Revised RFQ-20-178.pdf

AMENDMENT OF SOLICITATION/MODIFICATION OF CONTRACT 1. CONTRACT ID CODE

OMB#0990-0115

PAGE OF PAGES

2. AMENDMENT/MODIFICATION

One

3. EFFECTIVE DATE

September 21, 2020

4. REQUISITION/PURCHASE REQ. NO.

IHS1406762

5. PROJECT NO. (If applicable)

6. ISSUED BY CODE

Great Plains Area Indian Health Service Attn: Nichole R. Lerew, Supervisor Contract Specialist Room 309, Federal Building 115 4th Avenue Southeast Aberdeen, SD 57401

7. ADMINISTERED BY (If other than Item 6) CODE

8. NAME AND ADDRESS OF CONTRACTOR (No., street, county, State and ZIP Code)

(X) 9A. AMENDMENT OF SOLICITATION NO.

RFQ-20-178

X

9B. DATED (SEE ITEM 11)

04/30/2020

10A. MODIFICATION OF CONTRACT/ORDER

NO.

10B. DATED (SEE ITEM 13)

CODE FACILITY CODE

11. THIS ITEM ONLY APPLIES TO AMENDMENTS OF SOLICITATIONS

The above numbered solicitation is amended as set forth in Item 14. The hour and date specified for receipt of Offers is extended, is not extended.

Offers must acknowledge receipt of this amendment prior to the hour and date specified in the solicitation or as amended, by one of the following methods:

(a) By completing Items 8 and 15, and returning ____1___ copies of the amendment; (b) By acknowledging receipt of this amendment on each copy of the offer submitted; or (c) By separate letter or telegram which includes a reference to the solicitation and amendment numbers. FAILURE OF YOUR ACKNOWLEDGMENT TO BE RECEIVED AT THE PLACE DESIGNATED FOR THE RECEIPT OF OFFERS PRIOR TO THE HOUR AND DATE SPECIFIED MAY RESULT IN REJECTION OF YOUR OFFER. If by virtue of this amendment you desire to change an offer already submitted, such change may be made by telegram or letter, provided each telegram or letter makes reference to the solicitation and this amendment, and is received prior to the opening hour and date specified.

12. ACCOUNTING AND APPROPRIATION DATA (If required)

13. THIS ITEM APPLIES ONLY TO MODIFICATIONS OF CONTRACTS/ORDERS,

IT MODIFIES THE CONTRACT/ORDER NO. AS DESCRIBED IN ITEM 14.

(X) A. THIS CHANGE ORDER IS ISSUED PURSUANT TO: (Specify authority) THE CHANGES SET FORTH IN ITEM 14 ARE MADE IN THE CONTRACT

ORDER NO. IN ITEM 10A.

B. THE ABOVE NUMBERED CONTRACT/ORDER IS MODIFIED TO REFLECT THE ADMINISTRATIVE CHANGES (such as changes in paying office, appropriation date, etc.).

C. THIS SUPPLEMENTAL AGREEMENT IS ENTERED INTO PURSUANT TO AUTHORITY OF:

D. OTHER (Specify type of modification and authority)

E. IMPORTANT: Contractor Offers is not, is required to sign this document and return ___________ copies to the issuing office.

14. DESCRIPTION OF AMENDMENT/MODIFICATION (Organized by UCF section headings, including solicitation/contract subject matter where feasible.)

Amend as follows:

A. Amend RFQ-20-178 to extend the closing date to September 23, 2020, 3:00pm, CST from September 22, 2020.

B. See attached revised RFQ package and provide a quote in response to the revised RFQ package.

C. Question: Have you already selected a vendor for the telehealth software or is that part of the RFQ?

Answer: We have an enterprise call manager that registers all the peripheral devices. This order is only for peripheral devices, their support maintenance and their licenses. Although a technician will unbox and hang/place the larger units, our engineers will do the configuration to align with our current enterprise software and hardware. We run Cisco Meeting Server. That solution is already in place. This RFQ is for devices that can place calls through our existing enterprise.

D. There are no other changes made by reason of this amendment.

Except as provided herein, all terms and conditions of the document referenced in Item 9A or 10A, as heretofore changed, remains unchanged and in full force and effect.

15A. NAME AND TITLE OF SIGNER (Type of print)

16. NAME AND TITLE OF CONTRACTING OFFICER (Type or print)

CRAIG J. WELLS, IHS-CO-19-0009

15B. CONTRACTOR/OFFEROR

(Signature Of person authorized to sign)

15C. DATE SIGNED

16B. UNITED STATES OF AMERICA

(Signature Of Contracting Officer)

16C DATE SIGNED

NSN 7540-01-152-8070 30-105 STANDARD FORM 30 (REV. 10-83)

PREVIOUS EDITION UNUSABLE Prescribed by GSA

FAR (48 CFR) 53.243

Scope Part 1

SDPI Telehealth equipment and installation July 2020

Supplier shall supply and deliver the following items with the listed requirements and in the quantities specified, or approved equals, to the delivery addresses within 30 days from date of award listed below:

Item Specifications and quantity:

