Section V Cover Page.pdf

Section V Forms

PRINCETON PLASMA PHYSICS LABORATORY

REPRESENTATIONS & CERTIFICATIONS

Small Business Program Representations (completed by PPPL)

The NAICS code for this acquisition is

237130

The small business size standard is

45 million

Under U.S. Department of Energy contract number DE-AC02-09CH11466, Princeton University is responsible for the management, operation and maintenance of the Princeton Plasma Physics Laboratory (PPPL) in Princeton, New Jersey. The following representations and certifications are required from all subcontractors entering into agreements with PPPL. This document must be completed, signed and returned with the Offeror’s proposal.

1. Completed by Offeror:

Company/Organization Name (insert legal name of entity):

“Doing Business As” (DBA)

Street Address Line 1

Street Address Line 2

City, State, Country

Zip Code +4 /Country Code

Congressional District:

Point of Contact Name:

Point of Contact Email:

Telephone:

Fax:

*Taxpayer ID:

CAGE Code:

DUNS Number:

Unique Entity ID (UEI):

Applicable NAICS Codes:

2. Type of Business Organization (Derived from FAR 52.204-3)

(a) Definitions.

“Common parent,” as used in this provision, means that corporate entity that owns or controls an affiliated group of corporations that files its Federal income tax returns on a consolidated basis, and of which the offeror is a member.

“Taxpayer Identification Number (TIN),” as used in this provision, means the number required by the Internal Revenue Service (IRS) to be used by the offeror in reporting income tax and other returns. The TIN may be either a Social Security Number or an Employer Identification Number.

(b) All offerors must submit the information required in paragraphs (d) through (f) of this provision to comply with debt collection requirements of 31 U.S.C.7701(c) and 3325(d), reporting requirements of 26 U.S.C.6041, 6041 A, and 6050 M, and implementing regulations issued by the IRS. If the resulting subcontract is subject to the payment reporting requirements described in Federal Acquisition Regulation (FAR) 4.904, the failure or refusal by the offeror to furnish the information may result in a 31 percent reduction of payments otherwise due under the subcontract.

(c) The TIN may be used by the Government or Princeton to collect and report on any delinquent amounts arising out of the Offeror’s relationship with the Government or Princeton (31 U.S.C.7701(c)(3)). If the resulting subcontract is subject to the payment reporting requirements described in FAR 4.904, the TIN provided hereunder may be matched with IRS records to verify the accuracy of the offeror’s TIN.

(d) Taxpayer Identification Number (TIN).

TIN: ____________________________________.

TIN has been applied for

TIN is not required because:

Offeror is a nonresident alien, foreign corporation, or foreign partnership that does not have income effectively connected with the conduct of a trade or business in the United States and does not have an office or place of business or a fiscal paying agent in the United States

Offeror is an agency or instrumentality of a foreign government

Offeror is an agency or instrumentality of the Federal Government

Other:

(e) Type of organization.

Sole proprietorship

Government entity (Federal, State, or local)

Partnership

Foreign government

Corporate entity (not tax-exempt)

International organization per 26 CFR1.6049-4

Corporate entity (tax-exempt)

Other _______________________________

(f) Common parent.

Offeror is not owned or controlled by a common parent as defined in paragraph (a) of this provision.

Name and TIN of common parent:

Name ___________________________________

TIN____________________________________

3. Size of Business Organization (Derived from FAR 52.204-5, 52.219-1, 52.226-2)

Under 15 U.S.C. 645(d), any person who misrepresents a firm's status as a small, HUBZone small, small disadvantaged, service-disabled veteran-owned small, economically disadvantaged women-owned small, or women-owned small business concern eligible under the WOSB Program in order to obtain a contract to be awarded under the preference programs established pursuant to section 8, 9, 15, 31 or 36 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.

Please check all that apply:

Is Is Not

A U.S. domestic university or other U.S. institution of higher education

Is Is Not

A nonprofit scientific or educational organization qualified under a State nonprofit organization

Is Is Not

Foreign Corporation or Entity

Is Is Not

Large Business

Is Is Not

Women-Owned Business (Other than Small Business) means a firm 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 its stock is owned by one or more women; and whose management and daily business operations are controlled by one or more women.

Is Is Not

Small Business (SB) – means a firm, 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

Is Is Not

Small Disadvantaged Business (SDB) means a small business firm that is at least 51 percent owned and operated by one or more socially and economically disadvantaged individual(s); or, in the case of any publicly-owned business, at least 51 percent of the stock of which is owned by one or more socially and economically disadvantaged individuals; and whose management and daily business operations are controlled by one or more such individuals. A Small Disadvantaged Business can be self-certified or previously certified by the SBA.

