Attachment_3_-_Determination_of_Responsibility.docx

ATTACHMENT 3 – DETERMINATION OF RESPONSIBILITY FORM

Prospective Contractor: __________________________________________ Solicitation No: W912EP-17-R-0007 The following information is provided to assist the Contracting Officer in determining whether or not the proposed contractor meets the general standards of responsibility enumerated at FAR 9.104-1 and DFARS 209.104-1.FAR 9.104-1 General Standards. To be determined responsible, a prospective contractor must:

(a) HAVE ADEQUATE FINANCIAL RESOURCES TO PERFORM THE CONTRACT, OR THE ABILITY TO OBTAIN THEM (SEE 9.104-3(b)) The prospective contractor's financial statement for the period ending __________________ shows assets to liabilities at a ratio of ______ to ______.

PROVIDE A COPY OF YOUR LATEST FINANCIAL STATEMENT.

Comments by Contracting Officer: __________________________________ Banking References (Provide signed reference on letterhead from financial institution supporting each banking reference.)

1st bank's name: __________________________________________ Telephone #: _____________________________________________ Address: ________________________________________________ Person: _________________________________________________ Title: ___________________________________________________ Length of time with bank: ___________________________________ Credit Rating: ____________________________________________ Number/type of accounts: __________________________________ Amount in each account (# of figures): ________________________ Credit line:______________________ Secured/Unsecured Outstanding loans:_______________________ Secured/Unsecured

Comments by Contracting Officer: __________________________________

Banking References (continued) 2nd bank's name:__________________________________________ Telephone #: _____________________________________________ Address: ________________________________________________ Person: _________________________________________________ Title: ___________________________________________________ Length of time with bank: ___________________________________ Credit Rating: ____________________________________________ Number/type of accounts: ___________________________________ Amount in each account (# of figures): _________________________ Credit line:______________________ Secured/Unsecured Outstanding loans:_______________________ Secured/Unsecured

Comments by Contracting Officer: __________________________________

(b) BE ABLE TO COMPLY WITH THE REQUIRED OR PROPOSED DELIVERY OR PERFORMANCE SCHEDULE, TAKING INTO CONSIDERATION ALL EXISTING COMMERCIAL AND GOVERNMENTAL BUSINESS COMMITMENTS Comments by Contracting Officer: __________________________________

(c) HAVE A SATISFACTORY PERFORMANCE RECORD (SEE 9.104-3(c) and Subpart 42.15) Performance References 1st company: _____________________________________________ Telephone #: _____________________________________________ Address: _________________________________________________ Name: ___________________________________________________ Title: ____________________________________________________ Location and type of work: ___________________________________ Completed on time? ________________________________________ On budget? _______________________________________________ Quality of work? ____________________________________________ Management cooperative? ____________________________________ Any problems encountered: ___________________________________ Comments by Contracting Officer: __________________________________

Performance References (continued) 2nd company: ______________________________________________ Telephone #: _______________________________________________ Address: ___________________________________________________ Name: _____________________________________________________ Title: ______________________________________________________ Location and type of work: _____________________________________ Completed on time? __________________________________________ On budget? _________________________________________________ Quality of work? ______________________________________________ Management cooperative? ______________________________________ Any problems encountered: _____________________________________ Comments by Contracting Officer: __________________________________

(d) HAVE A SATISFACTORY RECORD OF INTEGRITY AND BUSINESS ETHICS Trade References 1st company: ________________________________________________ Telephone #: ________________________________________________ Address: ____________________________________________________ Name: _____________________________________________________ Title: _______________________________________________________ Length of time with company: ____________________________________ Credit line: ___________________________________________________ Average monthly business: ______________________________________ High credit: ___________________________________________________ Payment history: _______________________________________________ Takes discounts: _______________________________________________ Comments by Contracting Officer: _______________________________

Trade References (continued) 2nd company: _________________________________________________ Telephone #: __________________________________________________ Address: _____________________________________________________ Name: _______________________________________________________ Title: _________________________________________________________ Length of time with company: ______________________________________ Credit line: _____________________________________________________ Average monthly business: ________________________________________ High credit: _____________________________________________________ Payment history: _________________________________________________ Takes discounts: _________________________________________________ Comments by Contracting Officer: __________________________________

(e) HAVE THE NECESSARY ORGANIZATION, EXPERIENCE, ACCOUNTING AND OPERATIONAL CONTROLS, AND TECHNICAL SKILLS, OR THE ABILITY TO OBTAIN THEM (INCLUDING, AS APPROPRIATE, SUCH ELEMENTS AS PRODUCTION CONTROL PROCEDURES, PROPERTY CONTROL SYSTEMS, QUALITY ASSURANCE MEASURES, AND SAFETY PROGRAMS APPLICABLE TO MATERIALS TO BE PRODUCED OR SERVICES TO BE PERFORMED BY THE PROSPECTIVE CONTRACTOR AND SUBCONTRACTORS) (SEE 9.104-3(b)) Comments by Contracting Officer: __________________________________

(f) HAVE THE NECESSARY PRODUCTION, CONSTRUCTION, AND TECHNICAL EQUIPMENT AND FACILITIES, OR THE ABILITY TO OBTAIN THEM (SEE 9.104-3(b)) Comments by Contracting Officer: __________________________________

(g) BE OTHERWISE QUALIFIED AND ELIGIBLE TO RECEIVE AN AWARD UNDER APPLICABLE LAWS AND REGULATIONS The prospective contractor is ___ is not ___ registered in the System for Award Management (SAM) and has self-certified they are a Small Business in SAM.

The prospective contractor and its proposed subcontractors are ___ are not ____ debarred or excluded from restricted from doing business with the U.S. Federal Government (no exclusions are listed under SAM registration).

The prospective contractor is ___ is not ____ owned or controlled by a foreign government that supports terrorism (DFARS 209.104-1(g)) (See contractor's response in section K of Solicitation.)

Comments by Contracting Officer: __________________________________

Recommendation Based on the foregoing information, I recommend ___ do not recommend ___ that the prospective contractor be determined responsible for performance of this contract.

Contract Specialist: ___________________________________________

Date: __________________

Determination After considering the above information, I hereby determine that the prospective contractor is ___ is not ___ a responsible contractor for the purpose of performing the proposed contract.

Comments: __________________________________________________________

Contracting Officer: __________________________________________

Date: __________________