Appendix C Revised - Pre Award and Reps and Certs. (long form) 2017 Rev 6.pdf

Form, 48300.033 Procurement, 294-1780 Revision 6, March 2017

PRE-AWARD INFORMATION

Attached is the REPRESENTATIONS AND CERTIFICATIONS FORM for AMES LABORATORY. Please have it executed by an official authorized to sign on behalf of your organization and return it as soon as possible. In addition, please provide the PRE- AWARD INFORMATION sought below and return a copy of this page along with the executed

REPRESENTATIONS AND CERTIFICATIONS FORM.

1.

Name of Contractor DUNS

2.

Contract/Solicitation No.

3. (For purposes of this question, “radiation” includes particles with energies in the range of KeV or higher. It does not include laser, IR, UV or microwave radiation.)

a. Is there any planned or potential use of radioactive material under the ☐ Yes proposed contract?

b. Is there any planned or potential use of a radiation-producing device ☐ Yes (e.g., accelerator, reactor, x-ray machine, fusion device)?

If a. or b. above is answers “yes,” please provide the following information:

Principal Investigator Phone No.

Health Physicist/ Phone No.

Radiation Safety Officer

4. Will contractor personnel perform any part of the work at Ames Laboratory? ☐ No

A proposal may include technical data and other data, including trade secrets and/or privileged or confidential commercial or financial information, which the offeror does not want, disclosed to the public or used by the Laboratory or the Government for any purpose other than proposal evaluation. To protect such data, the offeror should specifically identify each page, including each line or paragraph thereof, containing the data to be protected, and mark the cover sheet of the proposal with the notice set forth immediately below:

NOTICE:

The data contained in pages of this proposal have been submitted in confidence and contain trade secrets or proprietary information, and such data shall be used or disclosed only for evaluation purposes; provided that if a contract is awarded to the offeror as a result of or in connection with the submission of this proposal, the Government and the Laboratory shall have the right to use or disclose the data herein to the extent provided in the contract. This restriction does not limit the Government's or the Laboratory's right to use or disclose data obtained without restriction from any source, including the offeror.

Reference to this notice on the cover sheet should be placed on each page to which the notice applies. Data or abstracts of data, marked with this notice will be retained in confidence and used by the Laboratory, DOE or its designated representative(s), including Laboratory or Government contractors and consultants, solely for the purpose of evaluating the proposal. The data so marked will not otherwise be disclosed or used without the offeror's prior written permission except to the extent provided in any resulting contract, or to the extent required by law. The restriction contained in the notice does not limit the Laboratory's nor the Government's right to use or disclose any data contained in the proposal if it is obtainable from any source, including the offeror, without restriction.

Although it is our policy to treat all proposals as confidential, neither the Laboratory nor the Government assumes any liability for disclosure or use of unmarked data and both may use or disclose such data for any purpose.

☐ No

☐ No

☐ Yes

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REPRESENTATIONS AND CERTIFICATIONS

CONTRACT/SOLICITATION NO. MODIFICATION NO.

THE OFFEROR REPRESENTS AND CERTIFITES THAT: (check or complete all applicable sections)

1. NAME AND LOCATION OF BUSINESS ORGANIZATION (PLACE OF PERFORMANCE)

Legal Name of Company DUNS #

Address (Include Zip Code)

E-mail address URL (Website Address)

Tax Payer Identification No. (TIN)

2. THE ORGANIZATION OPERATES AS:

□ An individual

□ A partnership

□ A non-profit* organization

□ An educational institution**

□ A government entity (Federal, State, or Local)

□ A corporation, incorporated under the laws of the State of .

If a corporation, does the corporation have three (3) employees or less? ☐ Yes ☐ No *Nonprofit organization” means a university or other institution of higher education or an organization of the type described in section 501 (c)(3) of the Internal Revenue Code of 1954 (26 U.S.C. 501 (c)) and exempt from taxation under section 501 (a) of the Internal Revenue Code (26 U.S.C. 501 (a)), or any nonprofit scientific or educational organization qualified under a State nonprofit organization statute. **Educational institution means a public or non- profit institution of higher education, e.g., an accredited college or university, as defined in section 1201 (s) of Public Law 89-329, November 8, 1965, Higher Education Act of 1965; (20 U.S.C. 1141 (a)).