Is Is Not

Woman-Owned Small Business (WOSB) – means a firm that is at least 51 percent owned and controlled 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.

Is Is Not

Economically Disadvantaged Woman-Owned Small Business (EDWOSB) – means a small business firm which is at least 51 percent directly and unconditionally owned by, one or more women who are citizens of the United states and who are economically disadvantaged in accordance with 13 CFR part 127 and the concern is certified by SBA or an approved third-part certified in accordance with 13 CFR 127.300. It automatically qualifies as a women-owned small business concern eligible under the WOSB program.

Is Is Not

Veteran-Owned Small Business (VOSB) – means a small business firm which is not less than 51 percent owned by one or more veterans, as defined in 38 U.S.C. 101(2), or, in the case of any publicly owned business, not less than 51 percent of the stock is owned by one or more veterans; and the management and daily business operations are controlled by one or more veterans.

Is Is Not

Service-Disabled Veteran-Owned Small Business (SDVOSB) – means a small business firm which is not less than 51 percent owned by one or more service-disabled veterans, as defined in 38 U.S.C. 101(16), or, in the case of any publicly owned business, not less than 51 percent of the stock is owned by one or more service-disabled veterans; and whose management and daily business operations are controlled by one or more service-disabled veterans or, in the case of a service-disabled veteran with permanent and severe disability, the spouse or permanent caregiver of such veteran or a small business concern eligible under the SDVOSB Program in accordance with 13 CFR part 128.

Is Is Not

Historically Underutilized Business Zone (HUBZONE) Small Business – means a small business firm as as having been certified by SBA as a HUBZone small business concern in the Dynamic Small Business Search and SAM, and will attempt to maintain an employment rate of HUBZone residents of 35 percent of its employees during performance of a HUBZone contract (see 13 CFR 126.200.

Is Is Not

Alaska Native Corporation – means any Regional Corporation, Village Corporation, Urban Corporation, or Group Corporation organized under the laws of the State of Alaska in accordance with the Alaska Native Claims Settlement Act, as amended (43 U.S.C. 1601, et seq.) and which is considered a minority and economically disadvantaged concern under the criteria at 43 U.S.C. 1626(e)(1). This definition also includes ANC direct and indirect subsidiary corporations, joint ventures, and partnerships that meet the requirements of 43 U.S.C. 1626(e)(2).

Is Is Not

Indian Tribe Representation - means any Indian tribe, band, group, pueblo, or community, including native villages and native groups (including corporations organized by Kenai, Juneau, Sitka, and Kodiak) as defined in the Alaska Native Claims Settlement Act (43 U.S.C. 1601 et seq.), that is recognized by the Federal Government as eligible for services from the Bureau of Indian Affairs in accordance with 25 U.S.C. 1452(c). This definition also includes Indian-owned economic enterprises that meet the requirements of 25 U.S.C. 1452(e)

Is Is Not

SBA Certified 8(A) – means a small business firm which is unconditionally owned and controlled by one or more socially and economically disadvantaged individuals and eligible for the SBA’s 8(a) Business Development Program (13 CFR 124-8(a)).

Is Is Not

Historically Black College or University (HBCU) – means an institution meeting the requirements of 34 CFR 608.2 as determined by the Secretary of Education.

Is Is Not

Minority Institution (MI) - means an institution of higher education meeting the requirements of Section 365 (3) of the Higher Education Act of 1965 (20 U.S.C. 1067k), including a Hispanic-serving institution of higher education, as defined in Section 502(a) of the Act (20 U.S.C. 1101a)

4. Use of Radioactive Materials

(For purposes of these questions, “radiation” includes particles capable of causing ionization of material or changes in nuclear characteristics of material. It does not include laser, IR, UV or microwave radiation.)

Yes No

Is there any planned or potential use of radioactive material under the proposed subcontract?

Yes No

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

If either of the above is answered “yes,” please provide the following information:

Principal Investigator Name:

Phone:

Health Physicist/Rad. Safety Officer Name:

Phone:

5. Representation by Corporations Regarding Delinquent Tax Liability or a Felony Conviction under any Federal Law (Derived from FAR 52.209-11)

The Offeror certifies, to the best of its knowledge and belief, that the Offer and/or any of its Principals:

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

Is Is Not a corporation that was convicted of a felony criminal violation under a Federal law within the preceding 24 months.