Notes: 5 Years of Support on all items

Part No Description Quantity

CP‐DX80‐K9= Cisco Webex DX80 60

CON‐SNT‐CPDX80KG SNTC‐8X5XNBD Cisco DX80 5 Years 60

CP‐PWR‐CORD‐NA Power Cord North America 60

CP‐DX80‐VESA=

VESA Adapter and Wall Mount Kit for

DX80 60

CUWL‐11X‐K9 Unified Workspace Licensing v. 11.x 60

CON‐ECMU‐CUW1LXK9

SWSS UPGRADES Unified Workspace Licensing v. 11.x 5 Years 60

NEW‐UWL

New or Migration users for a new CUWL Deployment 60

NEW‐UWL‐11X‐S‐SLED

New CUWL Std Edition 11.x Usr SLED/Govt/Edu Only 1 Usr 60

CON‐ECMU‐UWL11XS1

SWSS UPGRADES CUWL Standard 11.x Users ‐ Service Use O 5 Years 60

UCAPPS‐SW‐11.X‐K9 Version 11.x Software Kit 60

CS‐ROOM55‐K9 Room 55 with Touch10 and Mount 24

CON‐ECDN‐CSROOMK9

ESS WITH 8X5XNBD Cisco Spark Room 55 with Touch10 and Mou 5 Years 24

PWR‐CORD‐USA‐F

Power Cord for United States of America 4.5m 10A 24

CS‐ROOM55‐WBK Webex Room 55 Wheel Base Kit 24

CS‐ROOM55‐WMK= Webex Room 55 Wall Mount 1

CS‐ROOM55‐FSK= Webex Room 55 Floor Stand Kit 1

CS‐R55‐UNI2‐K9+ Cisco Webex Room 55 Main Unit 24

CAB‐PRES‐2HDMI‐GR‐

Presentation cable 8m GREY HDMI 1.4b

(W/ REPEATER) 24

CS‐TOUCH10+

Cisco Touch10 controller for collaboration endpoints 24

CAB‐DV10‐8M‐

8 meter flat grey Ethernet cable for Touch 10 24

CAB‐ETH‐5M‐GR‐ CAB (16 4 feet / 5m) GREY ETHERNET 24

CS‐MIC‐TABLE‐J+ Cisco Table Microphone with Jack plug 48

SW‐S53200‐CE9 SW Image for Cisco Spark Room 24

R‐UCL‐UCM‐LIC‐K9

Top Level SKU For UCL User License ‐ eDelivery 24

CON‐ECMU‐RUCLUCK9

SWSS UPGRADES Top Level SKU For 9. 5 Years 24

LIC‐TP‐11X‐ROOM

Telepresence Room Based Endpoint Single or Multi‐Screen 24

CON‐ECMU‐LICTP1RO

SWSS UPGRADES Telepresence Room Ba 5 Years 24

UCM‐PAK UCMPAK 24

EXPWY‐VE‐C‐K9 Cisco Expressway‐C Server Virtual Edition 48

EXPWY‐VE‐E‐K9 Cisco Expressway‐E Server Virtual Edition 48

LIC‐EXP‐ROOM Expressway Room License 24

LIC‐UC‐ENC UC Encryption License 24

LIC‐EXP‐E‐PAK Expressway Series Expressway‐E PAK 24

LIC‐EXP‐GW Enable GW Feature (H323‐SIP) 96

LIC‐EXP‐E Enable Expressway‐E Feature Set 48

LIC‐EXP‐TURN Enable TURN Relay Option 48

LIC‐EXP‐AN Enable Advanced Networking Option 48

LIC‐SW‐EXP‐K9 License Key Software Encrypted 96

LIC‐EXP‐SERIES Enable Expressway Series Feature Set 96

SW‐EXP‐12.X‐K9

Software Image for Expressway with Encryption Version X12 24

CUCM‐VERS‐11.5 CUCM Software version 11.5 24

ER11‐PAK EMRGNCY RSPNDR 11.X PAK 24

ER11‐USR‐1

EMRGNCY RSPNDR USR LIC 1 PHN FOR

NEW 11X SYSTEM 24

CON‐ECMU‐ER11USR1

SWSS UPGRADES EMRGNCY RSPNDR USR

LIC 1 PHN FOR NEW 11X 5 Years 24

CS‐ROOM70SG2‐K9

Cisco Webex Room 70 Single G2 with Codec Pro and Touch10 1

CON‐ECDN‐CSROOM7G

ESS WITH 8X5XNBD Cisco Room 70 Single with Codec Pro and 5 Years 1

PWR‐CORD‐USA‐F

Power Cord for United States of America 4.5m 10A 1

CS‐ROOM70S‐FSK

Cisco Room 70 Single Screen Floor Stand Kit 1

CS‐MIC‐TABLE‐E

Cisco Table Microphone with Euroblock plug 2

CON‐ECDN‐CSMICTPL

ESS WITH 8X5XNBD Cisco Table Microphone with Euroblock pl 5 Years 2

LIC‐ROOM70SG2 Cisco Webex Room 70S G2 Product ID 1

SW‐S53300‐CE9 SW Image for Cisco Webex Room 1

CS‐RQUADCAM+ Spark Quad Camera for Room70 1

CAB‐PRES‐2HDMI‐GR‐

Presentation cable 8m GREY HDMI 1.4b

(W/ REPEATER) 2

CAB‐ETH‐5M‐GR‐ CAB (16 4 feet / 5m) GREY ETHERNET 1

CS‐TOUCH10+

Cisco Touch10 controller for collaboration endpoints 1

CAB‐2DC‐BRL‐0.30M‐

DC Power Cable w/Barrel Plug 0.3 meters long 1

ANT‐ROOM70‐KIT‐ Antenna kit for ROOM 70 with brackets. 1

CAB‐2HDMI‐1.26M‐

HDMI to HDMI Cable 1.26 meters long for ROOM 70 1

CAB‐ETHRJ45‐1.40M‐ Ethernet Cable w/ RJ45 1.40 mts 1

CAB‐ROOM70‐L‐SPKR‐ Left Speaker Cable for ROOM 70 1

CAB‐ROOM70‐R‐SPKR‐ Right Speaker Cable for ROOM 70 1

CS‐ROOM70S‐FS‐GRK‐ Room 70S Floorstand Grill Kit 1

CAB‐USB‐A‐B‐1.35M‐

USB A ‐ USB B Cable 1.35 meters long for

ROOM 70 1

CS‐ROOM70S‐SKI‐

Cisco Room 70S Ski for Floor Stand Kit (freestand) LONG Vers 1

CS‐MIC‐TABLE‐E+

Cisco Table Microphone with Euroblock plug 2

CS‐RCODPRO‐K9+ Cisco Room Codec PRO 1

CAB‐DV10‐12.5M‐

12.5 meter flat grey Ethernet cable for Touch 10 1

CAB‐DV10‐4M‐

4 meter flat grey Ethernet cable for Touch 10 1

CAB‐2HDMILK‐1.15M‐

HDMI to HDMI Cable 1.15 meters long for ROOM 70 1

CS‐ROOM70‐CFBB‐ Center Frame Bottom Bracket Room 70 1

CS‐ROOM70S‐MON‐S‐ Monitor for Room 70S 1

FAN‐ROOM70‐2PK‐ FAN kit for ROOM 70 2pack 1

CS‐ROOM70‐MON‐SCV‐

Sidecover for Room 70 monitor ( left and right included) 1

CTS‐MX700800‐SPKR‐

Top speaker for MX700/800 and ROOM 70 2

PWR‐CAB‐INT‐0.2M