3. REPORTING EXECUTIVE COMPENSATION (May apply if subcontract is ≥ $30,000) Definitions. As used in this clause:

“Executive” means officers, managing partners, or any other employees in management positions.

“Months of award” means the month in which a contract is signed by the Contracting Officer or the month in which a first-tier subcontract is signed by the Contractor.

“First-tier subcontract” means a subcontract awarded directly by a Contracting to furnish supplies or services (including construction) for performance of a prime contract, but excludes supplier agreements with vendors, such as long term arrangements for materials or supplies that would normally be applied to a Contractor’s general and administrative expenses or indirect cost.

“Total compensation” means the cash and noncash dollar value earned by the executive during the Contractor’s preceding fiscal year and includes the following (for more information see 17 CFR 229.402(c)(2)):

1) Salary and bonus.

2) Awards of stock, stock options, and stock appreciation rights. Use the dollar amount recognized for financial statement reporting purposes with respect to the fiscal year in accordance with the financial Accounting Standards Board’s Accounting Standards Codification (FASB ASC) 718, Compensation-Stock Compensation.

3) Earnings for services under non-equity incentive plans. This does not include group life, health, hospitalization or medical reimbursement plans that do not discriminate in favor of executives, and are available generally to all salaried employees.

4) Change in pension value. This is the change in present value of defined benefit and actuarial pension plans.

5) Above-market earnings on deferred compensation which is not tax-qualified.

6) Other compensation, if the aggregate value of all such other compensation (e.g. severance, termination payments, value of life insurance paid on be4half of the employees, perquisites, or property) for the executive exceeds $10,000.

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Please check all that apply:

a) In the Contractor’s preceding fiscal year, the Contractor received-

□ 80 percent or more of its annual gross revenues in Federal contracts (and subcontracts), loans, grants (and sub grants) and cooperative agreements; and

□ $25,000,000 or more in annual gross revenues from Federal contracts (and subcontracts), loans, grants (and sub grants) and cooperative agreements; and

b) ☐ The public does not have access to information about the compensation of the executives though periodic reports filed 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.)

*If the offeror checked all of the boxes above in a) and b) the offeror must provide the names and total compensation of each of the five most highly compensated executives for the Contractor’s preceding completed fiscal year below. This must be provided by the end of the month following the month of award of a first-tier subcontract with a value of $30,000 or more, and annually thereafter unless directed by the Contracting Officer.

*Please provide the required information below:

1. Name Total Compensation

2. Name Total Compensation

3. Name Total Compensation

4. Name Total Compensation

5. Name Total Compensation Section 2(d)(2) of the Federal Funding Accountability and Transparency Act of 2006 (Pub. L. 109-282), as amended by section 6202 of the Government Funding Transparency Act of 2008 (Pub. L. 110-252), requires the Laboratory to report information on subcontract awards. The law requires all reported information be made public, therefore, the Laboratory is advising hereby its subcontractors that the required information will be made public.

Nothing in this clause requires the disclosure of classified information.

□ CHECK IF APPLICABLE: If the offeror in the previous tax year had gross income from all sources under $300,000, the Laboratory is not required to report award to that contractor.

4. AFFIRMATIVE ACTION COMPLIANCE (Required if firm has 50 or more employees AND current Government Contracts or Subcontracts totaling ≥ $50,000) I. ☐ It has developed and has on file, at each establishment, affirmative action programs required by the rules and regulations of the Secretary of Labor (41 CFR 60-1 and 60-2), or II. ☐ It has not previously had contracts subject to the written affirmative action programs requirement of the rules and regulations of the Secretary of Labor.

5. PREVIOUS CONTRACTS AND COMPLIANCE REPORTS (Required if proposal is ≥ $10,000) I. ☐ It has participated in a previous contract or subcontract subject either to the Equal Opportunity clause of this solicitation, the clause originally contained in Section 310 of Executive Order No. 10925, or the clause contained in Section 201 of Executive Order No. 11114;

II. ☐ It has filed all required compliance reports; and III. Representations indicating submission of required compliance reports, signed by proposed contractors, will be obtained before subcontract awards.

