Representations Certifications Form (05-24-2024).docx

REPRESENTATIONS & CERTIFICATIONS

The following representation & certification solicitation provisions, including Appendix A, must be completed and this form must be signed and returned with the Offeror’s Proposal to Lawrence Livermore National Security, LLC (“LLNS”). Please note that the Offeror must also sign and return Appendix A to LLNS as part of the Offeror’s proposal.

As used herein, the term “Subcontract” shall also mean “Purchase Order,” the term “Offer” shall also mean “Bid”, “Proposal”, and “Quotation”, and the term “Offeror” shall also mean “Bidder”, “Proposer, and “Quoter”, as applicable.

INDEX

1. OFFEROR INFORMATION (Check and Complete all that Apply.)

Company Name:

Company Address:

Parent Entity Unique Entity Identifier (if applicable):

(FAR 52.203-11; SEP 2007)

4. CERTIFICATION REGARDING KNOWLEDGE OF CHILD LABOR FOR LISTED END PRODUCTS

(a) Definition. As used in this provision, “Forced or indentured child labor”, is defined as all work or service-

(1) Exacted from any person under the age of 18 under the menace of any penalty for its nonperformance 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.

(b) Certification. The Offeror, by signing its offer, hereby certifies to the best of its knowledge and belief that if it supplies any end product listed in the List of Products Requiring Contract Certification as to Forced or Indentured Child Labor that was mined, produced or manufactured in the corresponding country as listed for that product, the Offeror has made a good faith effort to determine whether forced or indentured child labor was used to mine, produce, or manufacture such end product. On the basis of those efforts, the Offeror certifies it is not aware of any such use of child labor. The List of Products Produced by Forced or Indentured Child Labor is available at http://www.dol.gov/ilab/reports/child-labor/list-of-products/.

(FAR 52.222-18)

(C) 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

(D) Have |_|, have not |_|, within a three-year period preceding this offer, been notified of any delinquent Federal taxes in an amount that exceeds the threshold at FAR 9.104-5(a)(2) for which the liability remains unsatisfied.

Federal taxes are considered delinquent if both of the following criteria apply:

(i) The tax liability is finally determined. The liability is finally determined if it has been assessed. A liability is not finally determined if there is a pending administrative or judicial challenge. In the case of a judicial challenge to the liability, the liability is not finally determined until all judicial appeal rights have been exhausted.

(ii) The taxpayer is delinquent in making payment. A taxpayer is delinquent if the taxpayer has failed to pay the tax liability when full payment was due and required. A taxpayer is not delinquent in cases where enforced collection action is precluded.

See FAR 52.209-5 for additional information, including examples.

This certification concerns a matter within the jurisdiction 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.

(FAR 52.209-5; AUG 2020)

6. COMPLIANCE with Veterans’ Employment Reporting Requirements (Applicable to non-commercial products/services exceeding $250,000.)

The Offeror represents by submission of its offer, if it is subject to the reporting requirements of 38 U.S.C. 4212(d) (i.e., if it has any contract containing Federal Acquisition Regulation clause 52.222-37, Employment Reports on Veterans), it has submitted the most recent VETS-4212 Report required by that clause.

(FAR 52.222-38; FEB 2016)

7. PREVIOUS CONTRACTS AND COMPLIANCE REPORTS

(Not applicable to performance on Indian Reservations or outside the U.S. by employees not recruited from the U.S.)

The Offeror represents that:

If the answer to (a) above is “has participated” and the answer to (b) above is “has not filed all required compliance reports,” the Offeror certifies as the applicable reason that: it has less than fifty employees |_|; it does not have a Federal Government prime contract or first-tier-subcontract amounting to $50,000 or more |_|; or other |_| (explain):

(FAR 52.222-22; FEB 1999, Modified)

8. AFFIRMATIVE ACTION COMPLIANCE

(Not applicable to construction or performance on Indian Reservations or outside the U.S. by employees not recruited from the U.S.)

The Offeror represents that:

If the answer to (a) above is “has not developed and does not have on file”, the Offeror certifies as the applicable reason that: it has less than fifty employees |_|; it does not have a Federal Government prime contract or first-tier subcontract amounting to $50,000 or more |_|; or other |_| (explain):

(FAR 52.222-25; APR 1984, Modified)

9. BUY AMERICAN ACT CERTIFICATE

The Offeror certifies that each end product or construction material to be delivered, except those listed below, is a domestic end product or domestic construction material as defined in FAR Clause 52.225-1 Buy American – Supplies (NOV 2021) or FAR Clause 52.225-9 Buy American – Construction Material (NOV 2021), as applicable. The Offeror shall list as foreign end products or foreign construction materials, those end products or construction materials that do not satisfy the definition of domestic end product or domestic construction material.

