PR-TMP-01 Rev 8.0 Annual Commercial Item Acquisition Reps Certs.docx

ASRC Federal Legal Entity Below:

ANNUAL COMMERCIAL ITEM ACQUISITION REPRESENTATIONS AND CERTIFICATIONS (PR-TMP-01) (Rev 8.0) Effective 3/11/2021 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, B and C, 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.

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:

|_| (i) Paragraph (a) applies, If checked, Offeror must complete Part B and Part C below.

|_| (ii) Paragraph (a) does not apply and the offeror must complete Part A, B and C 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 entities;;

Form ASRCFH_PUR007 Rev. 02/12 7 of 21

PART “A”

THIS PART APPLIES IF OFFEROR IS NOT REGISTERED IN THE SYSTEMS FOR AWARDS MANAGEMENT

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

52.203-18 PROHIBITION ON CONTRACTING WITH ENTITIES THAT REQUIRE CERTAIN INTERNAL CONFIDENTIALITY AGREEMENTS OR STATEMENTS-REPRESENTATION (JAN 2017)

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.

The prohibition in the paragraph above 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.

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).

52.209-2 PROHIBITION ON CONTRACTING WITH INVERTED DOMESTIC CORPORATIONS—REPRESENTATION

(a) Definitions. “Inverted domestic corporation” and “subsidiary” have the meaning given in the clause of this contract entitled Prohibition on Contracting with Inverted Domestic Corporations (52.209-10).

(b) Government agencies are not permitted to use appropriated (or otherwise made available) funds for contracts with either an inverted domestic corporation, or a subsidiary of an inverted domestic corporation, unless the exception at 9.108-2(b) applies or the requirement is waived in accordance with the procedures at 9.108-4.

(c) Representation. The Offeror represents that—

(1) It |_| IS, |_| IS NOT an inverted domestic corporation; and

(2) It |_| IS, |_| IS NOT a subsidiary of an inverted domestic corporation

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

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.

52.209-11 REPRESENTATION BY CORPORATIONS REGARDING DELINQUENT TAX LIABILITY OR A FELONY CONVICTION UNDER ANY FEDERAL LAW

(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.

52.222-22 PREVIOUS CONTRACTS AND COMPLIANCE REPORTS

52.222-25 AFFIRMATIVE ACTION COMPLIANCE

This contractor and subcontractor shall abide by the requirements of 41 CFR §§ 60-1.4(a), 60-300.5(a) and 60 741.5(a). These regulations prohibit discrimination against qualified individuals based on their status as protected veterans or individuals with disabilities and prohibit discrimination against all individuals based on their race, color, religion, sex, or national origin. Moreover, these regulations require that covered prime contractors and subcontractors take affirmative action to employ and advance in employment individuals without regard to race, color, religion, sex, national origin, protected veteran status or disability.

52.225-2 BUY AMERICAN ACT CERTIFICATE

(c) The Prime Contractor will evaluate offers in accordance with the policies and procedures of Part 25 of the Federal Acquisition Regulation.

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

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

The Offeror/Seller represents that it is in agreement with the subject clause and the Executive Order 11246, as amended, and the rules, regulations, and Orders of the Secretary of Labor pertaining to Equal Opportunity.

PART “B”

THIS PART APPLIES TO ALL OFFEROR

52.204-10 REPORTING EXECUTIVE COMPENSATION AND FIRST-TIER SUBCONTRACT AWARDS, IS PART OF THIS SUBCONTRACT.

1) The Subcontractor’s SAMS UEI Number is:

Please indicate, by checking the appropriate box(es), the states or districts which your company is authorized to collect sales tax:

|_| All |_| Alabama |_| Alaska |_| Arizona |_| Arkansas |_| California |_| Colorado |_| Connecticut |_| Delaware |_| District of Columbia |_| Florida |_| Georgia |_| Hawaii |_| Idaho |_| Illinois |_| Indiana |_| Iowa |_|Kansas |_|Kentucky |_|Louisiana

|_|Maine |_|Maryland |_|Massachusetts |_|Michigan |_|Minnesota |_|Mississippi |_| Missouri |_| Montana |_| None |_| Nebraska |_| Nevada |_| New Hampshire |_| New Jersey |_| New Mexico |_| New York |_| North Carolina |_| North Dakota |_| Ohio

|_|Oklahoma |_|Oregon |_| Pennsylvania |_| Rhode Island |_| South Carolina |_| South Dakota |_| Tennessee |_| Texas |_| Utah |_| Vermont |_| Virginia |_| Washington |_| West Virginia |_| Wisconsin |_| Wyoming

PART “C”

THIS PART APPLIES TO ALL OFFEROR

FAR 52.204-26 Covered Telecommunications Equipment or Services - Representation (Dec 2019)

(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.

(b) 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."

(c) 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.

image1.png