCAL REPRODUCTION

PREVIOUS EDITION IS NOT USABLE

SEE SCHEDULE

20.

SCHEDULE OF SUPPLIES/ SERVICES

21.

QUANTITY UNIT

22. 23.

UNIT PRICE

24.

AMOUNT

19.

ITEM NO.

N00253-16-T-0305

Section SF 30 - BLOCK 14 CONTINUATION PAGE

SOLICITATION INFORMATION

Solicitation Information

NOTE 1: Government Point of Contact for this Solicitation/Request for Quote (RFQ) is: Diana

L. Lasota Purchasing Agent, Phone: 360-315-6721, Fax: 360-396-7036, Email:

diana.lasota@navy.mil

NOTE 2: All questions regarding this solicitation should be submitted in writing as soon as practicable after receipt of solicitation. Email questions to diana.lasota@navy.mil. Questions received after a reasonable time may not be entertained. (DO NOT include government drawings or government protected information in your reply emails unless they are digitally signed and encrypted per Federal Information Processing Standard (FIPS) Publication140-2.)

NOTE 3: If you cannot meet the requested delivery date line through and replace with your availability. Offers shall be FOB Destination to Pearl Harbor, HI 96860 in accordance with FAR

Clause 52.247-34.

NOTE 4: Constructive Acceptance Timeframe is 21 days after receipt of material.

NOTE 5: Firms interested in submitting quotes must (1) complete the pricing providing unit prices and extended pricing, (2) complete all representations and certifications found within this document and ensure your company’s registration in SAM is current and active.

https://www.sam.gov. Company quote forms may be used, but not substituted for a completed solicitation/amendment pages.

NOTE 6: The government prefers submission of this RFQ by email or fax.

NOTE 7: ARMS EXPORT CONTROL DRAWINGS

Restricted Drawings and Technical Information are only available by accessing Federal Business

Opportunities (FBO). Registration instructions and Vendor Guide books can be found on the

FBO homepage https://www.fbo.gov.

Drawings referenced in this solicitation are restricted by the Arms Export Control Act and are

ONLY available to vendors/contractors appointed Data Custodians that are registered with

Defense Logistics Information Service (DLIS) Joint Certification Program (JCP).

Vendor’s/Contractor’s Data Custodian’s that are not registered with DLIS JCP can obtain registration information at www.dlis.dla.mil/jcp/ or by phone at 888-352-9333.

Drawings for this solicitation have been posted to the FBO website: https://www.fbo.gov.

Bidders who have registered with FBO and have registered in DLIS JCP can access this data under solicitation number: N00253-16-T-0305.

mailto:diana.lasota@navy.mil mailto:diana.lasota@navy.mil https://www.sam.gov/ https://www.fbo.gov/ http://www.dlis.dla.mil/jcp/ https://www.fbo.gov/

NOTE 8: Performance under this contract requires the contractor to adhere to certain Operations

Security (OPSEC) requirements. Explanation of these requirements is detailed SECTION I of the

Operations Security Guide for Defense Contractors available online at:

http://www.navsea.navy.mil/Home/WarfareCenters/NUWCKeyport/Resources.aspx; click on

OPSEC Guide for Defense Contractors on the right-hand side.

NOTE 9: Failure to provide all required information from this solicitation and any subsequent amendment(s) may deem your company to be considered non-responsive.

SPECIFICATIONS

REQUIRED SPECIFICATIONS

CLIN 0001 - SUPPORT CYLINDER SPECIFICATIONS:

DUTY SERVICE: MEDIUM

ALL 316 STAINLESS STEEL CYLINDER EXCEPT AS OTHERWISE LISTED

BORE: 2-1/2 IN.

STROKE: 3 IN.

PISTON ROD: 1-3/4 IN. DIA,

PISTON ROD END: NFPA STYLE SF (SMALL FEMALE), 1-1/4-12 UNF x 2 IN. DP.

PISTON ROD MATERIAL: CHROME PLATED 316SS.

TIE RODS MIN. SIZE: 5/16-24 UNF.