Internal C13‐C14 Power Cord NOT APPROVED for Japan 110/22 1

R‐UCL‐UCM‐LIC‐K9

Top Level SKU For UCL User License ‐ eDelivery 1

CON‐ECMU‐RUCLUCK9

SWSS UPGRADES Top Level SKU For 9. 5 Years 1

LIC‐TP‐11X‐ROOM

Telepresence Room Based Endpoint Single or Multi‐Screen 1

CON‐ECMU‐LICTP1RO SWSS UPGRADES Telepresence Room Ba 1

UCM‐PAK UCMPAK 1

EXPWY‐VE‐C‐K9 Cisco Expressway‐C Server Virtual Edition 2

EXPWY‐VE‐E‐K9 Cisco Expressway‐E Server Virtual Edition 2

LIC‐EXP‐ROOM Expressway Room License 1

LIC‐UC‐ENC UC Encryption License 1

LIC‐EXP‐E‐PAK Expressway Series Expressway‐E PAK 1

LIC‐EXP‐GW Enable GW Feature (H323‐SIP) 4

LIC‐EXP‐E Enable Expressway‐E Feature Set 2

LIC‐EXP‐TURN Enable TURN Relay Option 2

LIC‐EXP‐AN Enable Advanced Networking Option 2

LIC‐SW‐EXP‐K9 License Key Software Encrypted 4

LIC‐EXP‐SERIES Enable Expressway Series Feature Set 4

SW‐EXP‐12.X‐K9

Software Image for Expressway with Encryption Version X12 1

CUCM‐VERS‐11.5 CUCM Software version 11.5 1

ER11‐PAK EMRGNCY RSPNDR 11.X PAK 1

ER11‐USR‐1

EMRGNCY RSPNDR USR LIC 1 PHN FOR

NEW 11X SYSTEM 1

CON‐ECMU‐ER11USR1

SWSS UPGRADES EMRGNCY RSPNDR USR

LIC 1 PHN FOR NEW 11X 5 Years 1

CP‐8865‐K9= Cisco IP Phone 8865 27

CON‐SNT‐CP8865KP SNTC‐8X5XNBD Cisco IP Phone 8865 27

CUWL‐11X‐K9 Unified Workspace Licensing v. 11.x 27

CON‐ECMU‐CUW1LXK9

SWSS UPGRADES Unified Workspace Licensing v. 11.x 5 Years 27

NEW‐UWL

New or Migration users for a new CUWL Deployment 27

NEW‐UWL‐11X‐S‐SLED

New CUWL Std Edition 11.x Usr SLED/Govt/Edu Only 1 Usr 27

CON‐ECMU‐UWL11XS1

SWSS UPGRADES CUWL Standard 11.x Users ‐ Service Use O 5 Years 27

UCAPPS‐SW‐11.X‐K9 Version 11.x Software Kit 27

NOTE:

Market Research was conducted, and three vendors were contacted during market research. The vendors were given the opportunity to provide an informational quote on computers and accessories scope.

Scope Part 2

SDPI Telehealth equipment Delivery and Installation

Vendor shall supply and deliver the equipment/accessories to the delivery site location as listed below.

The vendor will be responsible for unboxing, assembling all Room Kits (not the 8865 video phone or DX80 Desktop devices, for a total of 25 different units) and ensuring that the equipment powers on and can connect to the IHS network. In locations that require the wall mount unit (2 listed) the vendor will be responsible for pulling data and electrical connections, neatly installing those ports behind the wall mount unit and bracket.

For each of the wall mount units, a properly scaled (for size and weight) full motion, wall-mount bracket must also be included with the purchase/shipment of the unit. For devices and locations that do not have wall-mount video units, the vendor will simply be responsible for assembly, verifying the unit is in proper working condition, connecting to power and connecting to an active network port. Once functionality, power and data connections have been confirmed, the vendor will communicate with the Indian Health Service video support staff when the equipment is ready for testing and configuration. The vendor and the Indian Health Service video support staff will confirm it is operational before leaving the site. Network configuration will be handled by Indian Health Service staff.

The Indian Health Service video support staff can be located at ihsvideoadmins@ihs.gov and 605-335-2500.

Physical Location

Deliver To Location Point of Contact

DX 80

desktop (60)

Room Wheel (22)

Room Wall (1)

Room Floor (1)

Video Phone (27)

Room Floor Stand (1)

Rapid City

Rapid City Service Unit, Building 31‐ Okiciyapi Fitness Center

Beverly Grimshaw, SDPI Diabetes Program Director

(605) 719‐4072 Beverly.grimshaw@ihs.gov

3 2

Wagner

Wagner Service Unit‐ Diabetes Program

Michelle Olson, SDPI Diabetes Program Director

(605) 384‐3621 Michelle.Olson@ihs.gov

2 1 1 3

Oglala Sioux Tribe

SDPI

Diabetes Program‐ Oyate Blihelya Diabetes

Charles Standing Bear, SDPI Program Director

(605) 867‐1706 charliestandingbear@yahoo .com

3 2

Program 107 West Main. St.

Pine Ridge, SD 57770

Rosebud Sioux Tribe

SDPI

Diabetes Program‐ Rosebud Wellness Center

225 N. BIA

9 Ck Rd Rosebud, SD 57570

Connie Brushbreaker, SDPI Program Director

(605) 747‐4600 connie.brushbreaker@rst‐ nsn.gov

3 2 2

Santee Sioux Tribe

SDPI

Diabetes Program‐ Santee Health Center 110 S.

Visiting Eagle St.

Niobrara, NE 68760

Meagan Sailer, SDPI Diabetes Program Director

(402) 857‐2300 Meagan.Sailer@ihs.gov

3 2

Omaha Tribe

SDPI

Diabetes Prevention Program 100 Indian Hills Dr.

