PR-TMP-01 Annual Commercial Products and Services Reps Certs Form.pdf

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Annual Commercial Products & Services Representations and Certifications (PR-TMP-01) (Rev 9.1)

Effective 6/16/2025

Offeror will complete all of this Representations and Certifications form. Failure to furnish the following representations and certification may be cause of the rejection of Offeror’s bid(s) or proposal(s) as non-responsive, resulting in no contract award.

U.S. government regulations prohibit ASRC Federal and its subsidiaries (ASRC) from awarding a seller a procurement funded under a U.S. Government contract unless the seller certifies that it complies with certain U.S. policies. Your company is a potential supplier of goods and services to ASRC whose purchase by ASRC may be funded under a U.S. Government contract.

Accordingly, to be eligible for award you are required to complete the Representations and certification according to the following table:

Upon completion, please have the Representations and Certifications signed by an authorized representative of your company, date them and return them to ASRC as instructed.

ACKNOWLEDGED:

a. By signing below, the Offeror/Seller agrees to the foregoing and attests that the Representations and Certifications set forth in Parts A and B herein are current, accurate, and complete. Further, if Offeror’s/Seller’s status certified herein should change prior to any award based on this certification, the Offeror/Seller shall immediately notify, in writing, the person/office to whom this original certification was sent and submit an amended certification with any related data that may be required as a result of the change.

b. I hereby acknowledge an understanding of the U.S. Government contracting and subcontracting programs and confirm the accuracy of the statements made in this document.

c. The Offeror/Seller’s business organization PERMITS DOES NOT PERMIT authorized Offeror/Seller representatives to use electronic signatures as legally binding.

d. The Offeror/Seller RESIDES DOES NOT RESIDE in a legal jurisdiction that accepts electronic signatures as legally binding.

Firm Name:

Email:

Phone: Fax:

Signature: Date:

Typed Name: Title

If the offeror is currently registered in the System for Award Management (SAM) and has completed the Representations and Certifications section of SAM electronically, the offeror may choose to use paragraph (a) of this provision instead of completing the corresponding individual representations and certifications herein. The offeror shall indicate which option applies by checking one of the following boxes:

Paragraph (a) applies, If checked, Offeror must complete Part A below.

Paragraph (a) does not apply and the Offeror must complete Part A and B below.

(a) The offeror has completed the annual representations and certifications electronically via the SAM website. After reviewing the SAM database information, the offeror verifies by submission of the offer that the representations and certifications currently posted electronically, have been entered or updated within the last 12 months, are current, accurate, complete, and applicable (including the business size standard applicable to the NAICS code), as of the date of this offer and are incorporated in this offer by reference (see FAR 4.1201) Further, the offeror certifies the representations and certifications posted in the SAM database are equally made to ASRC Federal, including all of its subsidiaries.

ALL OFFEROR/ SELLER INFORMATION AND BUSINESS DECLARATIONS

It is the policy of ASRC Federal and its Subsidiaries that small business, small disadvantaged business concerns, woman-owned small businesses and HUBZone, veteran and service-disabled veterans small businesses concerns, have the maximum practicable opportunity to participate in the performance of contracts awarded by ASRC. In order to comply with this policy, please provide the following information and a copy of your W-9.

Offer’s/ Seller’s Legal Business Name (Provide as it appears in SAM, if registered) No. of Employees

Street Address Phone Number Fax Number

City State Zip Email Address

Remittance Street Address ( if different from above)

City State Zip

DUNS # System for Award Management (SAM) UEI # Federal Tax ID No. (EID) CAGE Code

Common parent.