TIE ROD MATERIAL: NITRONIC ® 50 (XM-19) (UNS S20910) STAINLESS STEEL.

TIE ROD THREAD FORMING PROCESS: ROLLED (ALTERNATE THREAD

FORMING PROCESSES (I.E. CUT THREADS) ARE UNACCEPTABLE.

TI E ROD THREAD CLASS: 2A

TIE ROD TORQUE SPECS: 22 FT-LBS.

TIE ROD ASSEMBLY INSTRUCTION: USE LOCTITE 242 THREADLOCKER.

MOUNTING STYLE: CAP RECTANGLE FLANGE (NFPA STYLE MF2), 3/8 IN. THICK

316SS PLATE.

RETRACTED LENGTH: 9.0 IN.

HYDRAULIC PORTS: 3/8 NPTF.

OPERATING MEDIUM: HYDRAULIC OIL.

OPERATING PRESSURE: 1200 PSI.

OPERATING TEMPERATURE RANGE: -10F THROUGH 165F.

ROD GLAND: BRONZE OR BRASS, REMOVABLE.

WIPER SEALS: DOUBLE OR DOUBLE LIP

ROD & SEAL KITS: REPLACEABLE.

O-RINGS: NITRILE.

PRIMARY PISTON ROD SEAL: ENHANCED POLYURETHANE.

PISTON ROD WIPER: NITRILE.

PISTON MATERIAL: ALUMINUM.

http://www.navsea.navy.mil/Home/WarfareCenters/NUWCKeyport/Resources.aspx

PISTON CHARACTERISTICS: ZERO LEAKAGE UNDER STATIC HOLDING

CONDITIONS.

REFERENCE: DRAWING-SUPPORT CYLINDER (AARON) MODIFIED BASE

MAY2012

PASSIVATE ALL STAINLESS STEEL COMPONENTS FOR MARINE ENVIRONMENT

CORROSION PROTECTION.

PROVIDE TEN EACH COMPLETE REPAIR KITS CONSISTING OF GLAND, ALL

SEALS AND ORINGS.

TO EACH INDIVIDUAL TIE ROD SHALL BE AFFIXED A STAINLESS STEEL

SHEETMETAL TAG EITHER ENGRAVED OR STAMPED WITH A UNIQUE SERIAL

NUMBER. DOCUMENTATION INCLUDING A DESCRIPTION OF THE TIE ROD AND

LISTING OF EACH TIE ROD BY SERIAL NUMBER SHALL BE SIGNED BY THE TIE

ROD MANUFACTURE CERTIFYING THE TIE RODS HAVE BEEN MANUFACTURED

USING NITRONIC ® 50 (XM-19) (UNS S20910) STAINLESS STEEL AND THAT THE

SCREW THREADS HAVE BEEN FORMED BY ROLLING.

AN EXTRA, SAMPLE TIE ROD ALSO TO BE SERIALIZED SHALL BE PROVIDED

AND WILL BE USED FOR ANALYSIS AND TESTING PURPOSES.

ALL CYLINDERS SHALL BE ASSEMBLED AND SHIPPED WITH THE SERIALIZED

TIE ROD TAGS INTACT.

THE ORIGINAL SIGNED COPY OF THE TIE ROD CERTIFICATION SHALL BE

ENCLOSED WITH THE SHIPMENT OF CYLINDERS.

CLIN 0002 - DOLLY LIFT CYLINDER SPECIFICATIONS:

DUTY SERVICE: MEDIUM

ALL 316 STAINLESS STEEL CYLINDER EXCEPT AS OTHERWISE LISTED

BORE: 2-1/2 IN.

STROKE: 6 IN.

PISTON ROD: 1-3/4 IN. DIA,

PISTON ROD END: NFPA STYLE SF (SMALL FEMALE), 1-1/4-12 UNF x 2 IN. DP.

PISTON ROD MATERIAL: CHROME PLATED 316SS.

TIE RODS MIN. SIZE: 5/16-24 UNF.

