W912ES25Q0023.pdf

SEE ADDENDUM

(No Collect Calls)

W912ES25Q0023 09-Dec-2024

b. TELEPHONE NUMBER

651-290-5418

8. OFFER DUE DATE/LOCAL TIME

02:00 PM 23 Dec 2024

5. SOLICITATION NUMBER 6. SOLICITATION ISSUE DATE

AUTHORIZED FOR LOCAL REPRODUCTION

PREVIOUS EDITION IS NOT USABLE

STANDARD FORM 1449 (REV. 2/2012)

Prescribed by GSA – FAR (48 CFR) 53.212

(TYPE OR PRINT)

(SIGNATURE OF CONTRACTING OFFICER)

ADDENDA ARE

26. TOTAL AWARD AMOUNT (For Gov t. Use Only )

23.

CODE 10. THIS ACQUISITION IS

SUCH ADDRESS IN OFFER

17b. CHECK IF REMITTANCE IS DIFFERENT AND PUT

BELOW IS CHECKED

TELEPHONE NO.

W912ES9. ISSUED BY

18b. SUBMIT INVOICES TO ADDRESS SHOWN IN BLOCK 18a. UNLESS BLOCK

7. FOR SOLICITATION

INFORMATION CALL:

a. NAME

BENJAMIN T KNUTSON

2. CONTRACT NO. 3. AWARD/EFFECTIVE DATE 4. ORDER NUMBER

(TYPE OR PRINT)

30b. NAME AND TITLE OF SIGNER 30c. DATE SIGNED 31b. NAME OF CONTRACTING OFFICER

30a. SIGNATURE OF OFFEROR/CONTRACTOR 31a.UNITED STATES OF AMERICA

0 27a. SOLICITATION INCORPORATES BY REFERENCE FAR 52.212-1. 52.212-4. FAR 52.212-3. 52.212-5 ARE ATTACHED.

25. ACCOUNTING AND APPROPRIATION DATA

1. REQUISITION NUMBER

20.

ADDITIONAL SHEETS SUBJECT TO THE TERMS AND CONDITIONS SPECIFIED.

OFFEROR TO COMPLETE BLOCKS 12, 17, 23, 24, AND 30

SOLICITATION/CONTRACT/ORDER FOR COMMERCIAL ITEMS

SEE SCHEDULE

ARE NOT ATTACHED

27b. CONTRACT/PURCHASE ORDER INCORPORATES BY REFERENCE FAR 52.212-4. FAR 52.212-5 IS ATTACHED. ADDENDA ARE ARE NOT ATTACHED

(BLOCK 5), INCLUDING ANY ADDITIONS OR CHANGES WHICH ARE

SET FORTH HEREIN, IS ACCEPTED AS TO ITEMS:

. YOUR OFFER ON SOLICITATION

28. CONTRACTOR IS REQUIRED TO SIGN THIS DOCUMENT AND RETURN

% FOR:SET ASIDE:UNRESTRICTED OR X

SMALL BUSINESSX

17a.CONTRACTOR/ CODE FACILITY

OFFEROR CODE

CONTRACTING DIVISION

USACE, ST PAUL

332 MINNESOTA STREET

SUITE E1500

ST PAUL MN 55101-1323

18a. PAYMENT WILL BE MADE BY CODE

RATED ORDER UNDER

DPAS (15 CFR 700)

13a. THIS CONTRACT IS A

13b. RATING

CODE15. DELIVER TO CODE 16. ADMINISTERED BY

SEE SCHEDULE

12. DISCOUNT TERMS11. DELIVERY FOR FOB DESTINA-

TION UNLESS BLOCK IS

MARKED

SEE SCHEDULE

14. METHOD OF SOLICITATION

RFQ IFB RFPX

FAX:

TEL: 651-290-5414 SERVICE-DISABLED

VETERAN-OWNED

SMALL BUSINESS

8(A)

HUBZONE SMALL

BUSINESS

SIZE STANDARD:

$47,000,000

NAICS:

562111

X

OFFER DATED

29. AWARD OF CONTRACT: REF.

DELIVER ALL ITEMS SET FORTH OR OTHERWISE IDENTIFIED ABOVE AND ON ANY

COPIES TO ISSUING OFFICE. CONTRACTOR AGREES TO FURNISH AND

EMAIL:

TEL:

31c. DATE SIGNED

SEE SCHEDULE

SCHEDULE OF SUPPLIES/ SERVICESITEM NO. QUANTITY UNIT UNIT PRICE AMOUNT

24.22.21.19.