Macy, NE 68039

Julie Jacobsen, SDPI Program Director

(402) 837‐5381 Julie.Jacobsen@ihs.gov

2 2

Sisseton‐ Wahpeton Tribe

SDPI

Diabetes Program ‐ Sisseton Wahpeton Oyate Health & Fitness Center 301 Tiospa Zina Drive Old Agency Village, SD 57262

Sara Lincoln, SDPI Program Director

(605) 698‐3922 SaraL@SWO‐NSN.GOV

2 1 1 2

Winnebago Tribe

SDPI

Diabetes Program‐

Camilla Barajas , SDPI Diabetes Program Director

(402) 878‐2722 9 1 4

Whirling Thunder Wellness Center 100 Bluff St.

Winnebago, NE 68071 camilla.barajas@winnebago tribe.com

Spirit Lake Tribe

SDPI

Diabetes Program ‐ A Sacred Life Center 123 1st Ave N. St.

Michael, ND 58370

Darcie Lohnes, SDPI Program Director

(701) 766‐4988 dlohnes@spiritlakenation.c om

1 1

Three Affilated Tribes

SDPI

Diabetes Program ‐ Awatii Wellness Center 24 Minne‐ Tohe Dr.

New Town, ND 58763

Jared Eagle, SDPI Diabetes Program Director

(701) 627‐7931 Jared.Eagle@ihs.gov

6 1 12

Cheyenne River Sioux Tribe

SDPI

Diabetes Program ‐ Youth Diabetes Prevention Program Jefferson St. Eagle Butte, SD 57625

Michelle Walking Elk, SDPI Program Director

(605) 964‐7774 michelle_walkingelk@hotm ail.com

10 1 2

Ponca Tribe

SDPI

Diabetes Program‐ Syracuse Ave.

Norfolk, NE 68701

Sara Pfeifer, SDPI Diabetes Program Director

(402) 371‐8834 spfeifer@poncatribe‐ne.org

2 2

Lower Brule Sioux Tribe

SDPI

Diabetes Program ‐ Diabetes

Leah House, SDPI Program Director

(605) 473‐0184 june40@hotmail.com 2 1

Prevention Program 187 Oyate Circle Lower Brule, SD 57548

Trenton Service Unit

SDPI

Diabetes Program‐ Community Clinic Wellness Center 331 4th Ave. E.

Trenton, NE 58853

Patricia Kittleson, SDPI Diabetes Program Director (701)‐572‐7485 Patricia.Kittleson@ihs.gov

1 1

South Dakota Urban Indian Health‐ Pierre, SD

SDPI

Diabetes Program ‐ 1714 Abbey Rd. Pierre, SD 57501

Tami Lorenzen, CNP ‐Pierre Site Lead

(605) 224‐8841 Tami.Hogie‐ Lorenzen@sduih.org

South Dakota Urban Indian Health‐ Sioux Falls, SD

SDPI

Diabetes Program ‐ 1200 N.

West Ave.

Sioux Falls, SD 57104

Karley Briggs, SDPI Diabetes Program Director

(605) 339‐0420 karley.briggs@sduih.org

5 1 2

Nebraska Urban Indian Health Coalition‐ Lincoln, NE

SDPI

Diabetes Program ‐

NUIMC

Fairfiel St.

Lincoln, NE 98521

Kari EricksonSDPI Diabetes Program Director

(401) 434‐7177 kerickson@nuihc.com

2 2

PROVISIONS AND CLAUSES INCORPORATED BY REFERENCE

52.252-1 -- Solicitation Provisions Incorporated by Reference (Feb 1998)

This solicitation incorporates one or more solicitation provisions by reference, with the same force and effect as if they were given in full text. Upon request, the Contracting Officer will make their full text available. The offeror is cautioned that the listed provisions may include blocks that must be completed by the offeror and submitted with its quotation or offer. In lieu of submitting the full text of those provisions, the offeror may identify the provision by paragraph identifier and provide the appropriate information with its quotation or offer. Also, the full text of a solicitation provision may be accessed electronically at this/these address(es): https://www.acquisition.gov/far.

(End of Provision)

52.252-2 -- Clauses Incorporated by Reference (Feb 1998)

This contract incorporates one or more clauses by reference, with the same force and effect as if they were given in full text. Upon request, the Contracting Officer will make their full text available. Also, the full text of a clause may be accessed electronically at this/these address(es): https://www.acquisition.gov/far.

(End of Clause)

I. Federal Acquisition Regulations (FAR) (48 CFR Chapter 1) Provisions and Clauses Incorporated by

Reference

FAR

CITATION

PROVISION/CLAUSE TITLE PROVISION/

CLAUSE DATE

52.204-7 System for Award Management October 2018

52.204-13 System for Award Management Maintenance October 2018

52.204-16 Commercial and Government Entity Code Reporting July 2016

52.204-17 Ownership or Control of Offeror July 2016

52.204-18 Commercial and Government Entity Code Maintenance July 2016

52.204-19 Incorporation by Reference of Representations and Certifications December 2014

52.211-6 Brand Name or Equal August 1999

52.211-17 Delivery of Excess Quantities September 1989

52.212-1 Instructions to Offerors – Commercial Items March 2020

52.212-4 Contract Terms and Conditions – Commercial Items October 2018

52.225-13 Restrictions on Certain Foreign Purchases June 2008

52.225-25 Prohibition on Contracting with Entities Engaging in Certain Activities or

Transactions Relating to Iran – Representations and Certifications

August 2018

52.232-39 Unenforceability of Unauthorized Obligations June 2013

52.232-40 Providing Accelerated Payments to Small Business Subcontractors December 2013

52.247-34 F.o.b. – Destination November 1991

52.253-1 Computer Generated Forms January 1991

PROVISIONS AND CLAUSES IN FULL TEXT

II. Federal Acquisition Regulations (FAR) (48 CFR Chapter 1) Provisions and Clauses in Full Text

FAR

CITATION

PROVISION/CLAUSE TITLE PROVISION/

CLAUSE DATE

52.204-24 Representation Regarding Certain Telecommunications and Video Surveillance

