Attachment_0004_-_Certification.docx

Attachment 0004 The offeror shall provide certification that the proposed Medium Caliber Weapon System (MCWS) is not, to the best of its knowledge, otherwise being offered in response to this RFQ. The certification statement below shall not be modified except as allowed in the fill-in lines, or the inclusion of additional fill-ins for additional teaming partner(s).

Certification Statement To the best of my knowledge, the proposed Medium Caliber Weapon System (MCWS) submitted by ____________________________________ (insert prime offeror) in response to RFQ W56HZV-19-Q-0082, is not otherwise being offered in response to this RFQ by an identified teaming partner(s), or other entity.

Identified Teaming partner(s):

I understand that knowingly and willfully providing false certification is a violation of 18 U.S.C. § 1001.

Prime Offeror:

Name of authorized representative

Signature of authorized representative

Authorized representative’s title

Authorized representative’s company

Date

Teaming Partner(s) (fill in/add as applicable):

Name of authorized representative

Signature of authorized representative

Authorized representative’s title

Authorized representative’s company

Date

Name of authorized representative

Signature of authorized representative

Authorized representative’s title

Authorized representative’s company

Date