6. E-Verify Compliance Flow-Down Requirements Certification (Derived From FAR 52.222-54)

(Applicable to all for commercial or non-commercial services except commercial services provided as part of the purchase of a commercially-off-the-shelf (COTS) item, or construction, with a value in excess of $3,500 and work is performed in the United States)

The Offeror represents that:

E-Verify is not applicable based on paragraph (e) of FAR 52.222-54 Employment Eligibility Verification

Is Is not

Currently enrolled in E-Verify

If not currently enrolled, it will enroll in E-Verify within 30 calendar days of subcontract award

It will include FAR 52.222-54 in applicable lower-tier subcontracts

7. Biobased Product Certification (Derived from FAR 52.223-1)

As required by the Farm Security and Rural Investment Act of 2002 and the Energy Policy Act of 2005 ( 7 U.S.C. 8102(c)(3)), the Offeror certifies, by signing this offer, that biobased products (within categories of products listed by the United States Department of Agriculture in 7 CFR part 3201, subpart B) to be used or delivered in the performance of the contract, other than biobased products that are not purchased by the offeror as a direct result of this contract, will comply with the applicable specifications or other contractual requirements.

8. Recovered Material Certification (Derived from FAR 52.223-4)

As required by the Resource Conservation and Recovery Act of 1976 (42 U.S.C.6962(c)(3)(A)(i)), the Offeror certifies, by signing this offer, that the percentage of recovered materials content for EPA-designated items to be delivered or used in the performance of the contract will be at least the amount required by the applicable contract specifications or other contractual requirements.

9. Buy American Act Certificate (Derived from FAR 52.225-2)

(1) The Offeror certifies that each end product, except those listed below, is a domestic end product and that for other than commercially available off-the-shelf (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 entitled “Buy American-Supplies.”

(2) Foreign End Products (list as necessary)

Line Item No.

Country of Origin

10. Export Control (Derived from DEAR 970.5225-1)

The Offeror represents that property has an Export Control Classification Number (ECCN) identified as:

Not Applicable

EAR99 for all property, and/or

Has a classification number other than “EAR99”. The ECCN(s) for each item to be acquired is/are:

Line Item No.

Item Name

ECCN

11. Representation of Limited Rights Data and Restricted Computer Software (Derived from FAR 52.227-15)

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

(b) By completing the reminder of this paragraph, the offeror represents that it has reviewed the requirements for the delivery of technical data or computer software and states [offeror check appropriate block]:

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

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

(c) Any identification of limited rights data or restricted computer software in the offeror’s response is not determinative of the status of the data should a subcontract be awarded to the offeror.

Note: "Limited rights data" and "Restricted computer software" are defined in the contract clause entitled "Rights in Data -- General."

12. Rights to Proposal Data Technical (Derived from FAR 227-23)

Except for data contained on pages_______ thru _______ it is agreed that as a condition of award of this subcontract, and notwithstanding the conditions of any notice appearing thereon, the Government shall have unlimited rights (as defined in the "Rights in Data--General" clause contained in this subcontract) in and to the technical data contained in the proposal dated _______________, 2____ upon which this subcontract is based.

13. Royalty Payments Certification (Derived from DEAR 970.5227-8)

In order that Princeton and the U.S. Department of Energy may be informed regarding royalty payments to be made by a subcontractor in connection with any acquisition, construction, or operation where the amount of the royalty payment is reflected in the subcontract price, or is to be reimbursed by Princeton, check one of the following:

The subcontract price includes no amount representing the payment of royalty by the offeror directly to others in connection with the performance of the subcontract.

The subcontract price includes an amount for royalty payment expected to be made in connection with the proposed award set forth below:

1. The amount of each payment

2. The names of the licensor

3. Either the patent numbers involved or such other information as will permit identification of the patents and patent applications and the basis on which royalties will be paid.

14. Representation Regarding Certain Telecommunications and Video Surveillance Services or Equipment

(a) The Offeror represents that:

Will Will Not provide covered telecommunications equipment or services to the Government or Princeton Plasma Physics Laboratory in the performance of any of contract, subcontract or other contractual instrument resulting from this solicitation.