Services or Equipment

December 2019 https://www.acquisition.gov/far https://www.acquisition.gov/far

52.209-11 Representation by Corporations Regarding Delinquent Tax Liability or a Felony

Conviction under any Federal Law

February 2016

52.212-3 Offeror Representations and Certifications -- Commercial Items March 2020

52.212-5 Contract Terms and Conditions Required to Implement Statutes or Executive

Orders -- Commercial Items

March 2020

52.219-1 Small Business Program Representations March 2020

52.204-24 Representation Regarding Certain Telecommunications and Video Surveillance Services or

Equipment (December 2019)

The Offeror shall not complete the representation in this provision if the Offeror has represented that it “does not provide covered telecommunications equipment or services as a part of its offered products or services to the

Government in the performance of any contract, subcontract, or other contractual instrument” in the provision at

52.204-26, Covered Telecommunications Equipment or Services-Representation, or in paragraph (v) of the provision at 52.212-3, Offeror Representations and Certifications-Commercial Items.

(a) Definitions. As used in this provision—

“Covered telecommunications equipment or services”, “critical technology”, and “substantial or essential component” have the meanings provided in clause 52.204-25, Prohibition on Contracting for Certain

Telecommunications and Video Surveillance Services or Equipment.

(b) Prohibition. Section 889(a)(1)(A) of the John S. McCain National Defense Authorization Act for Fiscal Year

2019 (Pub. L. 115-232) prohibits the head of an executive agency on or after August 13, 2019, from procuring or obtaining, or extending or renewing a contract to procure or obtain, 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. Contractors are not prohibited from providing—

(1)A service that connects to the facilities of a third-party, such as backhaul, roaming, or interconnection arrangements; or

(2) Telecommunications equipment that cannot route or redirect user data traffic or permit visibility into any user data or packets that such equipment transmits or otherwise handles.

(c) Procedures. The Offeror shall review the list of excluded parties in the System for Award Management

(SAM) (https://www.sam.gov) for entities excluded from receiving federal awards for “covered telecommunications equipment or services”.

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

(e) Disclosures. If the Offeror has represented in paragraph (d) of this provision that it “will” provide covered telecommunications equipment or services”, the Offeror shall provide the following information as part of the offer—

(1) A description of all covered telecommunications equipment and services offered (include brand; model number, such as original equipment manufacturer (OEM) number, manufacturer part number, or wholesaler number;

and item description, as applicable);

(2) Explanation of the proposed use of covered telecommunications equipment and services and any factors relevant to determining if such use would be permissible under the prohibition in paragraph (b) of this provision;

https://www.acquisition.gov/content/52204-26-covered-telecommunications-equipment-or-services-representation#id19CAC0P0ESS https://www.acquisition.gov/content/52212-3-offeror-representations-and-certifications-commercial-items#i1060550 https://www.acquisition.gov/content/52204-25-prohibition-contracting-certain-telecommunications-and-video-surveillance-services-or-equipment#id1989I600I4C https://www.sam.gov/

(3) For services, the entity providing the covered telecommunications services (include entity name, unique entity identifier, and Commercial and Government Entity (CAGE) code, if known); and

(4) For equipment, the entity that produced the covered telecommunications equipment (include entity name, unique entity identifier, CAGE code, and whether the entity was the OEM or a distributor, if known).

(End of provision)

52.209-11 – Representation by Corporations Regarding Delinquent Tax Liability or a Felony Conviction under any Federal Law (February 2016)

(a) As required by sections 744 and 745 of Division E of the Consolidated and Further Continuing Appropriations

Act, 2015 (Pub. L 113-235), and similar provisions, if contained in subsequent appropriations acts, the Government will not enter into a contract with any corporation that--

(1) Has any unpaid Federal tax liability that has been assessed, for which all judicial and administrative remedies have been exhausted or have lapsed, and that is not being paid in a timely manner pursuant to an agreement with the authority responsible for collecting the tax liability, where the awarding agency is aware of the unpaid tax liability, unless an agency has considered suspension or debarment of the corporation and made a determination that suspension or debarment is not necessary to protect the interests of the Government; or

(2) Was convicted of a felony criminal violation under any Federal law within the preceding 24 months, where the awarding agency is aware of the conviction, unless an agency has considered suspension or debarment of the corporation and made a determination that this action is not necessary to protect the interests of the Government.

(b) The Offeror represents that—

(1) It is [ ] is not [ ] a corporation that has any unpaid Federal tax liability that has been assessed, for which all judicial and administrative remedies have been exhausted or have lapsed, and that is not being paid in a timely manner pursuant to an agreement with the authority responsible for collecting the tax liability; and

(2) It is [ ] is not [ ] a corporation that was convicted of a felony criminal violation under a Federal law within the preceding 24 months.

(End of provision)

52.212-3 -- Offeror Representations and Certifications -- Commercial Items (March 2020)

The Offeror shall complete only paragraph (b) of this provision if the Offeror has completed the annual representations and certification electronically in the System for Award Management (SAM) accessed through https://www.sam.gov. If the Offeror has not completed the annual representations and certifications electronically, the Offeror shall complete only paragraphs (c) through (v)) of this provision.

(a) Definitions. As used in this provision—

“Covered telecommunications equipment or services” has the meaning provided in the clause 52.204-25, Prohibition on Contracting for Certain Telecommunications and Video Surveillance Services or Equipment.

Economically disadvantaged women-owned small business (EDWOSB) concern means a small business concern that is at least 51 percent directly and unconditionally owned by, and the management and daily business operations of which are controlled by, one or more women who are citizens of the United States and who are economically https://www.acquisition.gov/content/part-52-solicitation-provisions-and-contract-clauses#unique_1124452424 disadvantaged in accordance with 13 CFR part 127. It automatically qualifies as a women-owned small business eligible under the WOSB Program.

Forced or indentured child labor means all work or service—

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

Highest-level owner means the entity that owns or controls an immediate owner of the offeror, or that owns or controls one or more entities that control an immediate owner of the offeror. No entity owns or exercises control of the highest level owner.

Immediate owner means an entity, other than the offeror, that has direct control of the offeror. Indicators of control include, but are not limited to, one or more of the following: ownership or interlocking management, identity of interests among family members, shared facilities and equipment, and the common use of employees.

