SPMYM4-16-Q-0291.doc

DOC document 661 KB Posted Mar 4, 2016

Attached to: Various Specialty Gases
Solicitation number: SPMYM4-16-Q-0291
Issued by: Defense Logistics Agency Land and Maritime

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Section SF 30 - BLOCK 14 CONTINUATION PAGE

SAM

THE FOLLOWING INFORMATION MUST BE PROVIDED OR YOUR QUOTE

WILL NOT BE ACCEPTED

Estimated delivery time ______________ days/month

________ FOB Destination (Vendor pay to Destination)

Business Size (in accordance with Federal Government Standards)

Small ______ Large _______ Women-owned _____Disadvantaged _________

Prompt Payment Terms _________% _______ Days Net __________

Basis for price: [ ] Current Catalog: Title (or No.) ________________________

Year __________________ Page #(s) __________________

[ ] Published Price List, Year ____________________________

If on GSA Contract: [ ] GSA Contract # _________________________________

[ ] Expiration Date: _________________________________

Cage Code (Commercial & Government Entity No. ________________

DUNS (Dunn & Bradstreet No. ________________________________

SAM (System for Award Management ) Yes No (circle one)

TO OBTAIN A CAGE CODE @ 1-888-352-9333, fax (616) 691-5305, or email disc-cso@disc.dla.mil

TO OBTAIN A DUNS AND BRADSTREET NO. - CALL 1-800-333-0505

Or use web site (http: //www.dnb.com/dunsno/whereduns.htm)(A DUNS NO.

IS MANDATORY DATA FOR REGISTERING IN THE CCR)

The Contractor shall be registered in the SAM database prior to receiving of any contract, basic agreement, basic ordering agreement, or blanket purchasing agreement resulting from this solicitation.

The SAM registration shall be for the same name and address identified on the contract, with its associated CAGE code and DUNS or DUNS+4

Contractors may obtain information on registration and annual confirmation requirements via the SAM accessed through https://www.acquisition.gov or by calling 866-606-8220, or 334-206-7828 for international calls.

Section B - Supplies or Services and Prices

ITEM NO

SUPPLIES/SERVICES

QUANTITY

UNIT

UNIT PRICE

AMOUNT

Lab gases

FFP

FOB: Destination

PURCHASE REQUEST NUMBER: SPECIALITLYGASES

NET AMT

ITEM NO

SUPPLIES/SERVICES

QUANTITY

UNIT

UNIT PRICE

AMOUNT

0001AA

Cylinder

FFP

Air Primary Standard 1 with Cylinder

FFP

See Also Attachment 28.

GAS, ULTRA-HIGH PURITY (UHP) OXYGEN WITH CYLINDER

LSN: (TBD)

A. Composition: 99.994% minimum purity

B. Certificate of Analysis required, including expiration date.

C. 140 cubic feet (2000 psig) per cylinder

D. Cylinder (HP200, CGA 540) to be furnished by vendor

E. Gas to be furnished in cylinder purchased outright by government from vendor

F. Includes one-way freight, hazmat charges, fuel surcharges, and delivery

FOB: Destination

NET AMT

Section C - Descriptions and Specifications

SOW

Section C - Descriptions and Specifications

STATEMENT OF WORK

1. Background

The Laboratory Division, Quality Assurance Department, performs analysis of breathing air, nitrogen, argon, and welding gas mixtures for the Pearl Harbor Naval Shipyard and Intermediate Maintenance Facility (PHNY&IMF). To maintain accreditation, this work requires National Institute of Standards and Technology (NIST) – traceable reference gases for instrument calibration and calibration verification.

2. Objectives/Scope

Laboratory analysis of compressed gases supports Pearl Harbor Naval Shipyard and IMF operations by ensuring that applicable specification requirements are met.

The contractor shall perform the following:

2.1 Upon award, provide Safety Data Sheets (SDSs) for each CLIN specialty gas to facilitate local requirements for hazardous materials management.

2.2 Inspect, certify, and maintain government-owned cylinders and tanks prior to filling in accordance with contract requirements, as appropriate.

2.3 Invoice the government for the units of gas.

2.4 Provide a receipt or delivery ticket at time of delivery that contains information that matches the type of gas and quantity delivered.

2.5 Meet all requirements as stated in the contract for gases requiring preparation, testing, and certification, and provide all applicable documentation with each lot.

2.6 Provide a monthly report to the Contracting Officer representative (COR).

Note: Ozone Depleting Substances (ODS) are not to be provided under this contract.