TIE ROD MATERIAL: NITRONIC ® 50 (XM-19) (UNS S20910) STAINLESS STEEL.

TIE ROD THREAD FORMING PROCESS: ROLLED (ALTERNATE THREAD

FORMING PROCESSES (I.E. CUT THREADS) ARE UNACCEPTABLE.

TI E ROD THREAD CLASS: 2A

TIE ROD TORQUE SPECS: 22 FT-LBS.

TIE ROD ASSEMBLY INSTRUCTION: USE LOCTITE 242 THREADLOCKER.

MOUNTING STYLE: SIDE LUG (NFPA STYLE MS2 ) WITH THRUST KEY.

HYDRAULIC PORTS: 3/8 NPTF.

OPERATING MEDIUM: HYDRAULIC OIL.

OPERATING PRESSURE: 1500 PSI.

OPERATING TEMPERATURE RANGE: -10F THROUGH 165F.

ROD GLAND: BRONZE OR BRASS, REMOVABLE.

WIPER SEALS: DOUBLE OR DOUBLE LIP

ROD & SEAL KITS: REPLACEABLE.

O-RINGS: NITRILE.

PRIMARY PISTON ROD SEAL: ENHANCED POLYURETHANE.

PISTON ROD WIPER: NITRILE.

PISTON MATERIAL: ALUMINUM.

PISTON CHARACTERISTICS: ZERO LEAKAGE UNDER STATIC HOLDING

CONDITIONS.

REFERENCE: DRAWING – LIFT CYLINDER (AARON) MARCH 2014

PASSIVATE ALL STAINLESS STEEL COMPONENTS FOR MARINE ENVIRONMENT

CORROSION PROTECTION.

PROVIDE TEN EACH COMPLETE REPAIR KITS CONSISTING OF GLAND, ALL

SEALS AND ORINGS.

TO EACH INDIVIDUAL TIE ROD SHALL BE AFFIXED A STAINLESS STEEL

SHEETMETAL TAG EITHER ENGRAVED OR STAMPED WITH A UNIQUE SERIAL

NUMBER. DOCUMENTATION INCLUDING A DESCRIPTION OF THE TIE ROD AND

LISTING OF EACH TIE ROD BY SERIAL NUMBER SHALL BE SIGNED BY THE TIE

ROD MANUFACTURE CERTIFYING THE TIE RODS HAVE BEEN MANUFACTURED

USING NITRONIC ® 50 (XM-19) (UNS S20910) STAINLESS STEEL AND THAT THE

SCREW THREADS HAVE BEEN FORMED BY ROLLING.

AN EXTRA, SAMPLE TIE ROD ALSO TO BE SERIALIZED SHALL BE PROVIDED

AND WILL BE USED FOR ANALYSIS AND TESTING PURPOSES.

ALL CYLINDERS SHALL BE ASSEMBLED AND SHIPPED WITH THE SERIALIZED

TIE ROD TAGS INTACT.

THE ORIGINAL SIGNED COPY OF THE TIE ROD CERTIFICATION SHALL BE

ENCLOSED WITH THE SHIPMENT OF CYLINDERS.

CLIN 0003 - LAUNCH CYLINDER SPECIFICATIONS:

DUTY SERVICE: MEDIUM

ALL 316 STAINLESS STEEL CYLINDER EXCEPT AS OTHERWISE LISTED

BORE: 1 1/2 IN.

STROKE: 3.75 IN.

PISTON ROD: 5/8 IN. DIA,

PISTON ROD END: NFPA STYLE IM (INTERMEDIATE MALE), 1/2-20 UNF x 3/4 IN.

LG.

PISTON ROD MATERIAL: CHROME PLATED 316SS.

TIE RODS MIN SIZE: 1/4-28 UNF.

TIE ROD MATERIAL: NITRONIC ® 50 (XM-19) (UNS S20910) STAINLESS STEEL.

TIE ROD THREAD FORMING PROCESS: ROLLED (ALTERNATE THREAD

FORMING PROCESSES (i.e., CUT THREADS) ARE UNACCEPTABLE.)