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

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6. COMPLIANCE WITH VETERANS’ EMPLOYMENT REPORTING REQUIREMENTS (DEC 2001) (Required for awards $150,000 or greater) By submission of its offer, the offeror represents that, 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 Special Disabled Veterans, Veterans of the Vietnam Era, and Other Eligible Veterans), it has submitted the most recent VETS- 100 Report required by that clause.

7. CONTINGENT FEE REPRESENTATION AND AGREEMENT

I. Representation. Except for full-time bona fide employees working solely for the offeror, the offeror—

1) ☐ Has not employed or retained any person or company to solicit or obtain this contract; and

2) ☐ Has not paid or agreed to pay to any person or company employed or trained to solicit or obtain this contract any commission, percentage, brokerage, or other fee contingent upon or resulting from the award of this contract.

For interpretation of the representation, including the term “bona fide employees,” see Subpart 3.4 of Federal Acquisition Regulation.

II. Agreement. The offeror agrees to provide information relating to the above Representation as requested by the

Laboratory and, when subparagraph (a)(1) or (a)(2) is answered affirmatively, to promptly submit to the Laboratory:

1) A completed Statement of Contingent or Other Fees; or

2) A signed statement indicating that the statement was previously submitted to the Laboratory, including the date and applicable solicitation or contract number, and representing that the prior statement applies to the offer.

8. BUY AMERICAN ACT – SUPPLIES

The offeror certified that each end product, except those listed below is a domestic end product (as defined in the clause entitled, Buy American Act), and that components of unknown origin are considered to have been minded, produced, or manufactured outside the United States (as defined in the clause entitled, Buy American Act – Supplies). Note:

Applicable Foreign End Products will be evaluated in accordance with FAR 25.105.

Foreign End Products Country of Origin

(Provide additional list as necessary)

9. SMALL BUSINESS PROGRAM REPRESENTATION

1) (1) The North American Industry Classification System (NAICS) code for this acquisition is:

https://www.sba.gov/content/small-business-size-standards

(2) The small business size standard is .

The small business size standard for a concern which submits an offer in its own name, other than on a construction or service contract, but which proposes to furnish a product which it did not itself manufacture, is 500 employees. (Refer to definitions in paragraph (c) of this provision).

2) Representations. The offeror represents:

1) ☐ It is a small business.

Check all that apply for (2) through (6) if offeror is a small business. The offeror is:

2) ☐ A small disadvantaged business concern as defined in 13 CFR 124.1002, or

□ Has a completed SDB Application pending at the SBA or private Certifier

3) ☐ A women-owned small business concern.

4) ☐ A veteran-owned small business concern.

5) ☐ A service-disabled veteran-owned small business concern.

6) ☐ A HUBZone small business concern listed, on the date of this representation, on the List of Qualified https://www.sba.gov/content/small-business-size-standards

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HUBZone Small Business Concerns Maintained by the Small Business Administration, and no material change in ownership and control, principal place of ownership, or HUBZone employee percentage has occurred since it was certified by the Small Business Administration in accordance with 13 CFR part 126.

3) Definitions. As used in this provision- “Emerging small business” means a small business concern whose size is no greater than 50 percent of the numerical size standard for the NAICS code designated.

“Service-disabled veteran-owned small business concern” –

1) Means a small business concern-

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 which is owned by one or more service-disable 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 veteran with permanent and severe disability, the spouse or permanent caregiver of such veteran.

2) 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).

“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’s bidding on Government contracts, and qualified as a small business under the criteria in 13 CFR Part 121 and the size standard in paragraph (a) of this provision.

“Veteran-owned small business concern” means a small business concern-

1) Not less than 51 percent of which is owned by one or more veterans (as defined at 38 U.S.C. 101(2)) 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 veterans; and

2) The management and daily business operations of which are controlled by one or more veterans.

“Women-owned small business concern,” means a small business concern-

1) Which is at least 51 percent owned by one or more women or, in the case of any publicly owned business, at least 51 percent of the stock of which is owned by one or more women; and whose management and daily business operations are controlled by one or more women.

4) Notice.

1) If this solicitation is for supplies and has been set aside, in whole or in part, for small business concerns, then the clause in this solicitation providing notice of the set-aside contains restrictions on the source of the end items to be furnished.