3. Performance Requirements

The contractor shall meet the following requirements:

3.1 Safety Program. The contractor shall have a well-established internal standardized safety program. The contractor’s safety standards shall meet those set by the Compressed Gas Association (CGA) and the Department of Transportation (DOT). The contractor shall provide published safety information on each type of compressed gas on the contract. The contractor shall test all cylinders in accordance with MIL-STD-1411 (latest) specification requirements.

3.2 Product Quality. The contractor shall meet all applicable specification requirements in accordance with attachments 14 through 28 in the contract.

3.3 Ordering and Payment Process. The contractor shall be provided orders via telephone, fax, email or written document. Whether verbal or written, each order requires an order number. Contractor shall accept WAWF as a method of payment.

The contractor shall confirm orders on the same day they are placed and in the same manner they are received. Confirmation shall include the following: item number, CLIN, nomenclature, quantity, unit of issue, total price, requisition number, delivery order number, and delivery date.

The contractor shall have a customer assistance hot line 24 hours, seven days a week.

Additionally, the contractor shall offer personal contact on a monthly basis to ensure maximum customer satisfaction. The designated contact person’s name and contact information shall be provided, and arrangements for alternate point of contact shall be made in case the primary point of contact is not available.

3.4 Delivery time. Standard delivery time is eight (8) weeks because the gases require testing and certification and are shipped from the Continental U.S. to Hawaii. Required delivery time will be specified in the order.

3.5 Reporting Program.

3.5.1 The monthly report shall include at a minimum the following information:

3.5.1.1 Title (Monthly Status Report)

3.5.1.2 Contract Number

3.5.1.3 Contractor’s Name and Address

3.5.1.4 Date of Report

3.5.1.5 Reporting Period (Month/Year)

3.5.1.6 Name of individual preparing report and telephone number

3.5.1.7 The monthly report shall be in the contractor’s format and shall summarize information by delivery location.

3.5.1.8 For each line item the data fields shall include a description of the gas, the quantity delivered, cylinder size and a total dollar value.

4. Quality Assurance. The contractor shall meet all applicable requirements specified by attachments 14 through 28 in the contract. CLINs that require testing and certifications of specification compliance are identified in attachments 14 through 28 in the contract. The contractor shall ensure, in executing this contract, it thoroughly and timely investigates and resolves any issues relating to nonconforming or discrepant material. The contractor shall be responsible for picking up and refurbishing or replacing any material requiring refurbishment or replacement, and for delivery of conforming goods to the Shipyard.

5. Contractor Qualifications. 49 CFR Chapter 1 Part 107.805 requires that each hydrostatic test facility be registered with the DOT before it is placed in operation testing cylinders. Facilities performing ultrasonic examination must also be registered with the DOT and receive a special permit before they are placed in operation testing cylinders.

6. References.

6.1. CGA G-7.1, Commodity Specification for Air

6.2. CGA G-10.1, Commodity Specification for Nitrogen

6.3. CID A-A-59155, Nitrogen, High Purity, Special Purpose

6.4. MIL-A-18455, Argon, Technical

6.5. BB-O-925, Oxygen, Technical, Gas and Liquid

6.6. A-A-59860, Valves, Cylinder, Gas (For Compressed or Liquefied Gases)

6.7. CGA V-1, Compressed Gas Cylinder Valve Outlet and Inlet Connections

6.8. FED-STD-313, Material Safety Data, Transportation Data, and Disposal Data for Hazardous Materials Furnished to Government Activities

6.9. ISO 10012, Measurement Management Systems - Requirements for Measurement Processes and Measuring Equipment

6.10. MIL-STD-1411, Inspection and Maintenance of Compressed Gas Cylinders

6.11. ISO 17025, General Requirements for the Competence of Testing and Calibration Laboratories

6.12. Safety and Health Work Practices for Contractors Working with PHNSY&IMF 20 Jul 2009

6.13. Contractor Environmental Specification Guidelines 18 Feb 2009

7. Attachments Note: Attachment 1 thru 13 are not used for this solicitation and are not includcd.

7.19.14 Attachment 14 – Additional Special Requirements for CLIN 0012AA - Gas, Air Primary Standard 1 with Cylinder (LSN TBD)

7.19.15 Attachment 15 – Additional Special Requirements for CLIN 0012AB - Gas, Air Primary Standard 2 with Cylinder (LSN TBD)

7.19.16 Attachment 16 – Additional Special Requirements for CLIN 0012AC - Gas, Air Primary Standard 3 with Cylinder (LSN TBD)

7.19.17 Attachment 17 – Additional Special Requirements for CLIN 0012AD - Gas, Air Primary Standard 4 with Cylinder (LSN TBD)

7.19.18 Attachment 18 – Additional Special Requirements for CLIN 0012AE - Gas, Air Certified Standard 2 with Cylinder (LSN TBD)