Inverted domestic corporation, means a foreign incorporated entity that meets the definition of an inverted domestic corporation under 6 U.S.C. 395(b), applied in accordance with the rules and definitions of 6 U.S.C. 395(c).

Manufactured end product means any end product in product and service codes (PSCs) 1000-9999, except—

(1) PSC 5510, Lumber and Related Basic Wood Materials;

(2) Product or Service Group (PSG) 87, Agricultural Supplies;

(3) PSG 88, Live Animals;

(4) PSG 89, Subsistence;

(5) PSC 9410, Crude Grades of Plant Materials;

(6) PSC 9430, Miscellaneous Crude Animal Products, Inedible;

(7) PSC 9440, Miscellaneous Crude Agricultural and Forestry Products;

(8) PSC 9610, Ores;

(9) PSC 9620, Minerals, Natural and Synthetic; and

(10) PSC 9630, Additive Metal Materials.

Place of manufacture means the place where an end product is assembled out of components, or otherwise made or processed from raw materials into the finished product that is to be provided to the Government. If a product is disassembled and reassembled, the place of reassembly is not the place of manufacture.

Predecessor means an entity that is replaced by a successor and includes any predecessors of the predecessor.

Restricted business operations means business operations in Sudan that include power production activities, mineral extraction activities, oil-related activities, or the production of military equipment, as those terms are http://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title6-section395&num=0&edition=prelim http://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title6-section395&num=0&edition=prelim defined in the Sudan Accountability and Divestment Act of 2007 (Pub. L. 110-174). Restricted business operations do not include business operations that the person (as that term is defined in Section 2 of the Sudan Accountability and Divestment Act of 2007) conducting the business can demonstrate—

(1) Are conducted under contract directly and exclusively with the regional government of southern Sudan;

(2) Are conducted pursuant to specific authorization from the Office of Foreign Assets Control in the

Department of the Treasury, or are expressly exempted under Federal law from the requirement to be conducted under such authorization;

(3) Consist of providing goods or services to marginalized populations of Sudan;

(4) Consist of providing goods or services to an internationally recognized peacekeeping force or humanitarian organization;

(5) Consist of providing goods or services that are used only to promote health or education; or

(6) Have been voluntarily suspended.“Sensitive technology”—

Sensitive technology—

(1) Means hardware, software, telecommunications equipment, or any other technology that is to be used specifically—

(i) To restrict the free flow of unbiased information in Iran; or

(ii) To disrupt, monitor, or otherwise restrict speech of the people of Iran; and

(2) Does not include information or informational materials the export of which the President does not have the authority to regulate or prohibit pursuant to section 203(b)(3)of the International Emergency Economic Powers

Act (50 U.S.C. 1702(b)(3)).

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 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 veteransor, in the case of a service-disabled 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 is bidding on Government contracts, and qualified as a small business under the criteria in 13 CFR Part 121 and size standards in this solicitation.

http://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title38-section101&num=0&edition=prelim http://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title38-section101&num=0&edition=prelim

Small disadvantaged business concern, consistent with13 CFR 124.1002, means a small business concern under the size standard applicable to the acquisition, that—

(1) Is at least 51 percent unconditionally and directly owned (as defined at 13 CFR 124.105) by—

(i) One or more socially disadvantaged (as defined at13 CFR 124.103) and economically disadvantaged

(as defined at 13 CFR 124.104) individuals who are citizens of the United States; and

(ii) Each individual claiming economic disadvantage has a net worth not exceeding $750,000 after taking into account the applicable exclusions set forth at 13 CFR124.104(c)(2); and

(2) The management and daily business operations of which are controlled (as defined at 13.CFR 124.106) by individuals, who meet the criteria in paragraphs (1)(i) and (ii) of this definition.

Subsidiary means an entity in which more than 50 percent of the entity is owned—

(1) Directly by a parent corporation; or

(2) Through another subsidiary of a parent corporation

Successor means an entity that has replaced a predecessor by acquiring the assets and carrying out the affairs of the predecessor under a new name (often through acquisition or merger). The term “successor” does not include new offices/divisions of the same company or a company that only changes its name. The extent of the responsibility of the successor for the liabilities of the predecessor may vary, depending on State law and specific circumstances.

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 (WOSB) concern eligible under the WOSB Program (in accordance with 13 CFR part 127), means a small business concern that is at least 51 percent directly and unconditionally owned by, and the management and daily business operations of which are controlled by, one or more women who are citizens of the

United States.

Women-owned small business concern means a small business concern—

(1) That is at least 51 percent owned by one or more women; or, in the case of any publicly owned business, at least51 percent of the stock of which is owned by one or more women; and

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

(b)

(1) Annual Representations and Certifications. Any changes provided by the Offeror in paragraph (b)(2) of this provision do not automatically change the representations and certifications in SAM

(2) The offeror has completed the annual representations and certifications electronically in SAM accessed through http://www.sam.gov. After reviewing SAM information, the Offeror verifies by submission of this offer that http://www.sam.gov/ the representations and certifications currently posted electronically at FAR 52.212-3, Offeror Representations and

Certifications-Commercial Items, have been entered or updated in the last 12 months, are current, accurate, complete, and applicable to this solicitation (including the business size standard(s) applicable to the NAICS code(s) referenced for this solicitation), at the time this offer is submitted and are incorporated in this offer by reference (see

FAR 4.1201), except for paragraphs ______________.

[Offeror to identify the applicable paragraphs at (c) through (v) of this provision that the offeror has completed for the purposes of this solicitation only, if any.

These amended representation(s) and/or certification(s) are also incorporated in this offer and are current, accurate, and complete as of the date of this offer.

Any changes provided by the offeror are applicable to this solicitation only, and do not result in an update to the representations and certifications posted electronically on SAM.]

(c) Offerors must complete the following representations when the resulting contract will be performed in the

United States or its outlying areas. Check all that apply.

(1) Small business concern. The offeror represents as part of its offer that it □is, □is not a small business concern.