2) Under 15 U.S.C. 645(d), any person who misrepresents a firm’s status as a small, HUBZone small, small disadvantaged, or women-owned small business concern in order to obtain a contract to be awarded under the preference programs established pursuant to section 8(a), 8(d),9, or 15 of the Small Business Act or any other provision of Federal law that specifically references section 8(d) for a definition of program eligibility, shall –

i. Be punished by imposition of fine, imprisonment, or both;

ii. Be subject to administrative remedies, including suspension and debarment; and

iii. Be ineligible for participation in programs conducted under the authority of the Act.

10. CERTIFICATION OF NONSEGREGATED FACILITIES

I. “Segregated facilities,” as used in this provision, means any waiting rooms, work areas, rest rooms and wash rooms, restaurants and other eating areas, time clocks, locker rooms and other storage or dress areas, parking lots, drinking fountains, recreation or entertainment areas, transportation, and housing facilities provided for employees, that are segregated by explicit directive or are in fact segregated on the basis of race, color, religion, or national origin because of habit, local custom, or otherwise.

II. By the submission of this offer, the offeror certifies that it does not and will not maintain or provide for its employees any segregated facilities at any of its establishments, and that it does not and will not permit its employees to perform their services at any location under its control where segregated facilities are maintained. The offeror agrees that a breach of this certification is a violation of the Equal Opportunity clause in the contract.

III. The offeror further agrees that (except where it has obtained identical certifications from proposed subcontractors for specific time periods) it will –

1) Obtain identical certifications from proposed subcontractors before the award of subcontracts under which the subcontractor will be subject to the Equal Opportunity clause;

2) Retain the certifications in the files; and

3) Forward the following notice to the proposed subcontractors (except if the proposed subcontractors have submitted identical certifications for specific time periods):

NOTICE TO PROSPECTIVE SUBCONTRACTORS OF REQUIREMENT FOR CERTIFICATIONS OF

NON SEGREGATED FACILITIES

A Certification of Nonsegregated Facilities must be submitted before the ward of a subcontract under which the subcontractor will be subject to the Equal Opportunity clause. The certification may be submitted either for each subcontract or for all subcontracts during a period (i.e., quarterly, semiannually, or annually).

NOTE: The penalty for making false statements in offers is prescribed in 18 U.S.C. 1001.

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11. CERTIFICATE OF INDEPENDENT PRICE DETERMINATON (Required if OTHER than Commercial Item or Service ≥ $150,000) I. The offeror certified that:

1) The prices in this offer have been arrived at independently, without, for the purpose of restricting competition, any constitution, communication, or agreement with any other offeror or competitor relating to

(i) those prices, (ii) the intention to submit an offer, or (iii) the methods or factors used to calculate the prices offered;

2) The prices in this offer have not been and will not be knowingly disclosed by the offeror, directly or indirectly, to any other offeror or competitor before bid opening (formally advertised solicitation) or contract award (negotiated solicitation) unless otherwise required by law; and

3) No attempt has been made or will be made by the offeror to induce any other concern to submit or not to submit an offer for the purpose of restricting competition.

II. Each signature on the offer is considered to be a certification by the signatory that the signatory –

1) Is the person in the offeror’s organization responsible for determining the prices being offered in this bid or proposal, and that the signatory has not participated and will not participate in any action contrary to subparagraphs (a)(1) through (a)(3) above; or

2) (i) Has been authorized, in writing, to act as agent for the following principals in certifying that those principals have not participated, and will not participate in any action contrary to sub-paragraphs (a)(1) through (a)(3) above, that is responsible for determining the prices offered in this proposal.

Name of Person/s:

(ii) As an authorized agent, does certify that the principals named in subdivision (b)(2)(i) above have not participated, and will not participate, in any action contrary to subparagraphs (a)(1) through (a)(3) above;

and

(iii) As an agent, has not personally participated, and will not participate, in any action contrary to subparagraphs (a)(1) through (a)(3) above.

III. If the offeror deletes or modifies subparagraph (a)(2) above, the offeror must furnish with its offer a signed statement setting forth in detail the circumstances of the disclosure.

12. CERTIFICATION AND DISCLOSURE REGARDING PAYMENTS TO INFLUENCE CERTAIN FEDERAL

TRANSACTIONS (Applies to non-commercial awards ≥ $150,000) I. 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.