7.19.19 Attachment 19 – Additional Special Requirements for CLIN 0012AF - Gas, Nitrogen, Ultra High Purity (UHP) with Cylinder (LSN TBD)

7.19.20 Attachment 20 – Additional Special Requirements for CLIN 0012AG - Gas, Nitrogen, Certified Standard 1 with Cylinder (LSN TBD)

7.19.21 Attachment 21 – Additional Special Requirements for CLIN 0012AH - Gas, Nitrogen, Certified Standard 2 with Cylinder (LSN TBD)

7.19.22 Attachment 22 – Additional Special Requirements for CLIN 0012AJ - Gas, Argon, Ultra High Purity (UHP) with Cylinder (LSN TBD)

7.19.23 Attachment 23 – Additional Special Requirements for CLIN 0012AK - Gas, Argon, Certified Standard 1 with Cylinder (LSN TBD)

7.19.24 Attachment 24 – Additional Special Requirements for CLIN 0012AL – Gas, Argon, Certified Standard 2 with Cylinder (LSN TBD)

7.19.25 Attachment 25 – Additional Special Requirements for CLIN 0012AM – Gas, Argon, Certified Standard 3 with Cylinder (LSN TBD)

7.19.26 Attachment 26 – Additional Special Requirements for CLIN 0012AN – Gas, Argon, Certified Standard 4 with Cylinder (LSN TBD)

7.19.27 Attachment 27 – Additional Special Requirements for CLIN 0012AP – Gas, Argon, Certified Standard 5 with Cylinder (LSN TBD)

7.19.28 Attachment 28 – Additional Special Requirements for CLIN 0012AQ – Gas, Oxygen, Ultra High Purity (UHP) with Cylinder (LSN TBD)

8. Points of Contact

A. Technical:

Derek Mukai, Code 134.3 Pearl Harbor Naval Shipyard and IMF

667 Safeguard St. Suite 100

Pearl Harbor, HI 96860-5033

808.473.8000 x3451 derek.mukai@navy.mil Section E - Inspection and Acceptance

INSPECTION AND ACCEPTANCE TERMS

Supplies/services will be inspected/accepted at:

CLIN

INSPECT AT

INSPECT BY

ACCEPT AT

ACCEPT BY

0001

N/A

Government

0001AA

N/A

Government

0001AB

N/A

Government

0001AC

N/A

Government

0001AD

N/A

Government

0001AE

N/A

Government

0001AF

N/A

Government

0001AG

N/A

Government

0001AH

N/A

Government

0001AJ

N/A

Government

0001AK

N/A

Government

0001AL

N/A

Government

0001AM

N/A

Government

0001AN

N/A

Government

0001AP

N/A

Government

0001AQ

N/A

Government

Section F - Deliveries or Performance

DELIVERY INFORMATION

CLIN

DELIVERY DATE

QUANTITY

SHIP TO ADDRESS

UIC

0001

N/A

0001AA

N/A

0001AB

N/A

0001AC

N/A

0001AD

N/A

0001AE

N/A

0001AF

N/A

0001AG

N/A

0001AH

N/A

0001AJ

N/A

0001AK

N/A

0001AL

N/A

0001AM

N/A

0001AN

N/A

0001AP

N/A

0001AQ

N/A

Section G - Contract Administration Data

Section I - Contract Clauses

CLAUSES INCORPORATED BY REFERENCE

52.204-13

System for Award Management Maintenance

JUL 2013

52.212-1

Instructions to Offerors--Commercial Items

OCT 2015

52.212-4

Contract Terms and Conditions--Commercial Items

MAY 2015

52.223-11

Ozone-Depleting Substances

MAY 2001

52.228-5

Insurance - Work On A Government Installation

JAN 1997

52.232-33

Payment by Electronic Funds Transfer--System for Award Management

JUL 2013

52.237-2

Protection Of Government Buildings, Equipment, And Vegetation

APR 1984

52.242-15

Stop-Work Order

AUG 1989

52.246-11

Higher-Level Contract Quality Requirement

DEC 2014

52.246-15

Certificate of Conformance

APR 1984

52.247-34

F.O.B. Destination

NOV 1991

52.253-1

Computer Generated Forms

JAN 1991

252.203-7002

Requirement to Inform Employees of Whistleblower Rights

SEP 2013

252.204-7000

Disclosure Of Information

AUG 2013

252.204-7003

Control Of Government Personnel Work Product

APR 1992

252.204-7004 Alt A

System for Award Management Alternate A

FEB 2014

252.209-7004

Subcontracting With Firms That Are Owned or Controlled By The Government of a Country that is a State Sponsor of Terrorism

OCT 2015

252.225-7001

Buy American And Balance Of Payments Program-- Basic (Nov 2014)