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

Name and TIN of common parent:

Name

TIN

*This company is (check the ones that apply):

A Division of: A Subsidiary of: An Affiliate of:

Individual Partnership Independently Owned and Operated Consultant

Distributor Retailer Manufacturer Corporation, incorporated under the laws of the state:

Foreign Owned (non USA) Non-Profit

1099 Required: Yes No Other

*Identify Major Supplies/Services Primary North American Industry Classification System (NAICS) Codes NAICS:

Business Size Status (select one only): Small Other than Small

Small Business Socio-Economic Category (select all that apply):

Minority-Owned Small Business Small Disadvantaged Business Women-Owned Small Business Veteran-Owned Small Business Service-Disabled-Veteran-Owned Small Business HUB Zone Small Business

Historically Black College/Minority Institute (Certified by SBA)

If Minority-Owned or Small Disadvantaged is selected above, check the appropriate category in which business ownership falls:

African American Asian Pacific American Hispanic American Native American Subcontinent Asian American Alaska Native Corp (ANC) Other than those listed

PART “A”

THIS PART APPLIES TO ALL OFFERORS

Authorized Signature Title

Printed Name Date

ASRC Federal and its Subsidiaries (ASRC) may award procurement to the seller where the costs will be charged to a U.S. government prime or subcontract.

If so, the offeror/ seller is advised that the U.S. government may impose a penalty against a firm misrepresenting its business size and/or disadvantaged status for the purposes of obtaining procurement that is to be included as part, or all of a goal contained in ASRC’s Subcontracting plan. Eligibility as a small business is based on the regulations issued by the Small Business Administration in CFR 13, Part 121 of the SBA Rules and Regulations and FAR 52.219-1.

FAR 52.204-10 REPORTING EXECUTIVE COMPENSATION AND FIRST-TIER SUBCONTRACT AWARDS

Section 2(d)(2) of the Federal Funding Accountability and Transparency Act of 2006 (Public Law 109-282), as amended by section 6202 of the Government Funding Transparency Act of 2008 (Public law 110-252) requires contractors to report subcontract/ purchase order award data and the total compensation of the five most highly compensated executives of the supplier when certain criteria are met. As a supplier or potential supplier to ASRC Federal, unless otherwise directed by a contracting officer, ASRC Federal shall report information for awards $30,000 or more, which will be made public in accordance with FAR 52.204-10.

Legal Business Name:

(Provide as it appears in SAM, if registered)

Offeror’s legal business name by which it is incorporated and pays taxes is

SAM Unique Entity ID (UEI) (formerly DUNS Number): Offeror’s SAM UEI is .

Offeror’s Physical Address:

Street Address:

City:

State:

Zip Code (nine digits required):

Congressional district (required if in the United States):

SECTION I

Offeror’s gross income in the previous tax year from all sources DID DID NOT exceed $300,000.

INSTRUCTIONS: If “DID” is checked, proceed to Section II. If “DID NOT” is checked stop here.

SECTION II

A) In its preceding fiscal year, the Offeror DID DID NOT receive from Federal contracts (and subcontracts) loans, grants (and subgrants), cooperative agreements and other forms of Federal financial assistance:

i. 80% or more of its annual gross revenue; and

ii. $25M or more in annual gross revenue.

INSTRUCTIONS: If “DID” is checked, proceed to question (B). If “DID NOT” is checked stop here.

B) Access to information about the compensation of the senior executives IS IS NOT available to the public through periodic reports files under section 13(a) or 15(d) of the Securities Exchange Act of 1934 {15 U.S.C. 78m(a), 78o(d)} or section 6104 of the Internal Revenue Code of 1986. To determine if the public has access to the compensation information, see the U.S. Security and Exchange Commission total compensation filings at http://www.sec.gov/answers/execomp.htm.

INSTRUCTIONS: If “IS” is checked stop here. If “IS NOT” is checked, proceed to Section III.

SECTION III

A) Information regarding supplier’s executive compensation HAS HAS NOT been reported as part of its annual registration requirement in the System for Award Management (SAM) database and updated annually or when previously reported information has changed.

INSTRUCTIONS: If “HAS” is checked complete (C). If “HAS NOT” is checked complete (B) and (C).

http://www.sec.gov/answers/execomp.htm

B) Names and total compensation of each of the five most highly compensated officers for the Offeror’s preceding completed fiscal year:

C) If executive compensation data is provided through A or B above, the data is for calendar year 20 . Its fiscal year end date is .