TIE ROD THREAD CLASS: 2A

TIE ROD TORQUE SPECS: 15 FT-LBS.

MOUNTING STYLE: HEAD TRUNNION (NFPA STYLE MT1).

HYDRAULIC PORTS: 3/8 NPTF.

OPERATING MEDIUM: HYDRAULIC OIL.

OPERATING PRESSURE: 1200 PSI.

OPERATING TEMPERATURE RANGE: -10F THROUGH 165F.

ROD GLAND: BRONZE OR BRASS, REMOVABLE.

WIPER SEALS: DOUBLE OR DOUBLE LIP SEAL

ROD & SEAL KITS: REPLACEABLE.

O-RINGS: NITRILE.

PRIMARY PISTON ROD SEAL: ENHANCED POLYURETHANE.

PISTON ROD WIPER: NITRILE.

PISTON MATERIAL: ALUMINUM.

PISTON CHARACTERISTICS: ZERO LEAKAGE UNDER STATIC HOLDING

CONDITIONS.

REFERENCE: DRAWING-LAUNCH CYLINDER (AARON) MAY2012

PASSIVATE ALL STAINLESS STEEL COMPONENTS FOR MARINE ENVIRONMENT

CORROSION PROTECTION.

PROVIDE TEN EACH COMPLETE REPAIR KITS CONSISTING OF GLAND, ALL

SEALS AND ORINGS.

TO EACH INDIVIDUAL TIE ROD SHALL BE AFFIXED A STAINLESS STEEL

SHEETMETAL TAG EITHER ENGRAVED OR STAMPED WITH A UNIQUE SERIAL

NUMBER. DOCUMENTATION INCLUDING A DESCRIPTION OF THE TIE ROD AND

LISTING EACH TIE ROD BY SERIAL NUMBER SHALL BE SIGNED BY THE TIE ROD

MANUFACTURE CERTIFYING THE TIE RODS HAVE BEEN MANUFACTURED

USING NITRONIC ® 50 (XM-19) (UNS S20910) STAINLESS STEEL AND THAT THE

SCREW THREADS HAVE BEEN FORMED BY ROLLING.

AN EXTRA, SAMPLE TIE ROD ALSO TO BE SERIALIZED SHALL BE PROVIDED

AND WILL BE USED FOR ANALYSIS AND TESTING PURPOSES.

ALL CYLINDERS SHALL BE ASSEMBLED AND SHIPPED WITH THE SERIALIZED

TIE ROD TAGS INTACT.

THE ORIGINAL SIGNED COPY OF THE TIE ROD CERTIFICATION SHALL BE

ENCLOSED WITH THE SHIPMENT OF CYLINDERS.

CLIN 0004 - LATERAL CYLINDER SPECIFICATIONS:

DUTY SERVICE: HEAVY DUTY WELDED CONSTRUCTION.

ALL 316 STAINLESS STEEL CYLINDER EXCEPT AS OTHERWISE LISTED

BORE: 2 IN.

STROKE: 12 IN.

PISTON ROD MIN. DIA.: 1 1/8 IN.

PISTON ROD END MIN.: 1.0-12 UNF X 1 1/4 IN. LG. MIN.

PISTON ROD MATERIAL: CHROME PLATED 316SS.

HYDRAULIC PORTS: 3/8 NPTF.

OPERATING MEDIUM: HYDRAULIC OIL.

OPERATING PRESSURE: 3000 PSI.

OPERATING TEMPERATURE RANGE: -10F THROUGH 165F.

ROD GLAND: BRONZE OR BRASS, REMOVABLE.

WIPER SEALS: ZERO LEAK

ROD & SEAL KITS: REPLACEABLE

O-RINGS: NITRILE.

PRIMARY PISTON ROD SEAL: ENHANCED POLYURETHANE.

PISTON ROD WIPER: NITRILE OR URETHANE.

PISTON MATERIAL: ALUMINUM 6061.

PISTON CHARACTERISTICS: ZERO LEAKAGE UNDER STATIC HOLDING

CONDITIONS.

