N6809421R6018.pdf

Combined Synopsis/Solicitation

Solicitation Number: N6809421R6018

Purchase Description: ENDODONTIC DENTAL MICROSCOPES

This is a Combined Synopsis/Solicitation for the purchase of Commercial Items prepared in accordance with the format in

FAR 12.6, as supplemented with additional information included in this notice. This announcement constitutes the only solicitation; a written solicitation will not be issued. This solicitation will be posted to the Federal Business Opportunities

(FBO) web-site as a “Brand Name” 100% Total Small Business Set-Aside”.

Vendor shall be an Original Equipment Manufacturer (OEM) authorized dealer, authorized distributor or authorized reseller for the proposed equipment, such that OEM warranty and service are provided and maintained by the OEM. All software licensing, warranty and service associated with the equipment shall be in accordance with the OEM terms and conditions.

The units shall be compliant with the Food and Drug Administration (FDA) requirements to market and deliver medical products for use in the United States of America, even should delivery be requested outside of the United States. The claims made for the product shall comply with the regulations of the FDA, with respect to products for marketing and delivery of a medical product for use in the United States of America, even should delivery be requested outside of the United States. The unit shall be installed in compliance with Occupational Safety and Health Administration (OSHA) regulations/requirements.

The Navy Hospital Camp Pendleton (NHCP), Material Management Department, Contracting Division is issuing this combined synopsis/solicitation, reference solicitation number N6809421R6018, as a Request for Quote (RFQ) using FAR Part

12, Acquisition of Commercial Item, & FAR Part 13, Simplified Acquisition Procedures. The North American Industrial

Classification System (NAICS) code for this procurement is, “339114”, with a small business standard of “750”

The Government intends to award a Firm Fixed-Price Commercial Award. The solicitation document and incorporated provisions and clauses are those in effect through the Federal Acquisition Circular (FAC) 2021-06 effective July 12, 2021 and

Defense Federal Acquisition Regulation Supplement DPN 20210709 effective July 9, 2021

GOVERNMENT INTENDED USE STATEMENT (BACKGROUND/OVERVIEW): To be utilized in the Dental Clinics

DESCRIPTION OF ITEMS/SERVICES: All offers shall provide F.O.B. Destination for all CLIN’s.

Brand Name Justification

MFR: GLOBAL SURGICAL CORPORATION

***See attachments for additional details***

TOTAL: $_________________________

DELIVERY DATE(S): September 30, 2021

PLACE OF DELIVERY AND/OR SERVICE:

System #1

29 Palms Dental Clinic 1591 Griffin Road

Marine Corps Base

Twenty nine Palms, CA 92278

4-Step Axis Microscope, Wall Mount

Naval Dental Center, HQ

Receiving – Bldg 2238

Camp Pendleton, CA 92055

6-Step Axis Microscope, Wall Mount

Naval Dental Center, HQ

Receiving – Bldg 2238

Camp Pendleton, CA 92055

Responses/quotes MUST be received no later than August 3, 2021; 10am PST. Forward responses by e-mail to danielle.l.patterson3.civ@mail.mil. Due to technical issues, please allow additional time if you’re using electronic means.

Offerors must ensure that their company is registered with System for Award Management (SAM) prior to award. For information refer to (may have to copy/paste): https://www.sam.gov.

For equipment repair/maintenance solicitations/procurements only authorized distributors, and/or service providers of the manufacturer will be accepted. Manufacturer certifications/confirmations must be provided upon request of the Contracting

Office.

APPLICABLE FAR CLAUSES:

(1) FAR 52.212-1 (Deviation 2018-O0018): Instructions to Offerors – Commercial Items (JUN 2020)

(2) FAR 52.212-2: Evaluation - Commercial Items (Oct 2014): The evaluation procedures of FAR 12.602, Streamlined Evaluation of Offers, will be used to select the awardee/offer that represents the most advantageous offer to the Government based on the following evaluation factors:

Note: All evaluation factors other than cost or price, when combined, are equally important to cost or price. The

Contracting Officer may, at their discretion, request clarifications, however, IAW FAR 13.106-2(b)(3) there will not be a formal evaluation plan or competitive range established, award will be made without discussions, and offers will not be formally scored.

(a) Technical Capability: Meets Brand Name Government requirement, specifications, and product salient “must have” features as identified within each CLIN and/or Statement of Work (if applicable).

***The Government will consider offers/quotes only from “authorized resellers, distributors, & service providers” of the manufacturer***

(b) Price: No additional information from the offeror will be required if the price is based on adequate price competition. In the event adequate price competition does not exist, the contracting officer will obtain information from the offeror to the extent required to determine the reasonableness of the offered prices.