NOV 2014

252.225-7048

Export-Controlled Items

JUN 2013

252.232-7010

Levies on Contract Payments

DEC 2006

252.243-7001

Pricing Of Contract Modifications

DEC 1991

252.246-7003

Notification of Potential Safety Issues

JUN 2013

252.247-7023

Transportation of Supplies by Sea

APR 2014

CLAUSES INCORPORATED BY FULL TEXT

52.212-2 EVALUATION--COMMERCIAL ITEMS (OCT 2014)

(a) The Government will award a contract resulting from this solicitation to the responsible offeror whose offer conforming to the solicitation will be most advantageous to the Government, price and other factors considered. The following factors shall be used to evaluate offers:

1. Price

2. Technically Acceptable

3. Delivery

(b) Options. The Government will evaluate offers for award purposes by adding the total price for all options to the total price for the basic requirement. The Government may determine that an offer is unacceptable if the option prices are significantly unbalanced. Evaluation of options shall not obligate the Government to exercise the option(s).

(c) A written notice of award or acceptance of an offer, mailed or otherwise furnished to the successful offeror within the time for acceptance specified in the offer, shall result in a binding contract without further action by either party. Before the offer's specified expiration time, the Government may accept an offer (or part of an offer), whether or not there are negotiations after its receipt, unless a written notice of withdrawal is received before award.

(End of provision)

52.212-3 OFFEROR REPRESENTATIONS AND CERTIFICATIONS--COMMERCIAL ITEMS (NOV 2015) ALTERNATE I (OCT 2014)

The offeror shall complete only paragraphs (b) of this provision if the Offeror has completed the annual representations and certification electronically via the System for Award Management (SAM) Web site accessed through http://www.acquisition.gov . If the Offeror has not completed the annual representations and certifications electronically, the Offeror shall complete only paragraphs (c) through (p) of this provision.

(a) Definitions. As used in this provision--

“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 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.

“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 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—

(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 veterans or, 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.

“Small disadvantaged business concern, consistent with 13 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 at 13 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 CFR 124.104(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.

“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 business concern” means a concern which 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 its stock is owned by one or more women; and whose management and daily business operations are controlled by one or more women.

“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.

“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.

(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 posted on the SAMwebsite.

(2) The offeror has completed the annual representations and certifications electronically via the SAM website accessed through https://www.acquisition.gov. After reviewing the SAM database information, the offeror verifies by submission of this offer that the representation 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 applicable to the NAICS code referenced for this solicitation), as of the date of this offer and are incorporated in this offer by reference (see FAR 4.1201), except for paragraphs ___ . [Offeror to identify the applicable paragraphs at (c) through (p) 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 is to 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 CFR 124.1002.

(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.

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

(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.

(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.

(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.

(11) (Complete if the offeror has represented itself as disadvantaged in paragraph (c)(4) of this provision.)

[The offeror shall check the category in which its ownership falls]:

___ Black American.

___ Hispanic American.

___ Native American (American Indians, Eskimos, Aleuts, or Native Hawaiians).

___ Asian-Pacific American (persons with origins from Burma, Thailand, Malaysia, Indonesia, Singapore, Brunei, Japan, China, Taiwan, Laos, Cambodia (Kampuchea), Vietnam, Korea, The Philippines, Republic of Palau, Republic of the Marshall Islands, Federated States of Micronesia, the Commonwealth of the Northern Mariana Islands, Guam, Samoa, Macao, Hong Kong, Fiji, Tonga, Kiribati, Tuvalu, or Nauru).

___ Subcontinent Asian (Asian-Indian) American (persons with origins from India, Pakistan, Bangladesh, Sri Lanka, Bhutan, the Maldives Islands, or Nepal).

___ Individual/concern, other than one of the preceding.

(d) Representations required to implement provisions of Executive Order 11246 --

(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 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 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

___

(iii) The offeror shall list those supplies that are foreign end products (other than those listed in paragraph (g)(1)(ii) or 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

___

(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]

(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:

___

(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:

___

(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:

___

(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 Federal criminal tax laws, or receiving stolen property; and

(3) [ ___ ] Are, [ ___ ] are not presently indicted for, or otherwise criminally or civilly charged by a Government entity with, commission of any of these offenses enumerated in paragraph (h)(2) of this clause; and

(4) [ ___ ] 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.

(i) Taxes are considered delinquent if both of the following criteria apply:

(A) 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.

(B) 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.

(ii) Examples.

(A) The taxpayer has received a statutory notice of deficiency, under I.R.C. §6212, which entitles the taxpayer to seek Tax Court review of a proposed tax deficiency. This is not a delinquent tax because it is not a final tax liability.

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File details come from the government source that posted it. Updated Nov 14, 2017.