AB_1052_209-72.docx

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AB 1052.209-72 REPRESENTATION BY ENTITIES REGARDING INCORPORATION OR CHARTER IN BERMUDA OR THE CAYMAN ISLANDS - FISCAL YEAR 2015 APPROPRIATIONS, DIVISION E AGENCIES (DEVIATION 2015-00004) (APR 2015)

(a) In accordance with Section 627 of the Consolidated and Further Continuing Appropriations, Act, 2015 (Public Law 113-235) none of the funds made available by Division E of Public Law 113-235 may be used to enter into any contract with an incorporated entity if such entity`s sealed bid or competitive proposal shows that such entity is incorporated or chartered in Bermuda or the Cayman Islands, and such entity`s sealed bid or competitive proposal shows that such entity was previously incorporated in the United States.

(b) The Offeror represents that it is [ ] / is not [ ] an entity incorporated or chartered in Bermuda or the Cayman Islands, and was [ ] / was not [ ] previously incorporated in the United States.

(End of provision)

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Company NameContractor Printed Name

Contractor Signature and Date

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