(c) Past Performance: Will be evaluated as Acceptable or Unacceptable based on the contracting officer’s knowledge of and previous experience with the supply or service being acquired, the Past Performance Information Retrieval System

(PPIRS), and any other reasonable basis. In the case of an offeror without a record of relevant past performance or for whom information on past performance is not available, the offeror will not be evaluated favorably or unfavorably on past performance.

Past Performance Evaluation Ratings

Rating Description

Acceptable

Based on the offeror’s performance record, the Government has a reasonable expectation that the offeror will successfully perform the required effort, or the offeror’s performance record is unknown.

Unacceptable

Based on the offeror’s performance record, the

Government has no reasonable expectation that the offeror will be able to successfully perform the required effort.

mailto:danielle.l.patterson3.civ@mail.mil https://www.sam.gov/

SEE ADDENDUM

(No Collect Calls)

N6809421R6018 19-Jul-2021

b. TELEPHONE NUMBER

760-725-1597

8. OFFER DUE DATE/LOCAL TIME

10:00 AM 03 Aug 2021

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.

N680949. ISSUED BY

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

7. FOR SOLICITATION

INFORMATION CALL:

a. NAME

DANIELLE L. PATTERSON

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

0011674135

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 HOSPITAL CAMP PENDLETON

MATERIAL MGMT DEPT CODE 06B

NAVAL HOSPITAL, BOX 555191

CAMP PENDLETON CA 92055-5191

18a. PAYMENT WILL BE MADE BY CODE

RATED ORDER UNDER

DPAS (15 CFR 700)

13a. THIS CONTRACT IS A

13b. RATING

CODE15. DELIVER TO CODE 16. ADMINISTERED BY

SEE SCHEDULE

12. DISCOUNT TERMS11. DELIVERY FOR FOB DESTINA-

TION UNLESS BLOCK IS

MARKED

SEE SCHEDULE

14. METHOD OF SOLICITATION

RFQ IFB RFPX

(760) 725-1485FAX:

TEL: (760) 725-1425

SERVICE-DISABLED

VETERAN-OWNED

SMALL BUSINESS

8(A)

HUBZONE SMALL

BUSINESS

SIZE STANDARD:

NAICS:

339114

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 OF67

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.