(List as necessary; supplement this certificate with additional pages if necessary) 1 Country of Origin means the country of manufacture, mining, or production.

2 Country of Assembly means the country where the majority of the product's final assembly took place, if different than the Country of Origin. Assembly means the process of synthetic production in which materials or parts are combined without substantial changes. If Country of Assembly is the same as Country of Origin, enter the same country in both spaces.

3 If Country of Origin and Country of Assembly is the United States, insert “not applicable.”

LLNS shall consider an end product or construction material to be foreign if either the Country of Origin/Assembly is not the United States.

(Note: LLNS will take into consideration, applicable provisions of Part 25 of the Federal Acquisition Regulation in evaluating offers for foreign end products and foreign construction material.)

(FAR 52.225-2, FEB 2021, Modified; and FAR 52.225-10, MAY 2014)

(Check appropriate block)

NOTE: The terms “data”, “limited rights data”, “restricted computer software”, “computer software”, and “form, fit, and function data” are defined in DEAR 927.409 as follows:

Data means recorded information, regardless of form or the media on which it may be recorded. The term includes technical data and computer software. The term does not include data incidental to the administration of the subcontract, such as financial, administrative, cost and pricing, or management information.

Limited rights data means data, other than computer software, developed at private expense that embody trade secrets or are commercial or financial and confidential or privileged. (The Government’s rights to use, duplicate, or disclose limited rights data are as set forth in the Limited Rights Notice of the Rights in Data - General clause.)

Restricted computer software means computer software developed at private expense and that is a trade secret; is commercial or financial and is confidential or privileged; or is published copyrighted computer software, including minor modifications of any such computer software. (The Government’s rights to use, duplicate, or disclose restricted computer software are as set forth in the Restricted Rights Notice of the Rights in Data - General clause.)

Computer software means (i) computer programs which are data comprising a series of instructions, rules, routines, or statements, regardless of the media in which recorded, that allow or cause a computer to perform a specific operation or series of operations, and (ii) data comprising source code listings, design details, algorithms, processes, flow charts, formulae, and related material that would enable the computer program to be produced, created, or compiled. The term does not include computer data bases.

Form, fit, and function data means data relating to items, components, or processes that are sufficient to enable physical and functional interchangeability, as well as data identifying source, size, configuration, mating, and attachment characteristics, functional characteristics, and performance requirements; except that for computer software it means data identifying source, functional characteristics, and performance requirements but specifically excludes the source code, algorithm, process, formulae, and flow charts of the software.

(FAR 52.227-15; DEC 2007)

11. certification regarding violation of arms control treaties or agreements (Applicable to non-commercial products/services exceeding $250,000.)

(a) The Offeror shall check the appropriate block below:

|_| N/A (i.e., commercial products/services or non-commercial products/services less than or equal to $250,000).

|_| The Offeror certifies that:

(1) it does not engage and has not engaged in any activity that contributed to or was a significant factor in the President's or Secretary of State's determination that a foreign country is in violation of its obligations undertaken in any arms control, nonproliferation, or disarmament agreement to which the United States is a party, or is not adhering to its arms control, nonproliferation, or disarmament commitments in which the United States is a participating state. The determinations are described in the most recent unclassified annual report provided to Congress pursuant to section 403 of the Arms Control and Disarmament Act (22 U.S.C. 2593a). The report is available via the internet at https://www.state.gov/bureaus-offices/under-secretary-for-arms-control-and-international-security-affairs/bureau-of-arms-control-verification-and-compliance/; and

(2) no entity owned or controlled by the Offeror has engaged in any activity that contributed to or was a significant factor in the President's or Secretary of State's determination that a foreign country is in violation of its obligations undertaken in any arms control, nonproliferation, or disarmament agreement to which the United States is a party, or is not adhering to its arms control, nonproliferation, or disarmament commitments in which the United States is a participating state. The determinations are described in the most recent unclassified annual report provided to Congress pursuant to section 403 of the Arms Control and Disarmament Act (22 U.S.C. 2593a). The report is available via the internet at https://www.state.gov/bureaus-offices/under-secretary-for-arms-control-and-international-security-affairs/bureau-of-arms-control-verification-and-compliance/, or

|_| The Offeror is providing separate information with its offer in accordance with (d)(2) of FAR 52.209-13.

(b) 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 knowingly submitted a false certification, in addition to other remedies available to the Government or LLNS, such as suspension or debarment, LLNS may terminate any subcontract resulting from the false certification.