II. The offeror, by signing its offer hereby certifies to the best of his or her knowledge and belief as of December 23, 1989, that –

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 shall complete and submit, with its offer, OMB standard form LLL, Disclosure of Lobbying Activities, to the Laboratory; and

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

III. 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.

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13. CERTIFICATION REGARDING DEBARMENT, SUSPENSION, OR PROPOSED DEBARMENT

(Required ≥ $35,000 for other than commercial Off-the-Shelf Items) I. (1) The Offeror certifies, to the best of its knowledge and belief, that –

i. The Offeror and/or any of its Principals – A) ☐ Are not presently debarred, suspended, proposed for debarment, or declared ineligible for the award of contracts by any Federal agency;

B) ☐ Have not within a 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; and

C) ☐ Are not presently indicted for, or otherwise criminally or civilly charged by a governmental entity with, commission of any of the offenses enumerated in paragraph (a)(1)(i)(B) of this provision.

ii. ☐ The offeror has not within a three-year period preceding this offer, had one or more contracts terminated for default by any Federal agency.

(2) “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 Metter 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.

II. The Offeror shall provide immediate written notice to the Laboratory if, at any time prior to contract award, the Offeror learns that its certification was erroneous when submitted or has become erroneous by reason of changed circumstances.

III. 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’s responsibility. Failure of the Offeror to furnish a certification or provide such additional information as requested by the Laboratory shall render the Offeror nonresponsible.

IV. Nothing contained in the foregoing shall be constructed 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 is not required to exceed that which is normally possessed by a prudent person in the ordinary course of business dealings.

V. 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 rendered an erroneous certification, in addition to other remedies available to the Government, the Laboratory may terminate the contract resulting from this solicitation for default.

14. COST ACCOUNTING STANDARDS NOTICES AND CERTIFICATION (Required if proposed procurement is expected to be ≥ $750,000 and company’s AGGREGATE contract awards are expected to be ≥ $50,000,000) This notice does not apply to small businesses or foreign governments. Offerors shall examine each part and provide the requested information in order to determine Cost Accounting Standards (CAS) requirements applicable to any resultant contract.

I. DISCLOSURE STATEMENT-COST ACCOUNTING PRACTICES AND CERTIFICATION

a) Any contract in ≥ $750,000 resulting from this solicitation, except contracts in which the price negotiated is based on

1) Established catalog for market prices of commercial items sold in substantial quantities to the general public, or

2) Prices set by law or regulation will be subject to the requirements of 48 CFR Parts 9903 and 9904, except for those contracts which are exempt as specified in 48 CFR, Subpart 9903.201-1.

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b) Any offeror submitting a proposal which, if accepted, will result in a contract subject to the requirements of 48 CFR, Parts 9903 and 9904 must, as a condition of contracting, submit a Disclosure Statement as required by 48 CFR, Subpart 9903.202. The Disclosure Statement must be submitted as a part of the offeror’s proposal under this solicitation unless the offeror has already submitted a Disclosure Statement disclosing the practices used in connection with the pricing of this proposal. If an applicable Disclosure Statement has already been submitted, the offeror may satisfy the requirements for submission by providing the information requested in paragraph (c) of Part I of this provision.

CAUTION: In the absence of specific regulations or agreement, a practice disclosed in a Disclosure Statement shall not, by virtue of such disclosure, be deemed to be a proper, approved, or agree-to practice for pricing proposal or accumulating and reporting contract performance cost data.

c) Check the appropriate box below:

□ (1) Certificate of Concurrent Submission of Disclosure Statement. The Offeror hereby certifies that, as a part of the offer, copies of the Disclosure Statement have been submitted as follows: (i) original and one copy to the cognizant DOE Contracting Officer or cognizant federal agency official authorized to act in the capacity (Federal official), as applicable; and (ii) one copy to the cognizant contract auditor, (Disclosure must be on From No. CASB DS-1 or CASB DS-2. Forms may be obtained from the Laboratory Procurement Official, on-line, or from the F.A.R.)

Date of Disclosure Statement:

Name and address of Federal Agency where filed:

The Offeror further certifies that practices used in estimating costs in pricing this proposal are consistent with the cost accounting practices disclosed in the Disclosure Statement.

□ (2) Certificate of Previously Submitted Disclosure Statement.