N6809421R6018

Section SF 1449 - CONTINUATION SHEET

BUYER’S INFORMATION

Contract Specialist: Danielle Patterson

Tel: (760) 725-1597

E-mail: danielle.l.patterson3.civ@mail.mil

ITEM NO SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT

0001 1 Each

X MOUNT SLR ADAPTER

FFP

without camera ring coupler

FOB: Destination

BRAND NAME/SOLE SOURCE: BN

MFR PART NR: M 528XSLR

SPEC NR: PKG 21D005

PURCHASE REQUEST NUMBER: 0011674135

ADDITIONAL MARKINGS: 29 PALMS DENTAL CLINIC, SERGIO DALEY,

760-725-8595

PSC CD: 6520

NET AMT

mailto:danielle.l.patterson3.civ@mail.mil

0002 1 Each

DUAL PORT BEAMSPLITTER

FFP

50/50 and 50/50 portss, dove tall mount

FOB: Destination

BRAND NAME/SOLE SOURCE: BN

MFR PART NR: M A1061-D50

SPEC NR: PKG 21D005

PURCHASE REQUEST NUMBER: 0011674135

ADDITIONAL MARKINGS: 29 PALMS DENTAL CLINIC, SERGIO DALEY,

0003 1 Each

DUAL IRIS DIAPHRAGM

FFP

FOB: Destination

BRAND NAME/SOLE SOURCE: BN

MFR PART NR: M 512A

SPEC NR: PKG 21D005

PURCHASE REQUEST NUMBER: 0011674135

ADDITIONAL MARKINGS: 29 PALMS DENTAL CLINIC, SERGIO DALEY,

0004 1 Each

CLEARSIGHT, OBJECTIVE LENS COVER

FFP

for use with A-Series and Multi-Focal Lens, 3-pack

FOB: Destination

BRAND NAME/SOLE SOURCE: BN

MFR PART NR: M A1028CLST-3

SPEC NR: PKG 21D005

PURCHASE REQUEST NUMBER: 0011674135

ADDITIONAL MARKINGS: 29 PALMS DENTAL CLINIC, SERGIO DALEY,

0005 1 Each

4-STEP A-SERIES MICROSCOPE

FFP

AXIS systemm angle arm and coupler

FOB: Destination

BRAND NAME/SOLE SOURCE: BN

MFR PART NR: M A1004

SPEC NR: PKG 21D009

PURCHASE REQUEST NUMBER: 0011674135

ADDITIONAL MARKINGS: NAVAL DENTAL CENTER HQ, SERGIO

DALEY, 760-725-8595

0006 1 Each

INCLINABLE BINOCULAR

FFP

0-220 degrees, f:160, 10X eyepieces

FOB: Destination

BRAND NAME/SOLE SOURCE: BN

MFR PART NR: M A1022-10

SPEC NR: PKG 21D009

PURCHASE REQUEST NUMBER: 0011674135

ADDITIONAL MARKINGS: NAVAL DENTAL CENTER HQ, SERGIO

0007 1 Each

MULTI-FOCAL LENS

FFP

220-350mm optical range

FOB: Destination

BRAND NAME/SOLE SOURCE: BN

MFR PART NR: M 1028ML

SPEC NR: PKG 21D009

PURCHASE REQUEST NUMBER: 0011674135

ADDITIONAL MARKINGS: NAVAL DENTAL CENTER HQ, SERGIO

0008 1 Each

WALL MOUNT

FFP

high or low, mounting plate, 16" studs, shaft bracket, plate cover

FOB: Destination

BRAND NAME/SOLE SOURCE: BN

MFR PART NR: M A730W

SPEC NR: PKG 21D009

PURCHASE REQUEST NUMBER: 0011674135

ADDITIONAL MARKINGS: NAVAL DENTAL CENTER HQ, SERGIO

0009 1 Each

45 DEGREE ARM

FFP

spring arm, extension arm (for use with high wall and ceiling mount)