PISTON ROD END CLEVIS: THREADED 316 STAINLESS STEEL

REFERENCE: DRAWING-LATERAL CYLINDER MAY 2012

PASSIVATE ALL STAINLESS STEEL COMPONENTS FOR MARINE ENVIRONMENT

CORROSION PROTECTION.

PROVIDE SIX COMPLETE REPAIR KITS CONSISTING OF GLAND, ALL SEALS AND

ORINGS.

Section SF 1449 - CONTINUATION SHEET

ITEM NO SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT

0001 6 Each

CYLINDER, SUPPORT

FFP

Manufacture in accordance to the attached specifications and drawings posted in

FBO.

**WARNING** THIS DOCUMENT CONTAINS TECHNICAL DATA WHOSE

EXPORT IS RESTRICTED BY THE ARMS EXPORT CONTROL ACT (TITLE

22, U.S.C., SEC 2751, ET. SEQ.) OR THE EXPORT ADMINISTRATION ACT

OF 1979, AS AMENDED, TITLE 50, U.S.C., APP. 2401 ET. SEQ.

VIOLATIONS OF THESE EXPORT LAWS ARE SUBJECT TO SEVERE

CRIMINAL PENALTIES. DISSEMINATE IN ACCORDANCE WITH

PROVISIONS OF DOD DIRECTIVE 5230.25. DISTRIBUTION STATEMENT

D: DISTRIBUTION IS AUTHORIZED TO DOD AND DOD CONTRACTORS

ONLY. DUE TO CRITICAL TECHNOLOGY 2006-11-27 OTHER REQUESTS

FOR THIS DOCUMENT SHALL BE REFERRED TO NUWC SECURITY

MANAGER, 610 DOWELL ST, KEYPORT, WA 98345. DESTRUCTION

NOTICES DESTROY BY ANY METHOD WHICH WILL PREVENT

DISCLOSURE OF DESTROY BY ANY METHOD WHICH WILL PREVENT

DISCLOSURE OF CONTENTS OR RECONSTRUCTION OF THE

DOCUMENT. UNCLASSIFIED.

FOB: Destination

NET AMT

0002 4 Each

CYLINDER, DOLLY LIFT

FFP

Manufacture in accordance to the attached specifications and drawings posted in

FBO.

**WARNING** THIS DOCUMENT CONTAINS TECHNICAL DATA WHOSE

EXPORT IS RESTRICTED BY THE ARMS EXPORT CONTROL ACT (TITLE

22, U.S.C., SEC 2751, ET. SEQ.) OR THE EXPORT ADMINISTRATION ACT

OF 1979, AS AMENDED, TITLE 50, U.S.C., APP. 2401 ET. SEQ.

VIOLATIONS OF THESE EXPORT LAWS ARE SUBJECT TO SEVERE

CRIMINAL PENALTIES. DISSEMINATE IN ACCORDANCE WITH

PROVISIONS OF DOD DIRECTIVE 5230.25. DISTRIBUTION STATEMENT

D: DISTRIBUTION IS AUTHORIZED TO DOD AND DOD CONTRACTORS

ONLY. DUE TO CRITICAL TECHNOLOGY 2006-11-27 OTHER REQUESTS

FOR THIS DOCUMENT SHALL BE REFERRED TO NUWC SECURITY

MANAGER, 610 DOWELL ST, KEYPORT, WA 98345. DESTRUCTION

NOTICES DESTROY BY ANY METHOD WHICH WILL PREVENT

DISCLOSURE OF DESTROY BY ANY METHOD WHICH WILL PREVENT

0003 3 Each

CYLINDER, LAUNCH

FFP

Manufacture in accordance to the attached specifications and drawings posted in

FBO.

**WARNING** THIS DOCUMENT CONTAINS TECHNICAL DATA WHOSE

EXPORT IS RESTRICTED BY THE ARMS EXPORT CONTROL ACT (TITLE

22, U.S.C., SEC 2751, ET. SEQ.) OR THE EXPORT ADMINISTRATION ACT

OF 1979, AS AMENDED, TITLE 50, U.S.C., APP. 2401 ET. SEQ.

