TS-2663-1101135-A1.docx

Jet Propulsion Laboratory California Institute of Technology

Acknowledgement (RFP Attachment A-1) (This completed acknowledgement must accompany your offer)

Offeror Identification/Point of Contact

Defense Priorities and Allocations System

3. Are there any orders/contracts presently in your system that have priority, under the Defense Priorities and Allocations System, 15 CFR § 700 (DPAS), or otherwise, that would be placed ahead of the proposed work for JPL?

☐ No ☐ Yes – If yes, check all that apply below:

☐ Existing commercial order(s) ☐ Order(s) rated DO under DPAS ☐ Order(s) rated DX under DPAS ☐ Known priority delay(s) from any of your suppliers/lower-tiers

Terms and Conditions

4. The Offeror acknowledges that the offer will be valid for days after the date for receipt of offers specified on the cover page of this solicitation.

5. Disclosure of claims related to responsibility determination:

The Offeror (including all corporate affiliates of the Offeror, joint venture members, partners, and key lower-tier subcontractors) shall disclose any pending claims against it (legal or otherwise) that may impact JPL’s determination of responsibility under FAR Part 9. The disclosure shall state the basis of the claim, party asserting the claim and date of filing (or date the claim arose), court of jurisdiction (if applicable), Offeror’s point of contact to discuss the claim with JPL, and a brief summary of the nature and basis of the claim.

This disclosure shall include, but is not limited to the following:

· Filed or pending lawsuits, demand letters, or administrative actions

· Labor and employment disputes

· Co-employment claims

· Breach of contract claims

· Claims of fraudulent misrepresentation

· Defamation claims

· Claims of misappropriation of trade secrets

· Claims challenging the Offeror’s integrity or business ethics

· Claims based on discrimination

· Claims based on any tort |_| Nothing to Disclose

|_| The following is Disclosed (Note: fill in the blank or add attachment): ________________

(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 of this solicitation entitled "Limitation on Payments to Influence Certain Federal Transactions" ( 52.203-12) are hereby incorporated by reference in this 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 subcontract 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.

8. Can you supply the requested items through a Federal Supply Schedule (GSA) Contract?

|_| Yes If yes, list FSS (GSA) Contract No.: ; skip No. 10.

|_| No If no, complete the remainder of this form.

9. The Offeror |_| acknowledges |_| does not acknowledge the following are acceptable with no modifications, additions, or deletions in case of subcontract award: the Specimen Subcontract and its: Schedule/Articles, any exhibits and attachments, General Provisions (GPs) Set*, Additional General Provisions (AGPs) Set* (if applicable), and Subcontract Forms Set.* (*can be found at: https://acquisition.jpl.nasa.gov/terms-conditions/

Note: Many of the GPs and AGPs cannot be altered without NASA approval. If you answer “does not acknowledge” above, attach a detailed explanation of the exception(s), including a thorough rationale for each exception.

Buy American Act

11. Pursuant to FAR 52.204-25 and section 889(a)(1)(A) & (B) of the John S. McCain National Defense Authorization Act for Fiscal Year 2019 (Public Law 115-232), as well as FAR 52.204–23 and National Defense Authorization Act for Fiscal Year 2018 (Public Law 115-91), your organization shall not provide nor cause JPL to use any telecommunications equipment, surveillance equipment, software, system, or service (or a component thereof) from any prohibited entity, including but not limited to: Kaspersky Labs, Huawei Technologies Company, ZTE Corporation, Hytera Communications Corporation, Hangzhou Hikvision Digital Technology Company, Dahua Technology Company (or any subsidiary or affiliate of such entities), or an entity owned, controlled by, or connected to The People’s Republic of China, as determined by the Secretary of Defense.

Audit/EEO Information

12. Name, address, phone number of cognizant Government Audit Agency representative:

If yes, the “year ending” date of the most recent report is: (Attach a copy of the most recent report, unless previously submitted to JPL).