FOB: Destination

BRAND NAME/SOLE SOURCE: BN

MFR PART NR: M A730-45A

SPEC NR: PKG 21D009

PURCHASE REQUEST NUMBER: 0011674135

ADDITIONAL MARKINGS: NAVAL DENTAL CENTER HQ, SERGIO

0010 1 Each

LED LIGHTSOURCE

FFP

for the A-Series microscope, green and amber (UV) filter

FOB: Destination

BRAND NAME/SOLE SOURCE: BN

MFR PART NR: M A801-LED

SPEC NR: PKG 21D009

PURCHASE REQUEST NUMBER: 0011674135

ADDITIONAL MARKINGS: NAVAL DENTAL CENTER HQ, SERGIO

0011 1 Each

HD VIDEO CAMERA

FFP

1080P, with 25ft. HDMI cable for A-Series microscope systems

FOB: Destination

BRAND NAME/SOLE SOURCE: BN

MFR PART NR: M A517HD1080

SPEC NR: PKG 21D009

PURCHASE REQUEST NUMBER: 0011674135

ADDITIONAL MARKINGS: NAVAL DENTAL CENTER HQ, SERGIO

0012 1 Each

X MOUNT SLR ADAPTER

FFP

without camera ring coupler

FOB: Destination

BRAND NAME/SOLE SOURCE: BN

MFR PART NR: M 528XSLR

SPEC NR: PKG 21D009

PURCHASE REQUEST NUMBER: 0011674135

ADDITIONAL MARKINGS: NAVAL DENTAL CENTER HQ, SERGIO

0013 1 Each

T MOUNT ADAPTER

FFP

for Nikon F cameras

FOB: Destination

BRAND NAME/SOLE SOURCE: BN

MFR PART NR: M 528XSLR-F

SPEC NR: PKG 21D009

PURCHASE REQUEST NUMBER: 0011674135

ADDITIONAL MARKINGS: NAVAL DENTAL CENTER HQ, SERGIO

0014 1 Each

CAMERA ADAPTER

FFP

HD video, A-Series

FOB: Destination

BRAND NAME/SOLE SOURCE: BN

MFR PART NR: M A528STHDC

SPEC NR: PKG 21D009

PURCHASE REQUEST NUMBER: 0011674135

ADDITIONAL MARKINGS: NAVAL DENTAL CENTER HQ, SERGIO

0015 1 Each

DUAL PORT BEAMSPLITTER

FFP

50/50 and 50/50 ports, dove tail mount

FOB: Destination

BRAND NAME/SOLE SOURCE: BN

MFR PART NR: M A1061-D50

SPEC NR: PKG 21D009

PURCHASE REQUEST NUMBER: 0011674135

ADDITIONAL MARKINGS: NAVAL DENTAL CENTER HQ, SERGIO

0016 1 Each

CARR BINOCULAR ADAPTER

FFP

45 degree binocular extender

FOB: Destination

BRAND NAME/SOLE SOURCE: BN

MFR PART NR: M A1017

SPEC NR: PKG 21D009

PURCHASE REQUEST NUMBER: 0011674135

ADDITIONAL MARKINGS: NAVAL DENTAL CENTER HQ, SERGIO

0017 1 Each

BINOCULAR ROTATION RING

FFP

for use with A series

FOB: Destination

BRAND NAME/SOLE SOURCE: BN

MFR PART NR: M A1019

SPEC NR: PKG 21D009

PURCHASE REQUEST NUMBER: 0011674135

ADDITIONAL MARKINGS: NAVAL DENTAL CENTER HQ, SERGIO

0018 1 Each

43 INCH MONITOR

FFP

FOB: Destination

BRAND NAME/SOLE SOURCE: BN

MFR PART NR: M 547-43

SPEC NR: PKG 21D009

PURCHASE REQUEST NUMBER: 0011674135

ADDITIONAL MARKINGS: NAVAL DENTAL CENTER HQ, SERGIO

0019 1 Each

6-STEP A-SERIES MICROSCOPE

FFP

AXIS system, angle arm and coupler

FOB: Destination

BRAND NAME/SOLE SOURCE: BN

MFR PART NR: M A1006

SPEC NR: PKG 21D009

PURCHASE REQUEST NUMBER: 0011674135

ADDITIONAL MARKINGS: NAVAL DENTAL CENTER HQ, SERGIO

0020 1 Each

INCLINABLE BINOCULAR

FFP

0-220 degrees, f:160, 10X eyepieces

FOB: Destination

BRAND NAME/SOLE SOURCE: BN

MFR PART NR: M A1022-10

SPEC NR: PKG 21D009

PURCHASE REQUEST NUMBER: 0011674135

ADDITIONAL MARKINGS: NAVAL DENTAL CENTER HQ, SERGIO

0021 1 Each

MULTI-FOCAL LENS

FFP

200-350mm optical range

FOB: Destination

BRAND NAME/SOLE SOURCE: BN

MFR PART NR: M 1028ML

SPEC NR: PKG 21D009

PURCHASE REQUEST NUMBER: 0011674135

ADDITIONAL MARKINGS: NAVAL DENTAL CENTER HQ, SERGIO

0022 1 Each

WALL MOUNT

FFP

high or low, mounting plate, 16" studs, shaft bracket, plate cover

FOB: Destination

BRAND NAME/SOLE SOURCE: BN

MFR PART NR: M A730W

SPEC NR: PKG 21D009

PURCHASE REQUEST NUMBER: 0011674135

ADDITIONAL MARKINGS: NAVAL DENTAL CENTER HQ, SERGIO

0023 1 Each

45 DEGREE ARM

FFP

spring arm, extension arm (for use with high wall and ceiling mount)