(b) If the answer above is “Will”, the Offeror shall provide the following information as part of its offer:

(1) All covered telecommunication 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 appliable:

(2) Explanation of the proposed use of covered telecommunications services and any factors relevant to determining if such use would be permissible under paragraph (b) of FAR 52.204-24:

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

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

NOTE: The term “Covered telecommunications equipment or services” and “Covered foreign country” are de-fined in FAR 52.204-25 as follows:

Covered telecommunications equipment or services means (1) Telecommunications equipment produced by Huawei Technologies Company or ZTE Corporation (or any subsidiary or affiliate of such entities); (2) For the purpose of public safety, security of Government facilities, physical security surveillance of critical infrastructure, and other national security purposes, video surveillance and telecommunications equipment produced by Hytera Communications Corporation, Hangzhou Hikvision Digital Technology Company, or Dahua Technology Company (or any subsidiary or affiliate of such entities); (3) Telecommunications or video surveillance services provided by such entities or using such equipment; or (4) Telecommunications or video surveillance equipment or services produced or provided by an entity that the Secretary of Defense, in consultation with the Director of National Intelligence or the Director of the Federal Bureau of Investigation, reasonably believes to be an entity owned or controlled by, or otherwise connected to, the government of a covered foreign country.

Covered foreign country means The People’s Republic of China.

15. Previous Contracts and Compliance Reports (Derived from FAR 52.222-22)

Has Has Not participated in a previous contract or subcontract subject to the Equal Opportunity clause of this solicitation;

Has Has Not filed all required compliance reports.

N/A

No compliance reports have been required

16. Affirmative Action Compliance (Derived from FAR 52.222-25)

It has developed and has on file, has not developed and does not have 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

It has not previously had contracts subject to the written affirmative action programs requirement of the rules and regulations of the Secretary of Labor;

It is exempt (less than 50 employees and/or less than $50,000 in Government contracts during prior 12-month period).

Applicable for agreements exceeding $150,000

17. Certification and Disclosure Regarding Payments to Influence Certain Federal Transactions (Derived from FAR 52.203-11)

(a) Definitions. As used in this provision— “Lobbying contact” has the meaning provided at 2 U.S.C. 1602(8). The terms “agency,” “influencing or attempting to influence,” “officer or employee of an agency,” “person,” “reasonable compensation,” and “regularly employed” are defined in the FAR clause of this solicitation entitled “Limitation on Payments to Influence Certain Federal Transactions” (52.203-12).

(b) Prohibition. The prohibition and exceptions contained in the FAR clause entitled “Limitation on Payments to Influence Certain Federal Transactions” (52.203-12) are hereby incorporated by reference it his provision.

(c) Certification. The Offeror, by signing its offer, hereby 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 its behalf in connection with the awarding of this contract.

(d) Disclosure. 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.

(e) Penalty. Submission of this certification and disclosure is a prerequisite for making or entering into this contract imposed by 31 U.S.C. 1352.Any person who makes an expenditure prohibited under this provision or who fails to file or amend the disclosure required 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.

18. Combating Trafficking in Persons

Applicable to proposals supplies, other than commercially available off-the-shelf items, acquired outside the United States, or services to be performed outside the United States. All statements must be completed.

(a) The Offeror certifies, to the best of their knowledge and belief, that it-

Has Has Not implemented a compliance plan to prevent any prohibited activities identified in FAR 52.222-50, paragraph (b), and to monitor, detect and terminate the contract with any subcontractor engaging in prohibited activities identified at paragraph (b) of the clause at 52.222-50.

(b) The Offeror certifies, to the best of their knowledge and belief, that -

Has Has Not neither the offeror nor any of its proposed agents, subcontractors, or their agents is engaged in such activities; OR

Has Has Not if abuses relating to any of the prohibited activities identified in FAR 52.222-50, paragraph (b) have been found, the Offeror or proposed subcontractor has taken the appropriate remedial and referral actions.

19. Compliance with Veterans’ Employment Reporting Requirements (Derived from FAR 52.222-38)

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 filed the most recent VETS-4212 Report required by that clause.

Applicable for agreements exceeding $250,000

20. Certificate of Independent Price Determination (Derived from 52.203-2) (applies to firm-fixed price agreements)

(a) The Offeror certifies that-

(1) The prices in this offer have been arrived at independently, without, for the purpose of restricting competition, any consultation, 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 (in the case of a sealed bid solicitation) or subcontract award (in the case of a 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.

