Reps and certs Rider - September 2022.pdf

This is a Representations and Certifications Supplement form used by SLAC National Accelerator Laboratory (operated by Stanford University under DOE Contract DE-AC02-76SF00515) that must be completed by potential offerors. The form requires offerors to provide business information and certify various compliance requirements including System for Award Management (SAM) representations, E-Verify enrollment status for proposals over $3,500, employee-vendor relationship disclosures, and toxic chemical release reporting for offers over $100,000.

The form also contains sections on anti-kickback certification (for offers over $100,000), export control compliance related to nuclear materials and dual-use items, and control classifications. Offerors must certify they have not engaged in kickbacks and must disclose if any items fall under nuclear suppliers group trigger lists, US Munitions List items, or dual-use items 500/600 series. The form requires signature from an authorized representative and remains valid for one year from date of signature. Any false statements may result in criminal or civil penalties under 18 USC 1001 and 31 USC 3802.