FOB: Destination

BRAND NAME/SOLE SOURCE: BN

MFR PART NR: M A730-45A

SPEC NR: PKG 21D009

PURCHASE REQUEST NUMBER: 0011674135

ADDITIONAL MARKINGS: NAVAL DENTAL CENTER HQ, SERGIO

0024 1 Each

LED LIGHTSOURCE

FFP

for the A-Series microscope, green and amber (UV) filter

FOB: Destination

BRAND NAME/SOLE SOURCE: BN

MFR PART NR: M A801-LED

SPEC NR: PKG 21D009

PURCHASE REQUEST NUMBER: 0011674135

ADDITIONAL MARKINGS: NAVAL DENTAL CENTER HQ, SERGIO

0025 1 Each

HD VIDEO CAMERA

FFP

1080P, with 25ft. HDMI cable for A-Series microscope systems

FOB: Destination

BRAND NAME/SOLE SOURCE: BN

MFR PART NR: M A517HD1080

SPEC NR: PKG 21D009

PURCHASE REQUEST NUMBER: 0011674135

ADDITIONAL MARKINGS: NAVAL DENTAL CENTER HQ, SERGIO

0026 1 Each

X MOUNT SLR ADAPTER

FFP

without camera ring coupler

FOB: Destination

BRAND NAME/SOLE SOURCE: BN

MFR PART NR: M 528XSLR

SPEC NR: PKG 21D009

PURCHASE REQUEST NUMBER: 0011674135

ADDITIONAL MARKINGS: NAVAL DENTAL CENTER HQ, SERGIO

0027 1 Each

T MOUNT ADAPTER

FFP

for Nikon F camera

FOB: Destination

BRAND NAME/SOLE SOURCE: BN

MFR PART NR: M 528XSLR-F

SPEC NR: PKG 21D009

PURCHASE REQUEST NUMBER: 0011674135

ADDITIONAL MARKINGS: NAVAL DENTAL CENTER HQ, SERGIO

0028 1 Each

CAMERA ADAPTER

FFP

HD video, A-Series

FOB: Destination

BRAND NAME/SOLE SOURCE: BN

MFR PART NR: M A528STHDC

SPEC NR: PKG 21D009

PURCHASE REQUEST NUMBER: 0011674135

ADDITIONAL MARKINGS: NAVAL DENTAL CENTER HQ, SERGIO

0029 1 Each

DUAL PORT BEAMSPLITTER

FFP

50/50 and 50/50ports, dove tail mount

FOB: Destination

BRAND NAME/SOLE SOURCE: BN

MFR PART NR: M A1061-D50

SPEC NR: PKG 21D009

PURCHASE REQUEST NUMBER: 0011674135

ADDITIONAL MARKINGS: NAVAL DENTAL CENTER HQ, SERGIO

0030 1 Each

CARR BINOCULAR ADAPTER

FFP

45 degree binocular extender

FOB: Destination

BRAND NAME/SOLE SOURCE: BN

MFR PART NR: M A1017

SPEC NR: PKG 21D009

PURCHASE REQUEST NUMBER: 0011674135

ADDITIONAL MARKINGS: NAVAL DENTAL CENTER HQ, SERGIO

0031 1 Each

BINOCULAR ROTATION RING

FFP

for use with A series

FOB: Destination

BRAND NAME/SOLE SOURCE: BN

MFR PART NR: M A1019

SPEC NR: PKG 21D009

PURCHASE REQUEST NUMBER: 0011674135

ADDITIONAL MARKINGS: NAVAL DENTAL CENTER HQ, SERGIO

0032 1 Each

43 INCH MONITOR

FFP

FOB: Destination

BRAND NAME/SOLE SOURCE: BN

MFR PART NR: M 547-43

SPEC NR: PKG 21D009

PURCHASE REQUEST NUMBER: 0011674135

ADDITIONAL MARKINGS: NAVAL DENTAL CENTER HQ, SERGIO

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

0005 Destination Government Destination Government

0006 Destination Government Destination Government

0007 Destination Government Destination Government

0008 Destination Government Destination Government

0009 Destination Government Destination Government

0010 Destination Government Destination Government

0011 Destination Government Destination Government

0012 Destination Government Destination Government

0013 Destination Government Destination Government

0014 Destination Government Destination Government

0015 Destination Government Destination Government

0016 Destination Government Destination Government

0017 Destination Government Destination Government

0018 Destination Government Destination Government

0019 Destination Government Destination Government

0020 Destination Government Destination Government

0021 Destination Government Destination Government

0022 Destination Government Destination Government

0023 Destination Government Destination Government

0024 Destination Government Destination Government

0025 Destination Government Destination Government

0026 Destination Government Destination Government

0027 Destination Government Destination Government

0028 Destination Government Destination Government

0029 Destination Government Destination Government

0030 Destination Government Destination Government

0031 Destination Government Destination Government

0032 Destination Government Destination Government

DELIVERY INFORMATION

CLIN DELIVERY DATE QUANTITY SHIP TO ADDRESS DODAAC /

CAGE

0001 30-SEP-2021 1 NAVAL DENTAL COMMAND

NAVAL DENTAL COMMAND

BLDG 1591 MARINE CORP BASE 29

PALMS

TWENTYNINE PALMS, CA CA 92278-8280

FOB: Destination

HT0635

0002 30-SEP-2021 1 (SAME AS PREVIOUS LOCATION)

0003 30-SEP-2021 1 (SAME AS PREVIOUS LOCATION)

0004 30-SEP-2021 1 (SAME AS PREVIOUS LOCATION)

0005 30-SEP-2021 1 NAVAL DENTAL CENTER

NAVAL DENTAL CENTER

RECEIVING BLDG 2238

CAMP PENDLETON, CA CA 92055-5191

0006 30-SEP-2021 1 (SAME AS PREVIOUS LOCATION)

0007 30-SEP-2021 1 (SAME AS PREVIOUS LOCATION)

0008 30-SEP-2021 1 (SAME AS PREVIOUS LOCATION)

0009 30-SEP-2021 1 (SAME AS PREVIOUS LOCATION)

0010 30-SEP-2021 1 (SAME AS PREVIOUS LOCATION)

0011 30-SEP-2021 1 (SAME AS PREVIOUS LOCATION)

0012 30-SEP-2021 1 (SAME AS PREVIOUS LOCATION)

0013 30-SEP-2021 1 (SAME AS PREVIOUS LOCATION)

0014 30-SEP-2021 1 (SAME AS PREVIOUS LOCATION)

0015 30-SEP-2021 1 (SAME AS PREVIOUS LOCATION)

0016 30-SEP-2021 1 (SAME AS PREVIOUS LOCATION)

