14._DLA1822_End_Use_Certificate.pdf

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PDF (DLA)

DLA FORM 1822, JAN 2013

Page of

ALL OTHER VERSIONS ARE OBSOLETE

END-USE CERTIFICATE

(STATEMENT REGARDING DISPOSITION AND USE OF PROPERTY)

(Please read Privacy Act Statement on page 2 before completing this form.

If additional space is required, use separate sheets and identify by Block Number.)

TYPE OR PRINT ALL INFORMATION

FOR AGENCY USE ONLY

TSC

CLD

YES

NO

PRIMARY

PURCHASER

SUB-PURCHASER

Form Approved OMB No. 0704-0382 Expires Jan 31, 2016 The public reporting burden for this collection of information is estimated to average 20 minutes per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to the Department of Defense, Washington Headquarters Services, Executive Services Directorate, Information Management Division, 4800 Mark Center Drive, East Tower, Suite 02G09, Alexandria, VA 22350-3100 (0704-0382). Respondents should be aware that notwithstanding any other provision of law, no person shall be subject to any penalty for failing to comply with a collection of information if it oes not display a currently valid OMB control number. RETURN COMPLETED FORM TO THE OFFICE STATED ON THE IFB, SOLICITATION OR PROPOSAL.

INSTRUCTIONS. This form must be fully completed by all applicants for United States Munitions List items (USML)/Commerce Control List Items (CCLI) prior to acceptance by the U.S. Government and constitutes an integral part of this bid. The information given must be true and correct and will become a part of this contract. Every block MUST have an entry. If necessary, insert "NONE", "SAME AS BLOCK X " or "NOT APPLICABLE" (do not use "N/A"). If the applicant is acting solely as an Agent, a DLA Form 1822 must be signed by the Principal. The term Approving Official is used to indicate the person authorized to act for the U.S. Government (Sales Contracting Officer Plant Clearance Officer or other designated individual). FOR ALL SALES OF PROPERTY APPROVED BY PLANT CLEARANCE OFFICERS UPON THE REMOVAL OF THE PROPERTY, ALL DOCUMENTATION REQUIRED BY THIS FORM WILL BE FORWARDED TO THE IDENTIFIED TRADE SECURITY CONTROL OFFICE.

The following applies to all property subject of sale using this form: the use, disposition, export, or re-export of this property, is subject to the publications, penalties, and other provisions of the economic programs administered by the Office of Foreign Assets Control, U.S. Treasury Department, 31 CFR Chapter V.

THIS STATEMENT IS SUBMITTED IN CONNECTION WITH:

SECTION I. GENERAL INFORMATION

APPLICABILITY. This statement applies to the property for which we have submitted our bid/offer pursuant to the above identified invitation.

1. TYPE OF FIRM

5. BUSINESS/CORPORATION HEADQUARTERS

6. BRANCH OFFICE

7. ALL CORPORATE OFFICERS, PARTNERS AND/OR AGENTS ARE TO PROVIDE, ON SEPARATE SHEETS OF PAPER, THEIR NAMES, ADDRESSES, SSNs, DATES AND PLACES OF BIRTH. FAILURE TO PROVIDE THIS INFORMATION COULD RESULT IN SIGNIFICANT DELAY OR DENIAL OF THE AWARD. (See attached) SECTION II. END USE/USER INFORMATION. If this is a negotiated exchange, identify the property being exchanged:

1. PURPOSE. THE PROPERTY REFERRED TO IN ABOVE IFB/OFFER NUMBER WILL BE UTILIZED FOR THE FOLLOWING:

Enter and 'X' in the appropriate item(s) below. In the case of resale, Item 1.F. or 1.G. MUST be marked.

A. Retention for the following specific use (see note):

B. Resold in the form received for the following use (see note):

C. The property will not be sold or otherwise disposed of for use outside of the United States or to non-U.S. Citizens/Nationals in the United States.

D. The property may be exported or re-exported in the form received to the following country/countries:

E. Resale after following alteration (description of final production:

in (Country/Countries):

and distribution in (Country/Countries):

F. If sold, name, address, and telephone number of sub-purchaser(s):

G. The customers are unknown at this time. If required by the contract/transfer document, I will obtain prior written approval for the resale of any of the property covered by this contract.

NOTE: Example of specific uses: AIRCRAFT. The bidder/recipient certifies that the aircraft will be used: as a flyable aircraft; as a nonflyable aircraft to be used only for parts, display, or ground instruction, etc.; for resale as a flyable aircraft.

SECTION III. UNDERSTANDING AND NOTIFICATIONS

1 . The use, disposition, export and re-export of this property is subject to all applicable U.S. Laws and Regulations, including but not limited to the Arms Export Control Act (22 USC 2751 et seq.); Export Administration Act of 1979 (50 USC App.2401 et seq.) as continued under Executive Order 12924; International Traffic in Arms Regulations (22 CFR 120 et seq.); Export Administration Regulations (15 CFR 730 et seq.); Foreign Assets Control Regulations (31 CFR 500 et seq.) and the Espionage Act (18 USC 793 et seq.); which, among other things, prohibit: A. The making of false statements and concealment of any material information regarding the use or disposition, export or re-export of the property and B. Any use, disposition, export or re-export of the property not permitted by applicable statute and regulation.