(2) Veteran-owned small business concern. [Complete only if the offeror represented itself as a small business concern in paragraph (c)(1) of this provision.] The offeror represents as part of its offer that it □is, □is not a veteran-owned small business concern.

(3) Service-disabled veteran-owned small business concern. [Complete only if the offeror represented itself as a veteran-owned small business concern in paragraph (c)(2) of this provision.] The offeror represents as part of its offer that it □ is, □ is not a service-disabled veteran-owned small business concern.

(4) Small disadvantaged business concern. [Complete only if the offeror represented itself as a small business concern in paragraph (c)(1) of this provision.] The offeror represents, that it □is, □is not a small disadvantaged business concern as defined in 13 CFR124.1002.

(5) Women-owned small business concern. [Complete only if the offeror represented itself as a small business concern in paragraph (c)(1) of this provision.] The offeror represents that it □ is, □ is not a women-owned small business concern.

(6) WOSB concern eligible under the WOSB Program. [Complete only if the offeror represented itself as a women-owned small business concern in paragraph (c)(5) of this provision.] The offeror represents that-

(i) It □ is, □ is not a WOSB concern eligible under the WOSB Program, has provided all the required documents to the WOSB Repository, and no change in circumstances or adverse decisions have been issued that affects its eligibility; and

(ii) It □ is, □ is not a joint venture that complies with the requirements of 13 CFR part 127, and the representation in paragraph (c)(6)(i) of this provision is accurate for each WOSB concern eligible under the WOSB

Program participating in the joint venture. [The offeror shall enter the name or names of the WOSB concern eligible under the WOSB Program and other small businesses that are participating in the joint venture: __________.] Each

WOSB concern eligible under the WOSB Program participating in the joint venture shall submit a separate signed copy of the WOSB representation.

https://www.acquisition.gov/content/part-52-solicitation-provisions-and-contract-clauses#i1060550 https://www.acquisition.gov/content/part-4-administrative-and-information-matters#i1121876

(7) Economically disadvantaged women-owned small business (EDWOSB) concern. [Complete only if the offeror represented itself as a WOSB concern eligible under the WOSB Program in (c)(6) of this provision.] The offeror represents that-

(i) It □ is, □ is not an EDWOSB concern, has provided all the required documents to the WOSB

Repository, and no change in circumstances or adverse decisions have been issued that affects its eligibility; and

(ii) It □ is, □ is not a joint venture that complies with the requirements of 13 CFR part 127, and the representation in paragraph (c)(7)(i) of this provision is accurate for each EDWOSB concern participating in the joint venture. [The offeror shall enter the name or names of the EDWOSB concern and other small businesses that are participating in the joint venture: __________.] Each EDWOSB concern participating in the joint venture shall submit a separate signed copy of the EDWOSB representation.

Note: Complete paragraphs (c)(8) and (c)(9) only if this solicitation is expected to exceed the simplified acquisition threshold.

(8) Women-owned business concern (other than small business concern). [Complete only if the offeror is a women-owned business concern and did not represent itself as a small business concern in paragraph (c)(1) of this provision.] The offeror represents that it □ is a women-owned business concern.

(9) Tie bid priority for labor surplus area concerns. If this is an invitation for bid, small business offerors may identify the labor surplus areas in which costs to be incurred on account of manufacturing or production (by offeror or first-tier subcontractors) amount to more than 50 percent of the contract price:____________________________________

(10) HUBZone small business concern. [Complete only if the offeror represented itself as a small business concern in paragraph (c)(1) of this provision.] The offeror represents, as part of its offer, that–

(i) It □is, □is not a HUBZone small business concern listed, on the date of this representation, on the List of Qualified HUBZone Small Business Concerns maintained by the Small Business Administration, and no material changes in ownership and control, principal office, or HUBZone employee percentage have occurred since it was certified in accordance with 13 CFR Part 126; and

(ii) It □ is, □ is not a HUBZone joint venture that complies with the requirements of 13 CFR Part 126, and the representation in paragraph (c)(10)(i) of this provision is accurate for each HUBZone small business concern participating in the HUBZone joint venture. [The offeror shall enter the names of each of the HUBZone small business concerns participating in the HUBZone joint venture: __________.] Each HUBZone small business concern participating in the HUBZone joint venture shall submit a separate signed copy of the HUBZone representation.

(d) Representations required to implement provisions of Executive Order11246-

(1) Previous contracts and compliance. The offeror represents that-

(i) It □ has, □ has not participated in a previous contract or subcontract subject to the Equal Opportunity clause of this solicitation; and

(ii) It □ has, □ has not filed all required compliance reports.

(2) Affirmative Action Compliance. The offeror represents that-

(i) It □ has developed and has on file, □ has not developed and does not have on file, at each establishment, affirmative action programs required by rules and regulations of the Secretary of Labor (41 CFR parts

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.

(e) Certification Regarding Payments to Influence Federal Transactions (31 http://uscode.house.gov/ U.S.C.

1352). (Applies only if the contract is expected to exceed $150,000.) By submission of its offer, the offeror certifies to the best of its knowledge and belief that 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 award of any resultant contract. If any registrants under the Lobbying Disclosure Act of 1995 have made a lobbying contact on behalf of the offeror with respect to this contract, the offeror shall complete and submit, with its offer, OMB Standard Form LLL, Disclosure of Lobbying Activities, to provide the name of the registrants. The offeror need not report regularly employed officers or employees of the offeror to whom payments of reasonable compensation were made.

(f) Buy American Certificate. (Applies only if the clause at Federal Acquisition Regulation (FAR) 52.225-1, Buy

American-Supplies, is included in this solicitation.)

(1) The offeror certifies that each end product, except those listed in paragraph (f)(2) of this provision, is a domestic end product and that for other than COTS items, the offeror has considered components of unknown origin to have been mined, produced, or manufactured outside the United States. The offeror shall list as foreign end products those end products manufactured in the United States that do not qualify as domestic end products,i.e., an end product that is not a COTS item and does not meet the component test in paragraph (2) of the definition of

“domestic end product.” The terms “commercially available off-the-shelf (COTS) item” “component,” “domestic end product,” “end product,” “foreign end product,” and “United States” are defined in the clause of this solicitation entitled “Buy American-Supplies.”