VIOLATIONS OF THESE EXPORT LAWS ARE SUBJECT TO SEVERE

CRIMINAL PENALTIES. DISSEMINATE IN ACCORDANCE WITH

PROVISIONS OF DOD DIRECTIVE 5230.25. DISTRIBUTION STATEMENT

D: DISTRIBUTION IS AUTHORIZED TO DOD AND DOD CONTRACTORS

ONLY. DUE TO CRITICAL TECHNOLOGY 2006-11-27 OTHER REQUESTS

FOR THIS DOCUMENT SHALL BE REFERRED TO NUWC SECURITY

MANAGER, 610 DOWELL ST, KEYPORT, WA 98345. DESTRUCTION

NOTICES DESTROY BY ANY METHOD WHICH WILL PREVENT

DISCLOSURE OF DESTROY BY ANY METHOD WHICH WILL PREVENT

0004 3 Each

CYLINDER, LATERAL

FFP

Manufacture in accordance to the attached specifications and drawings posted in

FBO.

**WARNING** THIS DOCUMENT CONTAINS TECHNICAL DATA WHOSE

EXPORT IS RESTRICTED BY THE ARMS EXPORT CONTROL ACT (TITLE

22, U.S.C., SEC 2751, ET. SEQ.) OR THE EXPORT ADMINISTRATION ACT

OF 1979, AS AMENDED, TITLE 50, U.S.C., APP. 2401 ET. SEQ.

VIOLATIONS OF THESE EXPORT LAWS ARE SUBJECT TO SEVERE

CRIMINAL PENALTIES. DISSEMINATE IN ACCORDANCE WITH

PROVISIONS OF DOD DIRECTIVE 5230.25. DISTRIBUTION STATEMENT

D: DISTRIBUTION IS AUTHORIZED TO DOD AND DOD CONTRACTORS

ONLY. DUE TO CRITICAL TECHNOLOGY 2006-11-27 OTHER REQUESTS

FOR THIS DOCUMENT SHALL BE REFERRED TO NUWC SECURITY

MANAGER, 610 DOWELL ST, KEYPORT, WA 98345. DESTRUCTION

NOTICES DESTROY BY ANY METHOD WHICH WILL PREVENT

DISCLOSURE OF DESTROY BY ANY METHOD WHICH WILL PREVENT

INSPECTION AND ACCEPTANCE TERMS

Supplies/services will be inspected/accepted at:

CLIN INSPECT AT INSPECT BY ACCEPT AT ACCEPT BY

0001 Destination Government Destination Government

0002 Destination Government Destination Government

0003 Destination Government Destination Government

0004 Destination Government Destination Government

DELIVERY INFORMATION

CLIN DELIVERY DATE QUANTITY SHIP TO ADDRESS DODAAC

0001 60 dys. ADC 6 NAVAL UNDERSEA WARFARE CENTER

SUPPLY OFFICER

NUWC DETACHMENT PACIFIC

1894 WASP BLVD., BLDG.133

PEARL HARBOR HI 96860

(808) 472-1738

N35266

0002 60 dys. ADC 4 (SAME AS PREVIOUS LOCATION)

0003 60 dys. ADC 3 (SAME AS PREVIOUS LOCATION)

0004 60 dys. ADC 3 (SAME AS PREVIOUS LOCATION)

CLAUSES INCORPORATED BY REFERENCE

52.204-2 Security Requirements AUG 1996

52.204-7 System for Award Management JUL 2013

52.204-13 System for Award Management Maintenance JUL 2013

52.204-16 Commercial and Government Entity Code Reporting JUL 2015

52.204-18 Commercial and Government Entity Code Maintenance JUL 2015

52.204-19 Incorporation by Reference of Representations and

Certifications.