(b) 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 paragraphs(a)(1) through (a)(3) of this provision; 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 paragraphs(a)(1) through (a)(3) of this provision ____________________ [insert full name of person(s) in the offeror’s organization responsible for determining the prices offered in this bid or proposal, and the title of his or her position in the offeror’s organization];

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

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

(c) If the offeror deletes or modifies paragraph (a)(2) of this provision, the offeror must furnish with its offer a signed statement setting forth in detail the circumstances of the disclosure.

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.

21. Certification Regarding Responsibility Matters (Derived from FAR 52.209-5)

(a) The Offeror certifies, to the best of its knowledge and belief, that the Offer and/or any of its Principals:

Are□ Are Not□ presently debarred, suspended, proposed for debarment, or declared ineligible for the award of contracts by any Federal agency

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 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, violating Federal criminal tax laws, or receiving stolen property

Are□ 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

Have□ Have Not□ within a three-year period preceding this offer, been notified of any delinquent Federal taxes in an amount that exceeds $3,500 for which the liability remains unsatisfied.

Have□ Have Not□ within a three-year period preceding this offer, had one or more contracts terminated for default by any Federal agency.

(1) Federal taxes are considered delinquent if both of the following criteria apply:

(i) The tax liability is finally determined. The liability is finally determined if it has been assessed. A liability is not finally determined if there is a pending administrative or judicial challenge. In the case of a judicial challenge to the liability, the liability is not finally determined until all judicial appeal rights have been exhausted.

(ii) (ii) The taxpayer is delinquent in making payment. A taxpayer is delinquent if the taxpayer has failed to pay the tax liability when full payment was due and required. A taxpayer is not delinquent in cases where enforced collection action is precluded.

“Principal,” 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 SECTION1001, TITLE18, UNITED STATES CODE.

(b) The Offeror shall provide immediate written notice to the PPPL Procurement Specialist if, at any time prior to subcontract award, the Offeror learns that its certification was erroneous when submitted or has become erroneous by reason of changed circumstances.

(c) 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 PPPL Procurement Specialist may render the Offeror non-responsible.

(d) Nothing contained in the foregoing shall be construed 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.

(e) 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 or PPPL, the PPPL Procurement Specialist may terminate the contract resulting from this solicitation for default.

Company/Organization Name (insert legal name of entity):

Signature:

Signer’s Name (Printed):

Title:

Date:

Telephone Number:

Email:

image1.png

PQAS-C Rev 2 30-Apr-2019

PRINCETON PLASMA PHYSICS LABORATORY

PQA Supplier Quality Survey (Construction)

This survey is to be completed by the head of your Quality Department and returned to PPPL.

Please attach your Quality Manual and your organization chart that includes the Quality function and

Note: navigate from field to field using the tab key or mouse.

Would you be receptive to a site survey visit? --- If requested, would you be willing to supply specific quality procedures in the future? ---

PERSONNEL

Head of Quality Dept. Phone e-mail Reports to:

Production Manager Phone e-mail Reports to:

Total No. of Personnel Inspection/Test Certified Welders

Administrative QA/QC Other___________

Checklist Completed By Date Title

The survey need not be completed if you have completed one within the last 12 months and there have been no significant changes. If so, check here.

GENERAL INFORMATION

Name of Facility Years in Business under this Name

Division or subsidiary of:

Facility Address City State Zip Code - Mailing Address Phone Zip Code - Principle Products/Services Are you currently certified to any quality standards (ISO, ASME, etc.)? If so, please list them:

Identify the industry / national standard(s) that the quality system follows?

QUALITY SYSTEM

Yes

No

Comments/Explanation including Not Applicable (N/A)

Is there a formal quality system in place?

Is there a written Quality Manual?

Are there regular, documented, Quality Program audits?

Is formal document control implemented for project deliverables i.e. submittals, shop drawings, etc.?

Is there a nonconformance system that includes identification, segregation, customer notification and concurrence, and action to prevent recurrence through inspections, RFIs, change orders, or similar process?

Is there a calibration program that uses national standards, specifies calibration frequency, and includes tracking of calibrated equipment status?

Do all personnel receive quality program training?

Do Quality personnel review contract documents?

Do Quality personnel witness inspections and tests?

Do Quality personnel witness special processes such as welding or nondestructive testing?

SUBCONTRACTORS AND PURCHASED ITEMS

Are Quality personnel involved in sub-tier contract review?

Is there a documented subcontractor qualification process?

Does subcontractor oversight include visits to supplier’s site?

Is there a rating system for subcontractor performance?

Are all incoming items/materials inspected?

Are incoming materials verified to be traceable to the associated certifications?