(2) Foreign End Products:

Line Item No. Country of Origin

[List as necessary]

(3) The Government will evaluate offers in accordance with the policies and procedures of FAR part 25.

(g)

(1) Buy American-Free Trade Agreements-Israeli Trade Act Certificate. (Applies only if the clause at FAR 52.225-

3, Buy American-Free Trade Agreements-Israeli Trade Act, is included in this solicitation.)

(i) The offeror certifies that each end product, except those listed in paragraph (g)(1)(ii) or (g)(1)(iii) of this provision, is a domestic end product and that for other than COTS items, the offeror has considered components of unknown origin to have been mined, produced, or manufactured outside the United States. The terms

“Bahrainian, Moroccan, Omani, Panamanian, or Peruvian end product,” “commercially available off-the-shelf

(COTS) item,” “component,” “domestic end product,” “end product,” “foreign end product,” “Free Trade http://uscode.house.gov/browse.xhtml;jsessionid=114A3287C7B3359E597506A31FC855B3 https://www.acquisition.gov/content/part-52-solicitation-provisions-and-contract-clauses#i1053372 https://www.acquisition.gov/content/part-25-foreign-acquisition#i1093771 https://www.acquisition.gov/content/part-52-solicitation-provisions-and-contract-clauses#i1053446

Agreement country,” “Free Trade Agreement country end product,” “Israeli end product,” and “United States” are defined in the clause of this solicitation entitled “Buy American-Free Trade Agreements–Israeli Trade Act.”

(ii) The offeror certifies that the following supplies are Free Trade Agreement country end products (other than Bahrainian, Moroccan, Omani, Panamanian, or Peruvian end products) or Israeli end products as defined in the clause of this solicitation entitled “Buy American-Free Trade Agreements-Israeli Trade Act”:

Free Trade Agreement Country End Products (Other than Bahrainian, Moroccan, Omani, Panamanian, or

Peruvian End Products) or Israeli End Products:

Line Item No. Country of Origin

[List as necessary]

(iii) The offeror shall list those supplies that are foreign end products (other than those listed in paragraph

(g)(1)(ii) of this provision) as defined in the clause of this solicitation entitled “Buy American-Free Trade

Agreements-Israeli Trade Act.” The offeror shall list as other foreign end products those end products manufactured in the United States that do not qualify as domestic end products, i.e., an end product that is not a COTS item and does not meet the component test in paragraph (2) of the definition of “domestic end product.”

Other Foreign End Products:

Line Item No. Country of Origin

[List as necessary]

(iv) The Government will evaluate offers in accordance with the policies and procedures of FAR part 25.

(2) Buy American-Free Trade Agreements-Israeli Trade Act Certificate, Alternate I. If Alternate I to the clause at FAR 52.225-3 is included in this solicitation, substitute the following paragraph (g)(1)(ii) for paragraph

(g)(1)(ii) of the basic provision:

(g)(1)(ii) The offeror certifies that the following supplies are Canadian end products as defined in the clause of this solicitation entitled “Buy American-Free Trade Agreements-Israeli Trade Act”:

Canadian End Products:

Line Item No.

[List as necessary] https://www.acquisition.gov/content/part-25-foreign-acquisition#i1093771

(3) Buy American-Free Trade Agreements-Israeli Trade Act Certificate, Alternate II. If Alternate II to the clause at FAR 52.225-3 is included in this solicitation, substitute the following paragraph (g)(1)(ii) for paragraph

(g)(1)(ii) of the basic provision:

(g)(1)(ii) The offeror certifies that the following supplies are Canadian end products or Israeli end products as defined in the clause of this solicitation entitled “Buy American-Free Trade Agreements-Israeli Trade Act”:

Canadian or Israeli End Products:

Line Item No. Country of Origin

[List as necessary]

(4) Buy American-Free Trade Agreements-Israeli Trade Act Certificate, Alternate III. If Alternate III to the clause at 52.225-3 is included in this solicitation, substitute the following paragraph (g)(1)(ii) for paragraph (g)(1)(ii) of the basic provision:

(g)(1)(ii) The offeror certifies that the following supplies are Free Trade Agreement country end products

(other than Bahrainian, Korean, Moroccan, Omani, Panamanian, or Peruvian end products) or Israeli end products as defined in the clause of this solicitation entitled “Buy American-Free Trade Agreements-Israeli Trade Act”:

Free Trade Agreement Country End Products (Other than Bahrainian, Korean, Moroccan, Omani, Panamanian, or Peruvian End Products) or Israeli End Products:

Line Item No. Country of Origin

[List as necessary]

(5) Trade Agreements Certificate. (Applies only if the clause at FAR 52.225-5, Trade Agreements, is included in this solicitation.)

(i) The offeror certifies that each end product, except those listed in paragraph (g)(5)(ii) of this provision, is a U.S.-made or designated country end product, as defined in the clause of this solicitation entitled “Trade

Agreements.”

(ii) The offeror shall list as other end products those end products that are not U.S.-made or designated country end products.

Other End Products:

Line Item No. Country of Origin https://www.acquisition.gov/content/part-52-solicitation-provisions-and-contract-clauses#i1053446 https://www.acquisition.gov/content/part-52-solicitation-provisions-and-contract-clauses#i1053648

Line Item No. Country of Origin

[List as necessary]

(iii) The Government will evaluate offers in accordance with the policies and procedures of FAR part 25.

For line items covered by the WTO GPA, the Government will evaluate offers of U.S.-made or designated country end products without regard to the restrictions of the Buy American statute. The Government will consider for award only offers of U.S.-made or designated country end products unless the Contracting Officer determines that there are no offers for such products or that the offers for such products are insufficient to fulfill the requirements of the solicitation.

(h) Certification Regarding Responsibility Matters (Executive Order 12689). (Applies only if the contract value is expected to exceed the simplified acquisition threshold.) The offeror certifies, to the best of its knowledge and belief, that the offeror and/or any of its principals–

(1) □ Are, □ are not presently debarred, suspended, proposed for debarment, or declared ineligible for the award of contracts by any Federal agency;

(2) □ Have, □ 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 Federal, state or local government 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, violating…