(FAR 52.209-13; NOV 2021)

12. representation regarding certain telecommunications and video surveillance services or equipment

(a) The Offeror represents that it will |_|, will not |_| provide covered telecommunications equipment or services to the Government or LLNS in the performance of any of any contract, subcontract or other contractual instrument resulting from this solicitation.

(b) The Offeror represents that it will |_|, will not |_| use covered telecommunications equipment or services, or use 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 in the performance of a contract, subcontract or other contractual instrument that would result from this solicitation.

(c) If the answer is “will” to either (a) or (b), the Offeror shall provide the following information as part of its offer and designate whether it will provide or use the covered equipment or services:

(1) For covered equipment:

(i) The entity that produced the covered telecommunications equipment [include entity name, unique entity identifier, Commercial and Government Entity (CAGE) code, and whether the entity was the original equipment manufacturer (OEM) or a distributor, if known]:

(ii) 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:

(iii) 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) or (b)(2) of FAR 52.204-24:

(2) For covered services:

(i) If the service is related to item maintenance, a description of all covered telecommunication 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):

(ii) If the service is 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 such use would be permissible under the prohibition in paragraph (b)(1) or (b)(2) of FAR 52.204-24:

NOTE: The terms “Covered telecommunications equipment or services” and “Covered foreign country” are defined in FAR 52.204-25 as follows:

Covered telecommunications equipment or services means (1) telecommunications equipment produced by Huawei Technologies Company or ZTE Corporation (or any subsidiary or affiliate of such entities); (2) for the purpose of public safety, security of Government facilities, physical security surveillance of critical infrastructure, and other national security purposes, video surveillance and telecommunications equipment produced by Hytera Communications Corporation, Hangzhou Hikvision Digital Technology Company, or Dahua Technology Company (or any subsidiary of affiliate of such entities); (3) telecommunications or video surveillance services provided by such entities or using such equipment; or (4) telecommunications or video surveillance equipment or services produced or provided by an entity that the Secretary of Defense, in consultation with the Director of National Intelligence or the Director of the Federal Bureau of Investigation, reasonably believes to be an entity owned or controlled by, or otherwise connected to, the government of a covered foreign country.

Covered foreign country means The People’s Republic of China.

See FAR 52.204-25 for definitions of “critical technology” and “substantial or essential component.”

(FAR 52.204-24; NOV 2021)

I certify that, to the best of my knowledge, the above information is accurate as of the date of my signature.

LAWRENCE LIVERMORE NATIONAL LABORATORY

REPRESENTATIONS & CERTIFICATIONS

REPS/CERTS - 1 - (05/24/2024)

REPS/CERTS - 2 -

APPENDIX A

SMALL BUSINESS PROGRAM REPRESENTATIONS

(Applicable if any performance will be inside the United States, its territories or possessions, Puerto Rico, the District of Columbia, or the Trust Territory of the Pacific islands.)

(a) (1) The North American Industry Classification System (NAICS) Code for this acquisition is .

(NAICS Code and below small business size standard should be the same as indicated in the solicitation, if applicable.)

(Complete (2), (3), (4), (5), (6), (7), and (8) below, as applicable, only if Offeror represented itself as a small business concern in block (b)(1) of this provision. Definitions can be found on Appendix A-1.).

(ii) It is |_|, is not |_|, a joint venture that complies with the requirements of 13 CFR Part 126, and the representation in paragraph (b)(6)(i) of this provision is accurate for the HUBZone small business concern or concerns that are participating in the joint venture.

[The Offeror shall enter the name(s) of the HUBZone small business concern or concerns that are participating in the joint venture]:

Each HUBZone small business concern participating in the joint venture shall submit a separate signed copy of the HUBZone representation.

(FAR 52.219-1; MAY 2004, Modified)

I certify that, to the best of my knowledge, the above information is accurate as of the date of my signature.

REPRESENTATIONS & CERTIFICATIONS

Company: Date:

REPS/CERTS – Appendix A - 1 - (05/24/2024) Appendix A-1 Small Business Program Representations Definitions

As used in the Appendix A provision:

(1) “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 subcontracts, and qualified as a small business under the criteria in 13 CFR 121 and the size standard in paragraph (a) of this provision.

(ii) Whose management and daily business operations are controlled by one or more women.

(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.

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).

(6) “8(a)” is a business development program created by the SBA that is designed to help small disadvantaged businesses compete in the marketplace. The SBA certifies a company for the 8(a) program.

REPS/CERTS – Appendix A-1 - 1 - (05/24/2024)