52.203-11 CERTIFICATION AND DISCLOSURE REGARDING PAYMENTS TO INFLUENCE CERTAIN FEDERAL TRANSACTIONS

a. The definitions and prohibitions contained in the clause, at FAR 52.203-12, Limitation on Payments to Influence Certain Federal Transactions, included in this solicitation, are hereby incorporated by reference in paragraph (b) of this certification.

b. The Offeror/Seller hereby certifies to the best of his or her knowledge and belief that, as of the date of execution of this certification –

1) 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 awarding of any Federal contract, the making of any Federal grant, the making of any Federal loan, the entering into of any cooperative agreement, and the extension, continuation, renewal, amendment, or modification of any Federal contract, grant, loan, or cooperative agreement;

2) If any funds other than Federal appropriated funds (including profit or fee received under a covered Federal transaction) 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 this solicitation, the Offeror/Seller shall complete and submit, with its offer, OMB standard form LLL, Disclosure of Lobbying Activities, to the Contracting Officer, and

3) He or she will include the language of this certification in all subcontract awards at any tier and require that all recipients of subcontract awards in excess of $100,000 shall certify and disclose accordingly.

c. Submission of this certification and disclosure is a prerequisite for making or entering into this contract imposed by section 1352, title 31, United States Code. Any person who makes an expenditure prohibited under this provision or who fails to file or amend the disclosure form to be filed or amended by this provision, shall be subject to a civil penalty of not less than $10,000, and not more than $100,000, for each such failure.

FAR 52.204-26 COVERED TELECOMMUNICATIONS EQUIPMENT OR SERVICES - REPRESENTATION

(b) Definitions. As used in this provision, “covered telecommunications equipment or services” and “reasonable inquiry” has the meaning provided in the clause 52.204-25, Prohibition on Contracting for Certain Telecommunications and Video Surveillance Services or Equipment.

(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) (1) Representation. The Offeror represents that it DOES 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.

PART “B”

THIS PART APPLIES IF OFFEROR/SELLER IS NOT REGISTERED IN THE SYSTEM FOR AWARD

MANAGEMENT

EXECUTIVE NAME TITLE TOTAL COMPENSATION

(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 any equipment, system, or service that uses covered telecommunications equipment services.

52.209-5 CERTIFICATION REGARDING DEBARMENT, SUSPENSION, PROPOSED DEBARMENT, AND OTHER

RESPONSIBILITY MATTERS

a. The Offeror/Seller certifies, to the best of its knowledge and belief, that–

1) The Offeror/Seller and/or any of its Principals –

A) ARE ARE NOT presently debarred, suspended, proposed for debarment, or declared ineligible for the award of contracts by any Federal agency; HAVE HAVE NOT, within the three-year period preceding this offer, been convicted of or had a civil judgment rendered against them for: commission of fraud or a criminal offense in connection with obtaining, attempting to obtain, or performing a public (Federal, state, or local) contract or subcontract; violation of Federal or state antitrust statutes relating to the submission of offers;

or commission of embezzlement, theft, forgery, bribery, falsification or destruction of records, making false statements, tax evasion, or receiving stolen property;

B) ARE ARE NOT presently indicted for, or otherwise criminally or civilly charged by a governmental entity with, commission of any of the offenses enumerated in subdivision (a)(1)(i)(B) of this provision; and

2) The Offeror/Seller, aside from the offenses enumerated in paragraphs (a)(1)(i)(A), (B) and (C) of this provision, A) HAS HAS NOT, within the past three years, relative to tax, labor and employment, environmental, antitrust, or consumer protection laws

(i) Been convicted of a Federal or state felony (or has any Federal or state felony indictments currently pending against them); or

(ii) Had a Federal court judgment in a civil case brought by the United States rendered against them; or

(iii) Had an adverse decision by a Federal administrative law judge, board, or commission indicating a willful violation of law.

