2384-A1.docx

Jet Propulsion Laboratory California Institute of Technology

Acknowledgement (RFP Attachment A-1) (This completed acknowledgement must accompany your offer)

Offeror Identification/Point of Contact

Offeror Information

3. Please indicate your Business Classification and Organization Type:

Business Classification (check all appropriate boxes in the left OR right column)

|_| Large Business |_| Nonprofit Organization |_| Foreign Business/Institution |_| Government |_| Educational Institution |_| Historically Black Colleges & Universities/Other Minority Institutions (HBCU/MI) |_| Small Business (SB) (plus any of the below, if appropriate) |_| Small Disadvantaged Business (SDB) |_| Woman-Owned (WOSB) |_| HUBZone (HUB) |_| Veteran-Owned (VOSB) |_| Service-Disabled VO (SDVOSB)

Organization Type (check the appropriate type)

|_| Individual/Sole proprietor, under the laws of the State of _____________________.

|_| Partnership, under the laws of the State of _____________________.

|_| Corporation; incorporated under the laws of the State of ___________________.

|_| Non-profit |_| Government |_| Tax Exempt payee |_| Limited Liability Company (LLC) --- If “LLC” is checked, you must also select one of the following tax classifications:

|_| D=disregarded |_| C=corporation |_| P=partnership

Offeror Income Tax Information

4. To comply with CA Revenue and Taxation Code 18662 and CA Franchise Tax Board FTB Publ. 1023, and Internal Revenue Code 1441, JPL must determine if any tax reporting and tax withholding requirements are applicable. See “Notice of Potential Tax Withholding” in the “Subcontracts Form Set” located at: http://www.jpl.nasa.gov/acquisition/terms-conditions/for additional information.

Type(s) of Proposed Items (please check all that apply):

|_| Goods (commercial off-the-shelf items, no customization) |_| Customized Goods (goods made or modified for JPL use)

If ONLY the “Goods” box is checked in the above “Type(s) of Proposed Items,” skip the “Offeror Information” and “Source of Income” questions below and proceed to Paragraph 5.

Offeror Information

Source of Income

Terms and Conditions

7. Can you supply the requested items through a Federal Supply Schedule (GSA) Contract?

|_| Yes If yes, list FSS (GSA) Contract No.: ; skip No. 8.

|_| No If no, complete the remainder of this form.

8. The Offeror |_| acknowledges |_| does not acknowledge the following are acceptable with no modifications, additions, or deletions in case of subcontract award: the Specimen Subcontract and its: Schedule/Articles, any exhibits and attachments, General Provisions (GPs) Set*, Additional General Provisions (AGPs) Set* (if applicable), and Subcontract Forms Set.* (*can be found at: http://www.jpl.nasa.gov/acquisition/terms-conditions/

Note: Many of the GPs and AGPs cannot be altered without NASA approval. If you answer “does not acknowledge” above, attach a detailed explanation of the exception(s), including a thorough rationale for each exception.

Buy American Act

Audit/EEO Information

10. Name, address, phone number of cognizant Government Audit Agency representative:

If yes, the “year ending” date of the most recent report is: (Attach a copy of the most recent report, unless previously submitted to JPL).

12. All prospective procurements (excluding construction) with an estimated contract value of $10,000,000 or more require that a determination be made by the Department of Labor (DOL) regarding a prospective domestic subcontractor’s Equal Employment Opportunity (EEO) status. A determination that the Offeror is either in compliance or is able to comply with EEO laws is a prerequisite to the Offeror’s eligibility for award.

If the offer is for $10,000,000 or more, the Offeror acknowledges that it |_| has |_| has not successfully survived an EEO survey within two years of the anticipated award date. (If the “has” box is checked, a copy of the EEO Clearance should be included with the offer).

Earned Value Management (EVM)

If yes, validation certified by:

|_| Government Agency name:

|_| Self-Certified |_| Dollar threshold at which your organization’s internal policy requires EVM:

Offeror Certification

I, the undersigned, hereby declare that I am a duly authorized representative of the organization below, and I can certify and commit the organization regarding the information on this form, including the total offer amount submitted in response to RFQ/RFP No. .

Further, the Offeror acknowledges receiving the following Addenda No(s). to the RFQ/RFP:

Note: Failure to acknowledge receipt of all Addenda may result in your offer being rejected.

Organization:

Note: Insert legal name of the organization, not operating division. Such legal name is the name used on income tax filings.

Authorized Signature:

Date:

Type/Print Name:

Phone:

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