14. All prospective procurements (excluding construction) with an estimated contract value of $10,000,000 or more require that a determination be made by the Department of Labor (DOL) regarding a prospective domestic subcontractor’s Equal Employment Opportunity (EEO) status. A determination that the Offeror is either in compliance or is able to comply with EEO laws is a prerequisite to the Offeror’s eligibility for award.

If the offer is for $10,000,000 or more, the Offeror acknowledges that it |_| has |_| has not successfully survived an EEO survey within two years of the anticipated award date. (If the “has” box is checked, a copy of the EEO Clearance should be included with the offer).

Earned Value Management (EVM)

If yes, validation certified by:

|_| Government Agency name:

|_| Self-Certified |_| Dollar threshold at which your organization’s internal policy requires EVM:

Reporting Executive Compensation FAR 52.204-10

16. In accordance with Public Law 109-282 and FAR 52.204-10, Reporting Executive Compensation for First-Tier Subcontract Awards (OCT 2016), you are required to provide certain information pertaining to compensation of executives in order to be eligible for this subcontract award. You are required to answer the following in connection with this requirement:

(a) The public has access to information about the compensation of your executives through periodic reports filed with the Securities Exchange Commission |_|Yes |_| No If the answer is Yes to the above statement, you are exempt from this reporting requirement. Complete the “Offeror Certification” at the end of this form and submit with your proposal. If the answer is No, see section (b) below:

(b) Your organization in the previous tax year had gross income from all sources equal to or greater than $300,000;

and Your organization, in the previous fiscal year, received 80 percent or more of its annual gross revenue from Federal contracts (and subcontracts), loans, grants (and subgrants), cooperative agreements, and other forms of Federal financial assistance;

and Your organization, in the previous fiscal year, received $25,000,000 or more in annual gross revenue from Federal contracts (and subcontracts), loans, grants (and subgrants), cooperative agreements, and other forms of Federal financial assistance.

|_|Yes |_| No If the answer is No to the above statement, you are exempt from this reporting requirement. Complete the “Offeror Certification” at the end of this form and submit with your proposal.

If the answer is Yes to the above statement, FAR 52.204-10 applies and you are required to report the names and total compensation of each of the five most highly compensated executives for the preceding completed fiscal year:

1.

2.

3.

4.

5.

Note:

If the Offeror is awarded, the required information reported pursuant to FAR 52.204-10 will be made public.

If the answer to any of the above questions change during the course of the subcontract, contact the Subcontracts Manager to determine if you will be required to report Executive Compensation.

Offeror Information

17. Please indicate your Business Classification and Organization Type:

Business Classification (check all appropriate boxes in the left OR right column)

|_| Large Business |_| Nonprofit Organization |_| Foreign Business/Institution |_| Government |_| Educational Institution |_| Historically Black Colleges & Universities/Other Minority Institutions (HBCU/MI) |_| Small Business (SB) (plus any of the below, if appropriate) |_| Small Disadvantaged Business (SDB) |_| Woman-Owned (WOSB) |_| HUBZone (HUB) |_| Veteran-Owned (VOSB) |_| Service-Disabled VO (SDVOSB)

(check the appropriate types)

|_| Individual/Sole proprietor, under the laws of the State of _____________________.

|_| Partnership, under the laws of the State of _____________________.

|_| Corporation; incorporated under the laws of the State of ___________________.

|_| Non-profit |_| Government |_| Tax Exempt payee |_| Joint Venture |_| Limited Liability Company (LLC) --- If “LLC” is checked, you must also select one of the following tax classifications:

|_| D=disregarded |_| C=corporation |_| P=partnership

I, the undersigned, hereby declare that I am a duly authorized representative of the organization below, and I can certify and commit the organization regarding the information on this form, including the total offer amount submitted in response to RFQ/RFP No. .

Further, the Offeror acknowledges receiving the following Addenda No(s). to the RFQ/RFP:

Note: Failure to acknowledge receipt of all Addenda may result in your offer being rejected.

Organization:

Note: Insert legal name of the organization, not operating division. Such legal name is the name used on income tax filings.

Authorized Signature:

Date:

Type/Print Name:

Phone:

This document has been reviewed and determined not to contain export controlled technical data.

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