Is there a system of tagging or labeling material to maintain traceability?

Are receipt inspection results documented?

Are there controls to assure that unacceptable materials are not installed?

Are materials controls in place to prevent damage/deterioration in storage?

Are age-sensitive items identified & controlled?

Please describe your controls to prevent use of counterfeit and mis-identified materials.

ENGINEERING/DESIGN

Is there a system for documenting designs and design changes?

Is there a system for reviewing of designs and related design items, such as calculations, and documenting the review?

Are drawing and specification and their revisions reviewed for conformity to customer’s specifications?

INSPECTIONS & TESTS

Is there a formal inspection process for documenting inspections and testing?

Are plans used for inspections and testing?

Are written procedures or checklists used for inspections and tests?

Are records kept showing the acceptance, rejection, or disposal of material?

Does the Quality organization review testing and inspection documents?

Are records of results maintained? If so, how long?

OTHER

Are there other aspects of your Quality System that we should consider in evaluating your program (Customer approval/awards, CQM-C participation, 6-Sigma and/or process improvement programs, etc.)?

Please attach any supporting documentation helping to support the answers above. For example, certificates supporting certifications, a quality manual if available, special customer awards if appropriate.

PRINCETON PLASMA PHYSICS LABORATORY

PQA Supplier Quality Survey (Construction)

RFP 26-043JR

OFFEROR INFORMATION AND PRICING FORM

TO: PRINCETON PLASMA PHYSICS LABORATORY

JAMES FORRESTAL CAMPUS

P.O. BOX 451

PRINCETON, NEW JERSEY 08543

ATTENTION: RFP 26-043JR

JIMMY RUSSELL, PROCUREMENT SPECIALIST

SUBJECT: REQUEST FOR PROPOSALS RFP 26-043JR FOR Plumbing Repair, Emergency Response

& Technical Services

(FIRM NAME)

(BUSINESS ADDRESS)

(1) To perform the requirements of RFP 25-043JR we submit the following:

BASE PERIOD: Hourly Rates for the period July 1, 2026, through June 30, 2028 Hourly Labor Rates ($)

CRAFT CLASSIFICATION

STRAIGHT

TIME OVERTIME DOUBLE TIME

Project Manager* On-Site Construction Superintendent*

Plumber Apprentice

Plumber Journeyman

Pipefitter

OPTION PERIOD #1: Hourly Rates for the period July 1, 2028, through June 30, 2029

On-Site Construction Superintendent*

Plumber (Apprentice)

Plumber (Journeyman)

OPTION PERIOD #2: Hourly Rates for the period July 1, 2029, through June 30, 2030

On-Site Construction & Safety Superintendent*

OPTION PERIOD #3: Hourly Rates for the period July 1, 2030, through June 30, 2031

*Fully loaded rates to include profit, G&A & Overhead

TIME TIME OVERTIME DOUBLE TIME

Safety Superintendent (non-working) *

Master Plumber

(2) The following individual(s) are authorized to conduct discussions and provide information related to this proposal on behalf of the Offeror:

NAME:

NAME:

TITLE:

TITLE:

PHONE:

PHONE:

FAX:

FAX:

EMAIL:

EMAIL:

(3) Acceptance of Sample Subcontract terms and conditions. Please initial the applicable statement below in the space provided (initial one statement only):

I hereby affirm that I have reviewed the terms and conditions set forth in the Sample Subcontract Agreement set forth in RFP 26-043JR and will accept the terms and conditions set forth therein without exception if a Subcontract is awarded to my firm.

I have reviewed the terms and conditions set forth in the Sample Subcontract Agreement set forth in Section II of RFP 26-043JR. In the event that my firm is selected for award, I request that the exceptions and/or proposed revisions set forth in this proposal at Section _____ (attached additional sheets if required) be considered by PPPL. I understand that my proposal may be considered to be non-responsive depending on the extent and nature of the proposed exceptions/revisions and my firm’s willingness to discuss or negotiate these proposed exceptions/revisions with PPPL.

(4) We acknowledge receipt of the following Amendments:

Amendment Number Date of Amendment

(5) By submission of this signed Offeror Information and Pricing Form, the undersigned hereby certifies that the information provided is current, accurate, and complete as of the date submitted. The Offeror agrees that this proposal will remain valid for 90 days from the closing date specified for this RFP.

Signature of Authorized Individual

Typed Name

Title

Date

AFFIX

CORPORATE

SEAL

CORPORATE