2. The submission of false or misleading information and/or concealment of any material facts regarding the use, disposition or export of this property may constitute a violation of provisions of 18 USC 793/1001, 22 USC 2778/2779, 50 USC App. 2410, and 50 USC App. 1-44. Sanctions for violations will be in conformity with U.S. laws and regulations (including Federal Acquisition Regulations and DoDD 2030.8) and may include the denial of U.S. export privileges and of any participation in future U.S. Government contracts.

3. Transfers of USML and CCLI property by purchasers/bidders are subject to the requirements of the appropriate licensing department or agency. In many cases, an export license or other authorization may be required. With respect to USML, registration of the purchaser's/bidder's business with the Department of the State may also be required. It is the responsibility of the purchaser/bidder to determine what the applicable requirements may be and to obtain all necessary authorization or approvals.

4. When USML/CCLI property is transferred, the information in this form regarding the above laws and regulations must be passed to the subsequent purchaser/receiver. Records of Resale in buyer's possession should be available for Trade Security Controls Office review, if requested.

5. The Invitation For Bid and Sale/Exchange Contract number can be referenced when submitting an application for an export license or other authorization to the Department of State for USML or Department of Commerce for CCLI.

6. The Government expects the Purchaser/Recipient to cooperate with all authorized Government representatives to verify the existence and condition of USML/CCLI.

1 . I do certify that all information given in this Statement Regarding Disposition and Use of Property is true and correct to the best of my knowledge and belief and have not knowingly omitted any information which is inconsistent with this statement. I understand this statement will be referred to and be a part of the contract of sale/exchange with the U.S. Government. I agree to submit a written request for amendment of this statement to the Approving Official prior to effecting any change of fact or intention from that stated herein or in any prior amendment, whether occurring before or after the release of the commodities, and not to effect such changes without first receiving written approval of the Approving Official.

2. I acknowledge having been advised that the USML/CCLI property I purchased is controlled by the U.S. Government and in many cases cannot be transferred (exported, sold or given) to a foreign country, a non-U.S. Citizen/National or a non-Permanent US Resident without a valid State/Commerce Department export authorization. Should I transfer this property to a foreign country, a non-U.S. Citizen/National or a non-Permanent US Resident, I will obtain any required authorization before making such transfers. I will not transfer this property to countries, regimes and nationals targeted under the sanctions program administered by the U.S. Treasury Department's Office of Foreign Assets Control.

3. Neither the applicant, corporate officers, directors or partners is: A. The subject of an indictment for or has been convicted of violating any of the U.S. Criminal statutes enumerated in 22 CFR 120.27 since the effective date of the Arms Export Control Act, Public Law 94-329, 90 Stat. 729 (June 30, 1976) ; or B. Ineligible to contract with, or to receive, a license or other approval from any agency of the U.S. Government.

4. The person signing this DLA Form 1822 is:

a Citizen of the United States of America, or lawfully admitted to the United States for Permanent Residence and maintains such residence under the Immigration and Nationality Act, as amended (8 USC 1101 (a), 20, 60 Stat. 163) , or a Citizen of , and/or is an official of a foreign government entity in the United States.

SECTION IV. CERTIFICATION STATEMENT TO BE SIGNED BY BIDDER AT TIME OF RESPONSE TO IFB Authority: 10 U.S.C. 133, Under Secretary of Defense for Acquisition, Technology, and Logistics; 22 U.S.C. 2751-2799, Arms Export Control; 50 App. U.S.C. 2401 et seq., Export Administration; E.O. 12738 and E.O. 12981, Export Controls; 22 CFR 122, 15 CFR 762, 41 CFR 101 and 102; DoD Directive 2040.3, End Use Certificates (EUCS); DoD Instruction 2030.08, Implementation of Trade Security Controls (TSC) for Transfers of DoD U.S. Munitions List (USML) and Commerce Control List (CCL) Personal Property to Parties Outside DoD Control; DoD Instruction 2040.02, International Transfers of Technology, Articles, and Services; DoD Instruction 4161.2, Management, Control and Disposal of Government Property in the Possession of Contractors; DoD 4160.21-M, Defense Materiel Disposition Manual; DoD Manual 4160.28, Defense Demilitarization and E.O. 9397 (SSN), as amended.Purpose: Information is used to determine bidder eligibility to participate in the programs and to ensure that property recipients comply with the terms of the sale regarding end use of the property.Routine uses: Data may be disclosed to the Department of Transportation to ensure compliance with rules regarding Federal Aviation Administration airworthiness certificates for surplus military aircraft; to the General Services Administration to determine the presence of debarment proceedings against a bidder; to the Department of State to ensure compliance with the International Traffic in Arms regulations; to the Department of Commerce to ensure compliance with the Export Administration regulations; and to the Department of Justice for asset identification, location and recovery; and for immigration and naturalization data verification. Data may also be provided under the DoD “Blanket Routine Uses” published at http://dpclo.defense.gov/privacy/SORNs/blanket_routine_uses.html .Disclosure: Voluntary; however, failure to provide the requested information may result in ineligibility to receive surplus or foreign personal property.Rules of use: Rules for collecting, using, retaining, and safeguarding this information are contained in DLA Privacy Act system of records notice S640.45, entitled "End Use Certificates" available at http://dpclo.defense.gov/privacy/SORNs/component/dla/S640-45.html

PRIVACY ACT STATEMENT

9.0.0.2.20100902.2.720808