0017 30-SEP-2021 1 (SAME AS PREVIOUS LOCATION)

0018 30-SEP-2021 1 (SAME AS PREVIOUS LOCATION)

0019 30-SEP-2021 1 (SAME AS PREVIOUS LOCATION)

0020 30-SEP-2021 1 (SAME AS PREVIOUS LOCATION)

0021 30-SEP-2021 1 (SAME AS PREVIOUS LOCATION)

0022 30-SEP-2021 1 (SAME AS PREVIOUS LOCATION)

0023 30-SEP-2021 1 (SAME AS PREVIOUS LOCATION)

0024 30-SEP-2021 1 (SAME AS PREVIOUS LOCATION)

0025 30-SEP-2021 1 (SAME AS PREVIOUS LOCATION)

0026 30-SEP-2021 1 (SAME AS PREVIOUS LOCATION)

0027 30-SEP-2021 1 (SAME AS PREVIOUS LOCATION)

0028 30-SEP-2021 1 (SAME AS PREVIOUS LOCATION)

0029 30-SEP-2021 1 (SAME AS PREVIOUS LOCATION)

0030 30-SEP-2021 1 (SAME AS PREVIOUS LOCATION)

0031 30-SEP-2021 1 (SAME AS PREVIOUS LOCATION)

0032 30-SEP-2021 1 (SAME AS PREVIOUS LOCATION)

CLAUSES INCORPORATED BY REFERENCE

52.203-3 Gratuities APR 1984

52.204-7 System for Award Management OCT 2018

52.204-10 Reporting Executive Compensation and First-Tier

Subcontract Awards

JUN 2020

52.204-13 System for Award Management Maintenance OCT 2018

52.204-25 Prohibition on Contracting for Certain Telecommunications and Video Surveillance Services or Equipment.

AUG 2020

52.209-6 Protecting the Government's Interest When Subcontracting

With Contractors Debarred, Suspended, or Proposed for

Debarment

JUN 2020

52.209-10 Prohibition on Contracting With Inverted Domestic

Corporations

NOV 2015

52.212-4 Contract Terms and Conditions--Commercial Items OCT 2018

52.219-6 (Dev) Notice of Total Small Business Set-Aside (DEVIATION

2020-O0008).

OCT 2020

52.222-3 Convict Labor JUN 2003

52.222-19 (Dev) Child Labor - Cooperation with Authorities and Remedies

(DEVIATION 2020-O0019)

JUL 2020

52.222-50 Combating Trafficking in Persons OCT 2020

52.223-18 Encouraging Contractor Policies To Ban Text Messaging

While Driving

JUN 2020

52.225-13 Restrictions on Certain Foreign Purchases FEB 2021

52.232-1 Payments APR 1984

52.232-8 Discounts For Prompt Payment FEB 2002

52.233-3 Protest After Award AUG 1996

52.246-1 Contractor Inspection Requirements APR 1984

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

252.204-7003 Control Of Government Personnel Work Product APR 1992

252.232-7003 Electronic Submission of Payment Requests and Receiving

Reports

DEC 2018

252.232-7010 Levies on Contract Payments DEC 2006

252.243-7001 Pricing Of Contract Modifications DEC 1991

CLAUSES INCORPORATED BY FULL TEXT

52.203-18 PROHIBITION ON CONTRACTING WITH ENTITIES THAT REQUIRE CERTAIN INTERNAL

CONFIDENTIALITY AGREEMENTS OR STATEMENTS--REPRESENTATION (JAN 2017)

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

Internal confidentiality agreement or statement, subcontract, and subcontractor, are defined in the clause at 52.203-

19, Prohibition on Requiring Certain Internal Confidentiality Agreements or Statements.

(b) In accordance with section 743 of Division E, Title VII, of the Consolidated and Further Continuing

Appropriations Act, 2015 (Pub. L. 113-235) and its successor provisions in subsequent appropriations acts (and as extended in continuing resolutions), Government agencies are not permitted to use funds appropriated (or otherwise made available) for contracts with an entity that requires employees or subcontractors of such entity seeking to report waste, fraud, or abuse to sign internal confidentiality agreements or statements prohibiting or otherwise restricting such employees or subcontractors from lawfully reporting such waste, fraud, or abuse to a designated investigative or law enforcement representative of a Federal department or agency authorized to receive such information.

(c) The prohibition in paragraph (b) of this provision does not contravene requirements applicable to Standard Form

312, (Classified Information Nondisclosure Agreement), Form 4414 (Sensitive Compartmented Information

Nondisclosure Agreement), or any other form issued by a Federal department or agency governing the nondisclosure of classified information.

