RFQ 467353 - Enclosure B - AMS-Form-050 Reps and Certs.pdf
PDF 3 MB Posted
- Attached to
- Medium Voltage Vacuum Breakers (2 Ea)
- Solicitation number
- 467353
- Issued by
-
Department of Energy Office of Science
About this file
This document is an Annual Representations and Certifications form (AMS-Form-050) from Brookhaven National Laboratory for a federal contract opportunity. The form requires comprehensive business information and representations across multiple sections, including business details, small business status, and various federal contract compliance certifications. Key sections include:
Section A provides business information and requires the offeror to specify their business type, contact details, NAICS codes, and small business subcategories. Section B contains additional representations regarding government contracts, including certifications about previous contract compliance, affirmative action programs, and responsibility matters. Section C requires an authorized representative's signature attesting to the accuracy of the provided information, with acknowledgment that penalties may be imposed for misrepresentations. The form is part of a solicitation (RFQ 467353) for two Medium Voltage Vacuum Breakers, issued by the Department of Energy Office of Science, with specific technical requirements for 15KV max voltage, 500MVA/25kA, 1200A vacuum breakers.
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Text version
ANNUAL REPRESENTATIONS ERTIFICATIONS
Offeror: Offerors Offeror
All Offerors Section A.1. Section C all Small Business Offerors Section A.
Section A.1.:
A.1. Part I:
A.1. Part II:
Offeror
Offeror’s
AMS-Form-050 Rev. 1.0 - 09/2023
Offeror Yes No
Yes Offeror Offeror’s
Offeror
Section A. .: Applicable Only to Small Business Offerors
Offeror Offeror
Offeror
Offeror Offeror’s Section C, “Authorized Signature of Offeror ” Offeror Offeror Offeror
A. .1. Reference:
Offeror Offeror Offeror
Offeror
AND
Offeror Offeror
Offeror
Representations
NAICS Code : Small Business Concern ( Yes):
Offeror
Offeror
Offeror
Offeror
Offeror
Offeror
Offeror
Offeror
Offeror
Offeror and
Offeror
Offeror
Definitions and and and
Notice and
A. .2. Reference:
Offeror Offeror’s
Section B: Additional Representations and Certifications Required for Work Under U.S. Government Prime Contracts
B.1. FAR 52.203-11 (SEP 2007)
Offeror’s designated representative hereby certifies that he or she has read and understands (a) – (e), below.
Offeror
Offeror Offeror
Offeror Offeror
B.2 FAR 52.204-10 ( )
B. Offeror’s
Offeror Offeror
Offeror’s
Offeror’s Offeror
Yes No Yes
Offeror Offeror
Offeror
Yes No
Offeror’s Offeror
Yes No
Yes
No Offeror
Yes No
Yes Offeror
No
Offeror Offeror’s Offeror’s Offeror
Offeror Offeror’s
Executive Name: Executive Total Compensation:
Offeror Offeror
B. . FAR 52.209-5 ( )
Offeror:
Offeror
Offeror
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 Pursuant to 18 U.S.C. 1001.
Offeror Offeror
Offeror’s Offeror Offeror
Offeror
Offeror
B. . FAR 52.209-7 ( ) —
Offeror
Definitions
Offeror Offeror
Offeror Offeror
Offeror Offeror
Offeror
B. . FAR 52.222-22 (FEB 1999)
Offeror
B. . FAR 52.222-25 (APR 1984)
Offeror
OR
B. . Government Property Certification
Offeror
Section C: Authorized Signature of Offeror
Certification of Offeror or Offeror’s Authorized Representative:
Offeror Offeror Offeror’s
Offeror
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