DEC 2014

52.209-2 Prohibition on Contracting with Inverted Domestic

Corporations--Representation

NOV 2015

52.209-10 Prohibition on Contracting With Inverted Domestic

Corporations

NOV 2015

52.211-15 Defense Priority And Allocation Requirements APR 2008

52.212-1 Instructions to Offerors--Commercial Items OCT 2015

52.212-4 Contract Terms and Conditions--Commercial Items MAY 2015

52.232-39 Unenforceability of Unauthorized Obligations JUN 2013

52.232-40 Providing Accelerated Payments to Small Business

Subcontractors

DEC 2013

52.247-34 F.O.B. Destination NOV 1991

252.203-7000 Requirements Relating to Compensation of Former DoD

Officials

SEP 2011

252.203-7002 Requirement to Inform Employees of Whistleblower Rights SEP 2013

252.203-7005 Representation Relating to Compensation of Former DoD

Officials

NOV 2011

252.204-0001 Line Item Specific: Single Funding SEP 2009

252.204-7000 Disclosure Of Information AUG 2013

252.204-7003 Control Of Government Personnel Work Product APR 1992

252.204-7004 Alt A System for Award Management Alternate A FEB 2014

252.204-7005 Oral Attestation of Security Responsibilities NOV 2001

252.204-7008 Compliance With Safeguarding Covered Defense Information

Controls

DEC 2015

252.204-7009 Limitations on the Use or Disclosure of Third-Party

Contractor Reported Cyber Incident Information

DEC 2015

252.204-7012 Safeguarding Covered Defense Information and Cyber

Incident Reporting.

DEC 2015

252.204-7015 Disclosure of Information to Litigation Support Contractors FEB 2014

252.211-7003 Item Unique Identification and Valuation MAR 2016

252.213-7000 Notice to Prospective Suppliers on Use of Past Performance

Information Retrieval System--Statistical Reporting in Past

Performance Evaluations

JUN 2015

252.225-7001 Buy American And Balance Of Payments Program-- Basic

(Nov 2014)

NOV 2014

252.225-7048 Export-Controlled Items JUN 2013

252.232-7003 Electronic Submission of Payment Requests and Receiving

Reports

JUN 2012

252.232-7010 Levies on Contract Payments DEC 2006

252.243-7001 Pricing Of Contract Modifications DEC 1991

252.247-7023 Transportation of Supplies by Sea APR 2014

CLAUSES INCORPORATED BY FULL TEXT

52.204-17 OWNERSHIP OF CONTROL OF OFFEROR (NOV 2014)

(a) Definitions. As used in this provision--

Commercial and Government Entity (CAGE) code means—

(1) An identifier assigned to entities located in the United States or its outlying areas by the Defense Logistics

Agency (DLA) Contractor and Government Entity (CAGE) Branch to identify a commercial or government entity, or

(2) An identifier assigned by a member of the North Atlantic Treaty Organization (NATO) or by the NATO Support

Agency (NSPA) to entities located outside the United States and its outlying areas that the DLA Contractor and

Government Entity (CAGE) Branch records and maintains in the CAGE master file. This type of code is known as an NCAGE code.

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.

(b) The Offeror represents that it [ ___ ] has or [ ___ ] does not have an immediate owner. If the Offeror has more than one immediate owner (such as a joint venture), then the Offeror shall respond to paragraph (c) and if applicable, paragraph (d) of this provision for each participant in the joint venture.

(c) If the Offeror indicates ``has'' in paragraph (b) of this provision, enter the following information:

Immediate owner CAGE code:

Immediate owner legal name: ___

(Do not use a ``doing business as'' name)

Is the immediate owner owned or controlled by another entity?:

[ ___ ] Yes or [ ___ ] No.

(d) If the Offeror indicates ``yes'' in paragraph (c) of this provision, indicating that the immediate owner is owned or controlled by another entity, then enter the following information:

Highest-level owner CAGE code:

Highest-level owner legal name:

(Do not use a ``doing business as'' name)

(End of provision)

52.204-20 Predecessor of Offeror (APR 2016)

Commercial and Government Entity (CAGE) code means--

(1) An identifier assigned to entities located in the United States and its outlying areas by the Defense Logistics

Agency (DLA) Contractor and Government Entity (CAGE) Branch to identify a commercial or government entity, or

(2) An identifier assigned by a member of the North Atlantic Treaty Organization (NATO) or by NATO's Support

Agency (NSPA) to entities located outside the United States and its outlying areas that DLA Contractor and

Government Entity (CAGE) Branch records and maintains in the CAGE master file. This type of code is known as an NCAGE code.