(d) Representation. By submission of its offer, the Offeror represents that it will not require its employees or subcontractors to sign or comply with internal confidentiality agreements or statements prohibiting or otherwise restricting such employees or subcontractors from lawfully reporting waste, fraud, or abuse related to the performance of a Government contract to a designated investigative or law enforcement representative of a Federal department or agency authorized to receive such information (e.g., agency Office of the Inspector General).

(End of provision)

52.204-19 INCORPORATION BY REFERENCE OF REPRESENTATIONS AND CERTIFICATIONS (DEC

2014)

The Contractor's representations and certifications, including those completed electronically via the System for

Award Management (SAM), are incorporated by reference into the contract.

(End of clause)

52.204-24 REPRESENTATION REGARDING CERTAIN TELECOMMUNICATIONS AND VIDEO

SURVEILLANCE SERVICES OR EQUIPMENT (OCT 2020)

The Offeror shall not complete the representation at paragraph (d)(1) of this provision if the Offeror has represented that it "does not provide covered telecommunications equipment or services as a part of its offered products or services to the Government in the performance of any contract, subcontract, or other contractual instrument" in paragraph (c)(1) in the provision at 52.204-26, Covered Telecommunications Equipment or Services--

Representation, or in paragraph (v)(2)(i) of the provision at 52.212-3, Offeror Representations and Certifications-

Commercial Items. The Offeror shall not complete the representation in paragraph (d)(2) of this provision if the

Offeror has represented that it "does not use covered telecommunications equipment or services, or any equipment, system, or service that uses covered telecommunications equipment or services" in paragraph (c)(2) of the provision at 52.204-26, or in paragraph (v)(2)(ii) of the provision at 52.212-3.

(a) Definitions. As used in this provision-

Backhaul, covered telecommunications equipment or services, critical technology, interconnection arrangements, reasonable inquiry, roaming, and substantial or essential component have the meanings provided in the clause

52.204-25, Prohibition on Contracting for Certain Telecommunications and Video Surveillance Services or

Equipment.

(b) Prohibition.

(1) Section 889(a)(1)(A) of the John S. McCain National Defense Authorization Act for Fiscal Year 2019 (Pub. L.

115-232) prohibits the head of an executive agency on or after August 13, 2019, from procuring or obtaining, or extending or renewing a contract to procure or obtain, any equipment, system, or service that uses covered telecommunications equipment or services as a substantial or essential component of any system, or as critical technology as part of any system. Nothing in the prohibition shall be construed to--

(i) Prohibit the head of an executive agency from procuring with an entity to provide a service that connects to the facilities of a third-party, such as backhaul, roaming, or interconnection arrangements; or

(ii) Cover telecommunications equipment that cannot route or redirect user data traffic or cannot permit visibility into any user data or packets that such equipment transmits or otherwise handles.

(2) Section 889(a)(1)(B) of the John S. McCain National Defense Authorization Act for Fiscal Year 2019 (Pub. L.

115-232) prohibits the head of an executive agency on or after August 13, 2020, from entering into a contract or extending or renewing a contract with an entity that uses any equipment, system, or service that uses covered telecommunications equipment or services as a substantial or essential component of any system, or as critical technology as part of any system. This prohibition applies to the use of covered telecommunications equipment or services, regardless of whether that use is in performance of work under a Federal contract. Nothing in the prohibition shall be construed to--

(i) Prohibit the head of an executive agency from procuring with an entity to provide a service that connects to the facilities of a third-party, such as backhaul, roaming, or interconnection arrangements; or

(ii) Cover telecommunications equipment that cannot route or redirect user data traffic or cannot permit visibility into any user data or packets that such equipment transmits or otherwise handles.

(c) Procedures. The Offeror shall review the list of excluded parties in the System for Award Management (SAM)

(https://www.sam.gov) for entities excluded from receiving federal awards for "covered telecommunications equipment or services."

(d) Representations. The Offeror represents that--

(1) It [] will, [] will not provide covered telecommunications equipment or services to the Government in the performance of any contract, subcontract or other contractual instrument resulting from this solicitation. The Offeror shall provide the additional disclosure information required at paragraph (e)(1) of this section if the Offeror responds

"will" in paragraph (d)(1) of this section; and

(2) After conducting a reasonable inquiry, for purposes of this representation, the Offeror represents that--

It [] does, [] does not use covered telecommunications equipment or services, or use any equipment, system, or service that uses covered telecommunications equipment or services. The Offeror shall provide the additional disclosure information required at paragraph (e)(2) of this section if the Offeror responds "does" in paragraph (d)(2) of this section.

(e) Disclosures.

(1) Disclosure for the representation in paragraph (d)(1) of this provision. If the Offeror has responded "will" in the representation in paragraph (d)(1) of this provision, the Offeror shall provide the following information as part of the offer:

(i) For covered equipment--

(A) The entity that produced the covered telecommunications equipment (include entity name, unique entity identifier, CAGE code, and whether the entity was the original equipment manufacturer (OEM) or a distributor, if known);

(B) A description of all covered telecommunications equipment offered (include brand; model number, such as

OEM number, manufacturer part number, or wholesaler number; and item description, as applicable); and

(C) Explanation of the proposed use of covered telecommunications equipment and any factors relevant to determining if such use would be permissible under the prohibition in paragraph (b)(1) of this provision.

(ii) For covered services--

(A) If the service is related to item maintenance: A description of all covered telecommunications services offered

(include on the item being maintained: Brand; model number, such as OEM number, manufacturer part number, or wholesaler number; and item description, as applicable); or

(B) If not associated with maintenance, the Product Service Code (PSC) of the service being provided; and explanation of the proposed use of covered telecommunications services and any factors relevant to determining if such use would be permissible under the prohibition in paragraph (b)(1) of this provision.

(2) Disclosure for the representation in paragraph (d)(2) of this provision. If the Offeror has responded "does" in the representation in paragraph (d)(2) of this provision, the Offeror shall provide the following information as part of the offer:

(i) For covered equipment--

(A) The entity that produced the covered telecommunications equipment (include entity name, unique entity identifier, CAGE code, and whether the entity was the OEM or a distributor, if known);

(B) A description of all covered telecommunications equipment offered (include brand; model number, such as

OEM number, manufacturer part number, or wholesaler number; and item description, as applicable); and

(C) Explanation of the proposed use of covered telecommunications equipment and any factors relevant to determining if such use would be permissible under the prohibition in paragraph (b)(2) of this provision.

(ii) For covered services--

(A) If the service is related to item maintenance: A description of all covered telecommunications services offered

(include on the item being maintained: Brand; model number, such as OEM number, manufacturer part number, or wholesaler number; and item description, as applicable); or

(B) If not associated with maintenance, the PSC of the service being provided; and explanation of the proposed use of covered telecommunications services and any factors relevant to determining if such use would be permissible under the prohibition in paragraph (b)(2) of this provision.

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.

52.211-17 DELIVERY OF EXCESS QUANTITIES (SEP 1989)

The Contractor is responsible for the delivery of each item quantity within allowable variations, if any. If the

Contractor delivers and the Government receives quantities of any item in excess of the quantity called for (after considering any allowable variation in quantity), such excess quantities will be treated as being delivered for the convenience of the Contractor. The Government may retain such excess quantities up to $250 in value without compensating the Contractor therefor, and the Contractor waives all right, title, or interests therein. Quantities in excess of $250 will, at the option of the Government, either be returned at the Contractor's expense or retained and paid for by the Government at the contract unit price.

52.212-3 OFFEROR REPRESENTATIONS AND CERTIFICATIONS--COMMERCIAL ITEMS (FEB 2021)

The Offeror shall complete only paragraph (b) of this provision if the Offeror has completed the annual representations and certification electronically in the System for Award Management (SAM) accessed through https://www.sam.gov. If the Offeror has not completed the annual representations and certifications electronically, the Offeror shall complete only paragraphs (c) through (v) of this provision.

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

“Covered telecommunications equipment or services” has the meaning provided in the clause 52.204-25, Prohibition on Contracting for Certain Telecommunications and Video Surveillance Services or Equipment.

“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.

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

“Reasonable inquiry” has the meaning provided in the clause 52.204-25, Prohibition on Contracting for Certain

Telecommunications and Video Surveillance Services or Equipment.

“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"--

(1) 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.

(2) Affiliates, as used in this definition, means business concerns, one of whom directly or indirectly controls or has the power to control the others, or a third party or parties control or have the power to control the others. In determining whether affiliation exists, consideration is given to all appropriate factors including common ownership, common management, and contractual relationships. SBA determines affiliation based on the factors set forth at 13 CFR 121.103.

“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.

“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.

“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 stock of which 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 its stock is owned by one or more women; or

(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 in SAM.

(2) The offeror has completed the annual representations and certifications electronically in SAM accessed through http://www.sam.gov. After reviewing SAM information, the Offeror verifies by submission of this offer that the representations 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(s) applicable to the NAICS code(s) referenced for this solicitation), at the time this offer is submitted and are incorporated in this offer by reference (see FAR 4.1201), except for paragraphs __.

[Offeror to identify the applicable paragraphs at (c) through (v) 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 will 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.

(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 http://www.sam.gov/

(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.

No…