The Offeror hereby certifies that Disclosure Statement was filed as follows:

Date of Disclosure Statement:

Name and address of Federal Agency where filed:

The offeror further certifies that the practices used in estimating costs in pricing this proposal are consistent with the cost accounting practices disclosed in the applicable disclosure statement.

□ (3) Certificate of Monetary Exemption

The offeror hereby certifies that the offeror, together with all divisions, subsidiaries, and affiliates under common control, did not receive net awards of negotiated prime contracts and subcontracts subject to CAS totaling more than $25 million (of which at least one award exceeded $1 million) in the cost accounting period immediately preceding the period in which this proposal was submitted. The offeror further certifies that if such status changes before an award resulting from this proposal, the offeror will advise the Laboratory immediately.

□ (4) Certificate of Interim Exemption.

The offeror hereby certifies that (i) the offeror first exceeded the monetary exemption for disclosure, as defined in (3) above, in the cost accounting period immediately preceding the period in which this offer was submitted and (ii) in accordance with 48 CFR, Subpart 9903.202-1, the offeror is not yet required to submit a Disclosure Statement. The offeror further certifies that if an award resulting from this proposal has not been made within 90 days after the end of that period, the offeror will immediately submit a revised certificate to the Laboratory, in the form specified under subparagraph (c)(1) or (c)(2) of Part I of this provision, as appropriate, to verify submission of a completed Disclosure Statement.

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CAUTION: Offerors currently required to disclose because they were awarded a CAS-covered prime contract or subcontract of $10 million or more in the current cost accounting period may not claim this exemption (4). Further, the exemption applies only in connection with proposals submitted before expiration of the 90-day period following the cost accounting period in which the monetary exemption was exceeded.

II. COST ACCOUTNING STANDARDS-ELIGIBILITY FOR MODIFIED CONTRACT COVERAGE

If the offeror is eligible to use the modified provisions of 48 CFR Subpart 9903.201-2(b) and elects to do so, the offeror shall indicate by checking the box below. Checking the box below shall mean that the resultant contract is subject to the Disclosure and Consistency of Cost Accounting Practices clause in lieu of the Cost Accounting Standards clause.

□ The offeror hereby claims an exemption from the Cost Accounting Standards clause under the provisions of 48 CFR Subpart 9903.201-2(b) and certifies that the offeror is eligible for use of the Disclosure and Consistency of Cost Accounting Practices clause because during the cost accounting period immediately preceding the period in which this proposal was submitted, the offeror received less than $50 million in awards of CAS-covered prime contracts and subcontracts, or the offeror did not receive a single CAS-covered award exceeding $1 million. The offeror further certified that if such status changes before an award resulting from this proposal, the offeror will advise the Laboratory immediately.

CAUTION: An offeror may not claim the above eligibility for modified contract coverage if this proposal is expected to result in the award of a CAS-covered contract of $50 million or more or if, during its current cost accounting period, the offeror has been awarded a single CAS-covered prime contract or subcontract of $50 million or more.

III. ADDITIONAL COST ACCOUNTING STANDARDS APPLICABLE TO EXISITNG CONTRACTS

The offeror shall indicate below whether award of the contemplated contract would, in accordance with subparagraph (a)(3) of the Cost Accounting Standards clause, require a change in established cost accounting practices affecting existing contracts and subcontract

□ YES ☐ NO

15. SUSPECT/COUNTERFEIT PARTS CERTIFICATION

Suspect/counterfeit parts shall not be used in the performance of any work resulting from this offer, whether on or off the Laboratory site, nor shall suspect/counterfeit parts be included in any supplies furnished as a result of this offer.

16. RIGHTS IN PROPOSAL DATA

It is Laboratory policy for a contract award based on a proposal that, in consideration of the award, the Government shall obtain unlimited rights in the technical data (data which are of a scientific or technical nature) contained in the proposal unless the contractor marks those portions of the technical information which he asserts as "proprietary data" or specifies those portions of such technical data which are not directly related to or will not be utilized in the work to be funded under the contract. Accordingly, please indicate:

□ No restriction on Government rights in the proposal technical data; or

□ The following identified technical data is proprietary or is not directly related to or will not be utilized in the work to be funded under the contract:

□ Not Applicable.