Predecessor means an entity that is replaced by a successor and includes any predecessors of the predecessor.

Successor means an entity that has replaced a predecessor by acquiring the assets and carrying out the affairs of the predecessor under a new name (often through acquisition or merger). The term “successor” does not include new offices/divisions of the same company or a company that only changes its name. The extent of the responsibility of the successor for the liabilities of the predecessor may vary, depending on State law and specific circumstances.

(b) The Offeror represents that it [____] is or [____] is not a successor to a predecessor that held a Federal contract or grant within the last three years.

(c) If the Offeror has indicated “is” in paragraph (b) of this provision, enter the following information for all predecessors that held a Federal contract or grant within the last three years (if more than one predecessor, list in reverse chronological order):

Predecessor CAGE code: ____ (or mark “Unknown”).

Predecessor legal name: ____.

(Do not use a “doing business as” name).

52.209-11 REPRESENTATION BY CORPORATIONS REGARDING DELINQUENT TAX LIABILITY OR A

FELONY CONVICTION UNDER ANY FEDERAL LAW (FEB 2016)

(a) As required by sections 744 and 745 of Division E of the Consolidated and Further Continuing Appropriations

Act, 2015 (Pub. L. 113-235), and similar provisions, if contained in subsequent appropriations acts, the Government will not enter into a contract with any corporation that--

(1) Has any unpaid Federal tax liability that has been assessed, for which all judicial and administrative remedies have been exhausted or have lapsed, and that is not being paid in a timely manner pursuant to an agreement with the authority responsible for collecting the tax liability, where the awarding agency is aware of the unpaid tax liability, unless an agency has considered suspension or debarment of the corporation and made a determination that suspension or debarment is not necessary to protect the interests of the Government; or

(2) Was convicted of a felony criminal violation under any Federal law within the preceding 24 months, where the awarding agency is aware of the conviction, unless an agency has considered suspension or debarment of the corporation and made a determination that this action is not necessary to protect the interests of the Government.

(b) The Offeror represents that--

(1) It is [ ] is not [ ] a corporation that has any unpaid Federal tax liability that has been assessed, for which all judicial and administrative remedies have been exhausted or have lapsed, and that is not being paid in a timely manner pursuant to an agreement with the authority responsible for collecting the tax liability; and

(2) It is [ ] is not [ ] a corporation that was convicted of a felony criminal violation under a Federal law within the preceding 24 months.

52.211-14 NOTICE OF PRIORITY RATING FOR NATIONAL DEFENSE, EMERGENCY PREPAREDNESS, AND ENERGY PROGRAM USE (APR 2008)

Any contract awarded as a result of this solicitation will be DX rated order; X DO rated order certified for national defense, emergency preparedness, and energy program use under the Defense Priorities and Allocations

System (DPAS) (15 CFR 700), and the Contractor will be required to follow all of the requirements of this regulation. [Contracting Officer check appropriate box.]

52.212-3 OFFEROR REPRESENTATIONS AND CERTIFICATIONS--COMMERCIAL ITEMS (APR 2016)

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 accessed through http://www.acquisition.gov . If the Offeror has not completed the annual representations and certifications electronically, the Offeror shall complete only paragraphs (c) through (r) of this provision.

http://www.acquisition.gov/

“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 (q) 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 https://www.acquisition.gov/

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:

LINE ITEM NO. COUNTRY OF ORIGIN

[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:

LINE ITEM NO. COUNTRY OF ORIGIN

[List as necessary]

(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:

LINE ITEM NO. COUNTRY OF ORIGIN

[List as necessary]

(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:

Line Item No.: Country of Origin:

[List as necessary]

(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,…