B) If the Offeror/Seller has responded affirmatively, the Offeror/Seller shall provide additional information if requested by ASRC PROCUREMENT PROFESSIONAL and

C) The Offeror/Seller HAS HAS NOT within a three-year period preceding this offer, had one or more contracts terminated for default by any Federal agency.

b. “Principals,” for the purposes of this certification, means officers, directors, owners, partners, and persons having primary management or supervisory responsibilities within a business entity (e.g., general manager; plant manager; head of a subsidiary, division, or business segment; and similar positions).

THIS CERTIFICATION CONCERNS A MATTER WITHIN THE JURSIDICTION OF AN AGENCY OF THE UNITED STATES AND THE MAKING OF A FALSE, FICTITIOUS, OR FRAUDULENT CERTIFICATION MAY RENDER THE MAKER SUBJECT

TO PROSECUTION UNDER SECTION 1001, TITLE 18, UNITED STATES CODE.

1) The Offeror/Seller shall provide immediate written notice to ASRC PROCUREMENT PROFESSIONAL if, at any time prior to contract award, the Offeror/Seller learns that its certification was erroneous when submitted or has become erroneous by reason of changed circumstances.

2) A certification that any of the items in paragraph (a) of this provision exists will not necessarily result in withholding of an award under this solicitation. However, the certification will be considered in connection with a determination of the Offeror/Seller’s responsibility. Failure of the Offeror/Seller to furnish a certification or provide such additional information as requested by ASRC PROCUREMENT PROFESSIONAL may render the Offeror/Seller non-responsible.

3) Nothing contained in the foregoing shall be construed to require establishment of a system of records in order to render, in good faith, the certification required by paragraph (a) of this provision. The knowledge and information of an Offeror/Seller is not required to exceed that which is normally possessed by a prudent person in the ordinary course of business dealings.

4) The certification in paragraph (a) of this provision is a material representation of fact upon which reliance was placed when making award. If it is later determined that the Offeror/Seller knowingly rendered an erroneous certification, in addition to the other remedies available, ASRC PROCUREMENT PROFESSIONAL may terminate the contract resulting from this solicitation for default.

52.222-22 PREVIOUS CONTRACTS AND COMPLIANCE REPORTS

The Offeror/Seller represents that:

a. It HAS HAS NOT participated in a previous contract or subcontract subject to the Equal Employment Opportunity clause of any solicitation/procurement (FAR 52.222-26).

b. It HAS HAS NOT filed all required compliance reports.

c. Types of Equal Opportunity Certifications:

Applicable to Purchases and Subcontracts Under Contracts with the Department of Defense:

252.209-7001 DISCLOSURE OF OWNERSHIP OR CONTROL BY THE GOVERNMENT OF A TERRORIST COUNTRY

a. Prohibition on award. In accordance with 10 U.S.C. 2327, no contract may be awarded to a firm or a subsidiary of a firm if the government of a terrorist country has a significant interest in the firm or subsidiary or, in the case of a subsidiary, the firm that owns the subsidiary, unless a waiver is granted by the Secretary of Defense.

b. Disclosure. If the government of a terrorist country has a significant interest in the Offeror/Seller or a subsidiary of the Offeror/Seller, the Offeror/Seller shall disclose such interest in an attachment to its offer. If the Offeror/Seller is a subsidiary, it shall also disclose any significant interest the government of a terrorist country has in any firm that owns or controls the subsidiary. The disclosure shall include-

1) Identification of each government holding a significant interest; and

2) A description of the significant interest held by each government.

252.209-7002 DISCLOSURE OF OWNERSHIP OR CONTROL BY A FOREIGN GOVERNMENT

(a) Prohibition on award. No contract under a national security program may be awarded to an entity controlled by a foreign government if that entity requires access to proscribed information to perform the contract, unless the Secretary of Defense or a designee has waived application of 10 U.S.C. 2536(a).

(b) Disclosure. The Offeror/Seller shall disclose any interest a foreign government has in the Offeror/Seller when that interest constitutes control by a foreign government as defined in this provision. If the Offeror/Seller is a subsidiary, it shall also disclose any reportable interest a foreign government has in any entity that owns or controls the subsidiary, including reportable interest concerning the Offeror/Seller's immediate parent, intermediate parents, and the ultimate parent.