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17. REPRESENTATION OF LIMITED RIGHTS DATA AND RESTRICTED COMPUTER SOFTWARE

(a) This solicitation sets forth the work to be performed if a contract award results, and the Government's and the Laboratory's known delivery requirements for data (as defined in 48 CFR 52.227-14). Any resulting contract may also provide the Government and the Laboratory the option to order additional data under the Additional Data Requirements clause at 48 CFR 52.227-16 of the FAR, if included in the contract. Any data delivered under the resulting contract will be subject to the Rights in Data--General clause at 48 CFR 52.227-14 that is to be included in this contract. Under the latter clause, a Contractor may withhold from delivery data that qualify as limited rights data or restricted computer software, and deliver form, fit, and function data in lieu thereof. The latter clause also may be used with it Alternates II and/or III to obtain delivery of limited rights or restricted computer software, marked with limited rights or restricted rights notices, as appropriate. In addition, use of Alternate V with this latter clause provides the Government the right to inspect such data at the Contractor's facility.

(b) As an aid in determining the Government's and the Laboratory's need to include any of the aforementioned Alternates in the clause at 48 CFR 52.227-14, Rights in Data--General, the offeror's response to this solicitation shall, to the extent feasible, complete the representation in paragraph (b) of this provision to either state that none of the data qualify as limited rights data or restricted computer software, or identify which of the data qualifies as limited rights data or restricted computer software. Any identification of limited rights data or restricted computer software in the offeror's response is not determinative of the status of such data should a contract be awarded to the offeror.

REPRESENTATION CONCERNING DATA RIGHTS

Offeror has reviewed the requirements for the delivery of data or software and states (offeror check appropriate block)—

□ None of the data proposed for fulfilling such requirements qualifies as limited rights data or restricted computer software.

□ Data proposed for fulfilling such requirements qualify as limited rights data or restricted computer software and are identified as follows:

□ Not Applicable

NOTE: “Limited rights data” and “Restricted computer software” are defined in the contract clause “Rights in Data – General.” (48CFR 52.227-14)

18. CERTIFICATION AS TO SMALL BUSINESS OR NONPROFIT STATUS UNDER PUBLIC LAW 96-

517 AS AMENDED BY PUBLIC LAW 98-620

PATENT TERMS AND NOTICE OF RIGHT TO REQUEST PATENT WAIVER

1. Under the provisions of Public Law 96-517 as amended by Public Law 68-620, the patent terms required for contracts with offerors in certain categories are as set forth in DOE Acquisition Regulations. In order to determine the Patent Provisions applicable to this contract, please check the applicable box. Offeror is:

□ A small business firm as defined at Section 3 of Public Law 85-536 (15 U.S.C. 632) and implementing regulations of the Administrator of Small Business Administration.

□ A university or other institution of higher education or an organization of the type described in Section 501(c)(3) of the Internal Revenue Code of 1954 (26 U.S.C. 501(c)) and exempt from taxation under Section 501(a) of the Internal Revenue Code (26 U.S.C. 501(a)); or

□ A nonprofit scientific or educational organization qualified under a State nonprofit organization statute. Name of the statute:

□ None of the above.

2. Offerors who fall within any of the above categories have the right to request in advance of or within thirty (30) days after execution of the contract, in accordance with applicable statutes and DOE Patent Waiver Regulation 10 CFR 784, a waiver of all or any part of the rights of the United States in subject inventions. If the offeror intends to request a waiver to such invention rights pursuant to DOE Patent Waiver Regulation 10 CFR 784, please indicate:

I intend to request an advance waiver in accordance with DOE Patent Waiver Regulation 10 CFR 784.

I do not intend to request an advance waiver.

This is submitted with the intention that the Department of Energy rely on my representation that the offeror is a member of the category indicated.

Revision 6, March 2017

19. LABORATORY TERMS AND CONDITIONS

By submission of its offer, the offeror represents that, unless otherwise noted in the offeror’s proposal, the Laboratory’s standard terms and conditions (included in the Laboratory’s solicitation) will be included in and govern any subsequent contract.

20. CERTIFICATION

A person authorized to make legally binding commitments on behalf of the Offeror must sign below. By signing below, the Offeror certifies, under penalty of law, that these representations and certifications are accurate, current, and complete.

Company/Organization Name:

Signature:

Signer’s Name (Printed):

Title:

Date: _

Telephone Number:

Email Address: