P07 RPP HQ0034259JDEC Attachment 2 ABSC_TEMPLATE.docx
DOCX document 35 KB Posted
- Solicitation number
- HQ0034259JDEC
- Issued by
-
DOD Washington Headquarters Service
About this file
This document is an Affirmation of Business Status Certification template for the Joint Directed Energy Consortium Other Transaction Agreement (Solicitation HQ0034259JDEC). The template requires potential participants to self-certify their business status, including whether they are a Nontraditional Defense Contractor, Nonprofit Research Institution, Small Business, or Traditional Defense Contractor. Participants must provide detailed company information such as legal name, SAM registration status, CAGE code, point of contact details, and a description of their significant contribution to the prototype project.
The certification template is specifically designed for a Department of Defense (DoD) solicitation focused on developing directed energy technologies, with participants required to explain how their contribution will materially advance the project's goals. The document emphasizes the DoD's objective of accelerating access to innovative technologies that can counter emerging threats across multiple domains, with an emphasis on technologies that enable rapid responses and light-speed engagement. Participants must certify the accuracy of their representations and understand potential cost-sharing requirements if they do not meet specific contractor definitions.
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Text version
HQ0034259JDEC
ATTACHMENT 2: AFFIRMATION OF BUSINESS STATUS CERTIFICATION
Authority: To meet the requirements of 10 U.S.C. §4022(d)(1) the COMPANY shall provide the following information with a signature representing its certification.
Legal COMPANY Name:
Doing Business As:
| SAM Registration Status: |
| ☐ Active ☐ Inactive Expiration Date: |
SAM UEI:
CAGE Code:
| COMPANY Physical Address: |
| Street: |
City/State/Zip:
| COMPANY Point of Contact: |
| Name: |
Title:
Phone:
E-mail:
Representation: The COMPANY represents that it is a
Nontraditional Defense Contractor: As defined in 10 U.S.C. §4022(e)(2).
Nonprofit Research Institution: As defined in 40 C.F.R. § 262.200.
Small Business: As defined in 10 U.S.C. §4022(e)(4).
Traditional Defense Contractor[footnoteRef:1]: Does not meet one of the definitions identified above. [1: As required in 10 U.S.C. §4022(d)(1)(C), in the event the requirements of 10 U.S.C. §4022(d)(1)(A) or (B) are not met for the project, the COMPANY shall provide at least one third of the total cost of the prototype project, unless the COMPANY is otherwise notified that the Agreement Officer will pursue the requirements of 10 U.S.C. §4022(d)(1)(D).
Significant Participation[footnoteRef:2]: The COMPANY shall describe participant’s specific contribution(s) and the significance of the contribution to the overall project. [2: The July 2023 Other Transactions Guide states when evaluating the significance of the participant, the Agreements Officer should consider, by way of illustration and not limitation, whether the participant will supply a new key technology, product, or process; supply a novel application or approach to an existing technology, product, or process; provide a material increase in the performance, efficiency, quality, or versatility of a key technology, product, or process; accomplish a significant amount of the prototype project; cause a material reduction in the cost or schedule of the prototype project; or, provide for a material increase in performance of the prototype project.]
| Participant |
| Contribution and Significance to Overall Project |
Name:
What is the significant contribution(s)?
Why/how is the contribution significant?
*Note: Please add new row for each significant participant.
Certification: The undersigned hereby certifies that the representations made herein are accurate and true regarding the COMPANY identified above. I authorize my electronic signature to carry the same weight and legal effect as my written signature.
Name:
Title:
Email:
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