BioEPIC CM-GC Rep-Cert.docx

The following Representation & Certification provisions must be completed and this form must be signed and returned as part of the Offeror’s proposal. As used herein, the term “contract” shall mean the UC/LBNL award resulting from the Offeror’s proposal; “offer” includes “bid,” “proposal,” and “quotation;” and “Offeror” includes “bidder,” “proposer,” and “quoter”, as may be applicable.

INDEX

TAX LIABILITY OR A FELONY CONVICTION UNDER ANY FEDERAL LAW

CERTAIN FEDERAL TRANSACTIONS

COMPUTER SOFTWARE

University of California Lawrence Berkeley National Laboratory

REPRESENTATIONS AND CERTIFICATIONS

(For Procurements under LBNL Contract No. DE-AC02-05CH11231 with the Department of Energy)

University of California, Lawrence Berkeley National Laboratory Representations and Certifications for Procurements Under LBNL Contract No. DE-AC02-05CH11231 with the Department of Energy

1. OFFEROR INFORMATION

(Complete and check all that applies.)

Place of Performance (principal plant or place of business where the items will be produced, supplied from stock, or where the service will be performed): Zip+4 ___ Country_

Type of Domestic Organization

Type of Foreign Organization

2. SMALL BUSINESS PROGRAM REPRESENTATIONS

(Per FAR 52.219-1) Do Not Complete Section 2 if Non-Profit or Not-For Profit (Applies if any performance will be in the U.S. or its outlying areas.)

The Offeror represents as part of its offer that:

(1) It |_| is, |_| is not, a small business concern.

[Complete the following sections only if the Offeror represents in paragraph (b)(1) that it is a small business concern.]

(ii) It |_| is, |_| is not, a joint venture that complies with the requirements of 13 CFR Part 126, and the representation in paragraph (b)(7)(i) of this provision is accurate for the HUBZone small business concern or concerns that are participating in the joint venture.

[The Offeror shall enter the name of the HUBZone small business concern or concerns participating in the joint venture:]

Date

Title

(c) Definitions. As used in this provision- "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 the size standard in paragraph (a) of this provision.

"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 least 51 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.

"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.

"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).

"Service-disabled veteran-owned small business concern" means a small business concern:

(1) 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

(2) 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.

(d) 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.

3. PREVIOUS CONTRACTS AND COMPLIANCE REPORTS

(Per FAR 52.222-22) (Not Applicable if performance will be on an Indian Reservation or outside the U.S. by employees not recruited in the U.S.)

The Offeror represents that:

4. AFFIRMATIVE ACTION COMPLIANCE

(Per FAR 52.222-25) (Not applicable if the offer is for construction work or work on an Indian Reservation or outside the U.S. by employees not recruited in the U.S.)

The Offeror represents that:

5. COMPLIANCE WITH VETERANS’ EMPLOYMENT REPORTING REQUIREMENTS

(Per FAR 52.222-38) (Applies to offers >$250,000) 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 Veterans), it has submitted the most recent VETS-4212 Report required by that clause.

6. CERTIFICATION AND DISCLOSURE ON PAYMENTS TO INFLUENCE CERTAIN FEDERAL TRANSACTIONS (Per FAR 52.203-11)

7. CERTIFICATION ON RESPONSIBILITY MATTERS

(Per FAR 52.209-5)

(ii) The Offeror has |_| 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 an officer, director, owner, partner, or a person having primary management or supervisory responsibilities within a business entity (e.g., general manager; plant manager; head of a division, or business segment, and similar positions).

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 UNDER SECTION 1001, TITLE 18, OF THE UNITED STATES CODE.

8. REPRESENTATIONS BY CORPORATIONS REGARDING DELINQUENT TAX LIABILITY OR A FELONY CONVICTION UNDER ANY FEDERAL LAW (Per FAR 52.209-11) (Applies to Corporations only)

9. INFORMATION REGARDING RESPONSIBILITY MATTERS

(Per FAR 52.209-7)

(a) Definitions. As used in this provision— “Administrative proceeding” means a non-judicial process that is adjudicatory in nature in order to make a determination of fault or liability (e.g., Securities and Exchange Commission Administrative Proceedings, Civilian Board of Contract Appeals Proceedings, and Armed Services Board of Contract Appeals Proceedings). This includes administrative proceedings at the Federal and State level but only in connection with performance of a Federal contract or grant. It does not include agency actions such as contract audits, site visits, corrective plans, or inspection of deliverables.

“Federal contracts and grants with total value greater than $10,000,000” means—

“Principal” means an officer, director, owner, partner, or a person having primary management or supervisory responsibilities within a business entity (e.g., general manager; plant manager; head of a division or business segment; and similar positions).

10. CERTIFICATION REGARDING TAX MATTERS

(Per FAR 52.209-12)

11. BUY AMERICAN ACT CERTIFICATION

(Per FAR 52.225-2)

(a) The Offeror certifies that each end product to be delivered or construction material to be incorporated into the work, except those listed in paragraph (b) of this provision, is a domestic end product or construction material, mined, produced, or manufactured in the United States. Components thereof of unknown origin, other than com-mercially available off-the-shelf (COTS) items, have been considered as mined, produced, or manufactured outside the United States.

The items listed in paragraph (b) are not mined, produced, or manufactured in the United States or are mined, produced, or manufactured in the United States but are not a COTS item and do not meet the component test of the domestic end product or construction material definitions.

NOTE: The terms used in this provision are defined in FAR Clause 52.225-1, Buy American Act-Supplies, or FAR Clause 52.225-9, Buy American Act-Construction Materials, of this solicitation. The University will consider applicable provisions of FAR Subpart 25.1 in evaluating offers for foreign end products or construction material.

12. REPRESENTATION OF LIMITED RIGHTS DATA AND RESTRICTED COMPUTER SOFTWARE

(Per FAR 52.227-15, and definitions in DEAR 927.409) (Applies if data will be produced, furnished, or acquired)

(a) This solicitation sets forth the known requirements for data. Any data delivered under the resulting contract will be subject to the Rights in Data-General clause at FAR 52.227-14. Under that clause, data that qualifies as limited rights data or restricted computer may be withheld from delivery, with form, fit, and function data delivered in lieu thereof, or delivered as limited rights data or restricted computer software per Alternates II or III of the clause, provided it is marked with the appropriate limited rights or restricted rights notice. Use of Alternate V with the clause provides the University and DOE the right to inspect such data at the Subcontractor's facility.

(b) By completing the remainder of this paragraph, the Offeror represents that it has reviewed the requirements for data, including technical data and computer software, and states:

(check appropriate box)

13. EXPORT CONTROLLED ITEM CLASSIFICATION

(1) The items quoted are |_| are not |_| export controlled.

[Complete the following sections only if the Offeror represents in paragraph (b)(1) that items quoted are export controlled.] (2)The export classification for the item (s) being purchased are identified as follows: Please include for each item; 1) Manufacturer’s name; 2) Model Number; 3) Description of item; 4) Export Authority (ITAR, EAR, or NRC). 5)(a) If an EAR classification, provide the applicable Export Control Classification Number (ECCN), 5(b) If an ITAR classification, provide USML category, 5(c) If an NRC classification, provide relevant NRC section. Attach an additional sheet if necessary:

(3) The Offer represents that if an award is made for the quoted items, that the Offer will |_| will not |_| be delivering export controlled equipment user guides, installation/repair/maintenance documentation or software that is designated as proprietary and export controlled.

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