WOMEN-OWNED SMALL BUSINESS (WOSB)

ELIGIBLE UNDER THE WOMEN-OWNED

SMALL BUSINESS PROGRAM

EDWOSB

32g. E-MAIL OF AUTHORIZED GOVERNMENT REPRESENTATIVE

SOLICITATION/CONTRACT/ORDER FOR COMMERCIAL ITEMS

(CONTINUED)

PAGE 2 OF64

ACCEPTED, AND CONFORMS TO THE CONTRACT, EXCEPT AS NOTED: ______________________________________________________

32a. QUANTITY IN COLUMN 21 HAS BEEN

RECEIVED INSPECTED

32b. SIGNATURE OF AUTHORIZED GOVERNMENT

REPRESENTATIVE

32c. DATE 32d. PRINTED NAME AND TITLE OF AUTHORIZED GOVERNMENT

REPRESENTATIVE

32e. MAILING ADDRESS OF AUTHORIZED GOVERNMENT REPRESENTATIVE 32f . TELEPHONE NUMBER OF AUTHORIZED GOVERNMENT REPRESENTATIVE

37. CHECK NUMBER

FINALPARTIALCOMPLETE

36. PAYMENT35. AMOUNT VERIFIED

CORRECT FOR

34. VOUCHER NUMBER

FINAL

33. SHIP NUMBER

PARTIAL

38. S/R ACCOUNT NUMBER 39. S/R VOUCHER NUMBER 40. PAID BY

41a. I CERTIFY THIS ACCOUNT IS CORRECT AND PROPER FOR PAYMENT

41b. SIGNATURE AND TITLE OF CERTIFYING OFFICER 41c. DATE

42a. RECEIVED BY (Print)

42b. RECEIVED AT (Location)

42c. DATE REC'D (YY/MM/DD) 42d. TOTAL CONTAINERS

STANDARD FORM 1449 (REV. 2/2012) BACK

Prescribed by GSA – FAR (48 CFR) 53.212

AUTHORIZED FOR LOCAL REPRODUCTION

PREVIOUS EDITION IS NOT USABLE

SEE SCHEDULE

20.

SCHEDULE OF SUPPLIES/ SERVICES

21.

QUANTITY UNIT

22. 23.

UNIT PRICE

24.

AMOUNT

19.

ITEM NO.

W912ES25Q0023

Section SF 1449 - CONTINUATION SHEET

INSTRUCTIONS TO QUOTERS

This section is general guidance for preparing the quotation in response to this solicitation. This solicitation is a Request for Quote (RFQ), which shall result in one (1) firm fixed price contract. The Quoter’s response to this solicitation must include all data and information requested herein and in accordance with the following instructions:

1. Price Quote.

Standard Form 1449 Solicitation/Contract/Order for Commercial Items;

o Complete Blocks 17 and 30a-c.

Acknowledgement of Amendments;

o Complete only as necessary and provide signed copies of the Standard Form 30 Amendment of Solicitation/Modification of Contract with your quote. Failure to acknowledge amendments may result in the quote’s removal from consideration for contract award.

Price Quote:

o All pricing (unit, total, subtotal, grand total, etc.) must be in whole penny amounts.

Note: Freight and/or shipping & handling charges shall be included in the unit price.

Do not quote freight charges separately.

2. Questions.

All questions regarding this solicitation shall be submitted via email to benjamin.t.knutson@usace.army.mil and sharon.m.frank-scheierl@usace.army.mil.

Responses to interested quoter questions will be published in amendments to this solicitation at https://SAM.gov. Interested firms are responsible for monitoring https://SAM.gov for any amendments to this solicitation.

3. Submitting Quotes.

All transmittals shall be submitted electronically to benjamin.t.knutson@usace.army.mil and sharon.m.frank-scheierl@usace.army.mil. Transmittals shall contain the solicitation number in the subject line.

Quotes must be received no later than the date and time stated in Block 8 of the Standard Form 1449.

Quotes received after the deadline will be late and may not be considered for contract award.

4. Quoter shall be registered in the System for Award Management (SAM), https://SAM.gov to include the FAR and DFARS Representations and Certifications section.

For assistance with SAM, please contact:

SAM Service Desk Website https://www.fsd.gov U.S. Calls 1-866-606-8220 Hours of Operation Monday-Friday 8am to 8pm ET

5. As a component of the U.S. Government, the U.S. Army Corps of Engineers is exempt from Federal, State, and Local Taxes, including sales taxes. Do not include sales tax(es) in quoted price.

6. System limitations require that DFARS Clause 252.232-7003 must be added to this solicitation. However, the U.S. Army Corps of Engineers, St. Paul District does not use Wide Area Workflow (WAWF), and our financial management system does not allow for direct electronic submission of payment requests. Therefore, the terms of DFARS Clause 252.232-7003 will not apply to this solicitation’s resulting contract. The Contractor shall submit invoices in accordance with the SOW herein or as amended.

SCOPE OF WORK

U.S. Army Corps of Engineers

Upper St. Anthony Falls Lock & Dam Lower St. Anthony Falls Lock & Dam

Lock & Dam #1

Garbage Removal/Recycling Scope of Work

General:

This scope of work provides detail for the acquisition of Garbage Removal Services for the U.S. Army Corps of Engineers (Corps) Upper St Anthony Falls Lock & Dam, Lower St Anthony Falls Lock & Dam, and lock and Dam #1. This contract consists of the acquisition of garbage services by USACE with a base contract period of 1 year with 4 subsequent option years plus an additional 6 months, for a total of 5.5 years

1. Project Location: Upper St. Anthony Falls (USAF), Lower St. Anthony Falls (LSAF) and Lock & Dam #1 are within the city limits of Minneapolis. A site visit is encouraged, and can be arranged through the POC, however, it is not required.

2. The addresses are:

Upper Saint Anthony Falls 1 Portland Avenue Minneapolis, MN 55401-2528

Lower Saint Anthony Falls 1875 West River Parkway Minneapolis, MN 55434-1027

Lock & Dam 1 5000 West River Parkway Minneapolis, MN 55417

3. Garbage Dumpsters: The Contractor shall supply and maintain 2(two), four (4) Cubic Yard garbage dumpsters and 1 (one), 2 Cubic Yard garbage dumpsters, all with lids and in good working condition.

4. Garbage Container Location: The 2 Cubic Yard dumpster shall be placed at the Upper Saint Anthony Falls location. One 4 cubic dumpster shall be place at Lower Saint Anthony Falls location, and One 4 cubic yard dumpster shall be placed at Lock & Dam #1 location. All dumpsters shall be placed in the location specified by the USACE Point of Contact.

5. Recycle containers: The Contractor shall supply and maintain two (2), four-yard recycling dumpsters with lids in good working condition

6. Recycle Container Locations; One shall be placed at the Lock & Dam #1 location, and one shall be place at the Lower Saint Anthony Falls location. All dumpsters shall be placed in the location as directed by the USACE Point of Contact.

7. Dumpsters shall be in good condition and replaced with a clean dumpster if they become unsightly or strong smelling as deemed by the USACE Point of Contact. Exact locations of both dumpsters within the Lock and

Dam area may be subject to change if needs dictate. The contractor will be notified by the point of contact at least one week in advance of any intended change to dumpster locations.

8. Service Hours: All dumpsters shall be emptied between the hours of 7:00 am and 5:00 pm.

9. Frequency of service garbage: The 4-yard Garbage dumpsters, one located at Lower Saint Anthony Falls and one located at Lock & Dam #1, shall be emptied 2 times per month. The 2-yard Dumpster located at Upper Saint Anthony Falls shall be dumped one time per month.

10. Frequency of service Recycle. The Recycle container locate at Lock and Dam #1 shall be emptied once per month. The Recycle container located at Lower Saint Anthony Falls shall be emptied twice per month.

11. Damages: The Contractor shall be responsible for notifying the Point of Contact of any damages to Government property which is related to the work under this contract. Notification shall be within 24 hours of discovery of damages.

12. Equipment and Safety: Contractor vehicles shall be in good working order. Vehicles leaking motor oil, hydraulic fluid, etc. shall not be allowed on the site. Contractor vehicles shall follow posted speed limits within the Lock and Dam Area. Careless or reckless operation within the Lock and Dam Area shall not be allowed. The contractor shall comply with all applicable federal, state and local safety and occupational health laws, rules, and regulations and shall complete all work in a safe manner in accordance with EM 385-1-1 Safety & Health Requirements Manual. An online version can be reviewed at http://www.publications.usace.army.mil/Portals/76/Publications/EngineerManuals/E M_385-1-1.pdf.

ITEM NO SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT

0001 12 Months Upper St Anthony Falls Trash

FFP

2 yard dumpster to be emptied once per month.

FOB: Destination

MILSTRIP: W81G6743252038

PURCHASE REQUEST NUMBER: W81G6743252038

PSC CD: S205

NET AMT

0002 12 Months Lower St Anthony Falls Trash

FFP

4 yard dumpster to be emptied twice a month.

FOB: Destination MILSTRIP: w81G6743252057

PURCHASE REQUEST NUMBER: W81G6743252057

0003 12 Months Lower St Anthony Falls Recycling

FFP

4 yard dumpster to be emptied twice a month.

FOB: Destination

MILSTRIP: W81G6743252057

PURCHASE REQUEST NUMBER: W81G6743252057

0004 12 Months Lock & Dam 1 Trash Service

FFP

4 yard dumpster to be emptied twice a month.

FOB: Destination

MILSTRIP: W81G6743252058

PURCHASE REQUEST NUMBER: W81G6743252058

0005 12 Months Lock & Dam 1 Recycling Service

FFP

4 yard dumpster to be emptied once a month.

FOB: Destination

MILSTRIP: W81G6743252058

PURCHASE REQUEST NUMBER: W81G6743252058

1001 12 Months OPTION Upper St Anthony Falls Trash

FFP

2 yard dumpster to be emptied once a month.

FOB: Destination

1002 12 Months OPTION Lower St Anthony Falls Trash Service

FFP

4 yard dumpster to be emptied twice a month

1003 12 Months OPTION Lower St Anthony Falls Recycling Service

FFP

4 yard dumpster to be emptied twice a month.

1004 12 Months OPTION Lock & Dam 1 Trash Service

FFP

4 yard dumpster to be emptied twice a month.

1005 12 Months OPTION Lock & Dam 1 Recycling Service

FFP

4 yard dumpster to be emptied once a month.

2001 12 Months OPTION Upper St Anthony Falls Trash Service

FFP

2 yard dumpster to be emptied once a month

2002 12 Months OPTION Lower St Anthony Falls Trash Service

FFP

4 yard dumpster to be emptied twice a month.

2003 12 Months OPTION Lower St Anthony Falls recycling service

FFP

4 yard dumpster to be emptied twice a month.

2004 12 Months OPTION Lock and Dam 1 Trash Service

FFP

4 yard dumpster to be emptied twice a month.

2005 12 Months OPTION Lock and Dam 1 Recycling Service

FFP

4 yard dumpster to be emptied once a month.

3001 12 Months OPTION Upper St Anthony Falls Trash Service

FFP

2 yard dumpster to be emptied once a month

3002 12 Months OPTION Lower St Anthony Falls Trash Service

FFP

4 yard dumpster to be emptied twice a month.

3003 12 Months OPTION Lower St Anthony Falls Recycling Service

FFP

4 yard dumpster to be emptied twice a month.

3004 12 Months OPTION Lock and Dam 1 Trash Service

FFP

4 yard dumpster to be emptied twice a month.

3005 12 Months OPTION Lock and Dam 1 Recycling Service

FFP

4 yard dumpster to be emptied twice a month.

4001 12 Months OPTION Upper St Anthony Falls Trash Service

FFP

2 yard dumpster to be emptied once a month.

4002 12 Months OPTION Lower St Anthony Falls Trash Service

FFP

4 yard dumpster to be emptied twice a month.

4003 12 Months OPTION Lower St Anthony Falls Trash Service

FFP

4 yard dumpster to be emptied twice a month.

4004 12 Months OPTION Lock and Dam 1 Trash Service

FFP

4 yard dumpster to be emptied twice a month.

4005 12 Months OPTION Lock and Dam 1 Recycling Service

FFP

4 yard dumpster to be emptied twice a month.

5001 6 Months OPTION Upper St Anthony Falls Trash Service

FFP

2 yard dumpster to be emptied once a month.

5002 6 Months OPTION Lower St Anthony Falls Trash Service

FFP

4 yard dumpster to be emptied twice a month.

5003 6 Months OPTION Lower St Anthony Falls Recycling Service

FFP

4 yard dumpster to be emptied twice a month.

5004 6 Months OPTION Lock and Dam 1 Trash Service

FFP

4 yard dumpster to be emptied twice a month.

5005 6 Months OPTION Lock and Dam 1 Recycling Service

FFP

4 yard dumpster to be emptied twice a month.

NOTE: The requirements in DFARS 252.211-7003, Item Identification and Valuation, are applicable for this line item. The contractor shall provide DoD unique identification or a DoD recognized unique identification equivalent.

INSPECTION AND ACCEPTANCE TERMS

Supplies/services will be inspected/accepted at:

CLIN INSPECT AT INSPECT BY ACCEPT AT ACCEPT BY

0001 Destination N/A N/A Government 0002 Destination N/A N/A Government 0003 Destination N/A N/A Government 0004 Destination N/A N/A Government 0005 Destination N/A N/A Government 1001 Destination N/A N/A Government

1002 Destination N/A N/A Government 1003 Destination N/A N/A Government 1004 Destination N/A N/A Government 1005 Destination N/A N/A Government 2001 Destination N/A N/A Government 2002 Destination N/A N/A Government 2003 Destination N/A N/A Government 2004 Destination N/A N/A Government 2005 Destination N/A N/A Government 3001 Destination N/A N/A Government 3002 Destination N/A N/A Government 3003 Destination N/A N/A Government 3004 Destination N/A N/A Government 3005 Destination N/A N/A Government 4001 Destination N/A N/A Government 4002 Destination N/A N/A Government 4003 Destination N/A N/A Government 4004 Destination N/A N/A Government 4005 Destination N/A N/A Government 5001 Destination N/A N/A Government 5002 Destination N/A N/A Government 5003 Destination N/A N/A Government 5004 Destination N/A N/A Government 5005 Destination N/A N/A Government

DELIVERY INFORMATION

CLIN DELIVERY DATE QUANTITY SHIP TO ADDRESS DODAAC /

CAGE

0001 POP 06-JAN-2025 TO

05-JAN-2026

N/A UPPER ST. ANTHONY FALLS

RICHARD WEITZEL

1 PORTLAND AVENUE

MINNEAPOLIS MN 55401-2528

815-326-1426

966301

0002 POP 06-JAN-2025 TO

05-JAN-2026

N/A LOWER ST. ANTHONY FALLS

RICHARD WEITZEL

1875 WEST RIVER PARKWAY

MINNEAPOLIS MN 55454-1027

965605

0003 POP 06-JAN-2025 TO

N/A (SAME AS PREVIOUS LOCATION)

0004 POP 06-JAN-2025 TO

N/A LOCK & DAM #1

RICHARD WEITZEL

5000 WEST RIVER PARKWAY

MINNEAPOLIS MN 55417-1681

651-290-5928

966303

0005 POP 06-JAN-2025 TO

N/A (SAME AS PREVIOUS LOCATION)

1001 POP 06-JAN-2026 TO

05-JAN-2027

N/A UPPER ST. ANTHONY FALLS

RICHARD WEITZEL

1 PORTLAND AVENUE

MINNEAPOLIS MN 55401-2528

815-326-1426

1002 POP 06-JAN-2026 TO

N/A LOWER ST. ANTHONY FALLS

RICHARD WEITZEL

1875 WEST RIVER PARKWAY

MINNEAPOLIS MN 55454-1027

1003 POP 06-JAN-2026 TO

N/A (SAME AS PREVIOUS LOCATION)

1004 POP 06-JAN-2026 TO

N/A LOCK & DAM #1

RICHARD WEITZEL

5000 WEST RIVER PARKWAY

MINNEAPOLIS MN 55417-1681

651-290-5928

1005 POP 06-JAN-2026 TO

N/A (SAME AS PREVIOUS LOCATION)

2001 POP 06-JAN-2027 TO

05-JAN-2028

N/A UPPER ST. ANTHONY FALLS

RICHARD WEITZEL

1 PORTLAND AVENUE

MINNEAPOLIS MN 55401-2528

815-326-1426

2002 POP 06-JAN-2027 TO

N/A LOWER ST. ANTHONY FALLS

RICHARD WEITZEL

1875 WEST RIVER PARKWAY

MINNEAPOLIS MN 55454-1027

2003 POP 06-JAN-2027 TO

N/A (SAME AS PREVIOUS LOCATION)

2004 POP 06-JAN-2027 TO

N/A (SAME AS PREVIOUS LOCATION)

2005 POP 06-JAN-2027 TO

N/A LOCK & DAM #1

RICHARD WEITZEL

5000 WEST RIVER PARKWAY

MINNEAPOLIS MN 55417-1681

651-290-5928

3001 POP 06-JAN-2028 TO

05-JAN-2029

N/A UPPER ST. ANTHONY FALLS

RICHARD WEITZEL

1 PORTLAND AVENUE

MINNEAPOLIS MN 55401-2528

815-326-1426

3002 POP 06-JAN-2028 TO

N/A LOWER ST. ANTHONY FALLS

RICHARD WEITZEL

1875 WEST RIVER PARKWAY

MINNEAPOLIS MN 55454-1027

3003 POP 06-JAN-2028 TO

N/A (SAME AS PREVIOUS LOCATION)

3004 POP 06-JAN-2028 TO

N/A LOCK & DAM #1

RICHARD WEITZEL

5000 WEST RIVER PARKWAY

MINNEAPOLIS MN 55417-1681

651-290-5928

3005 POP 06-JAN-2028 TO

N/A (SAME AS PREVIOUS LOCATION)

4001 POP 06-JAN-2029 TO

05-JAN-2030

N/A UPPER ST. ANTHONY FALLS

RICHARD WEITZEL

1 PORTLAND AVENUE

MINNEAPOLIS MN 55401-2528

815-326-1426

4002 POP 06-JAN-2029 TO

N/A LOWER ST. ANTHONY FALLS

RICHARD WEITZEL

1875 WEST RIVER PARKWAY

MINNEAPOLIS MN 55454-1027

4003 POP 06-JAN-2029 TO

N/A (SAME AS PREVIOUS LOCATION)

4004 POP 06-JAN-2029 TO

N/A LOCK & DAM #1

RICHARD WEITZEL

5000 WEST RIVER PARKWAY

MINNEAPOLIS MN 55417-1681

651-290-5928

4005 POP 06-JAN-2029 TO

N/A (SAME AS PREVIOUS LOCATION)

5001 POP 06-JAN-2030 TO

05-JUN-2030

N/A UPPER ST. ANTHONY FALLS

RICHARD WEITZEL

1 PORTLAND AVENUE

MINNEAPOLIS MN 55401-2528

815-326-1426

5002 POP 06-JAN-2030 TO

N/A LOWER ST. ANTHONY FALLS

RICHARD WEITZEL

1875 WEST RIVER PARKWAY

MINNEAPOLIS MN 55454-1027

5003 POP 06-JAN-2030 TO

N/A (SAME AS PREVIOUS LOCATION)

5004 POP 06-JAN-2030 TO

N/A LOCK & DAM #1

RICHARD WEITZEL

5000 WEST RIVER PARKWAY

MINNEAPOLIS MN 55417-1681

651-290-5928

5005 POP 06-JAN-2030 TO

N/A (SAME AS PREVIOUS LOCATION)

CLAUSES INCORPORATED BY REFERENCE

52.204-7 System for Award Management OCT 2018 52.204-13 System for Award Management Maintenance OCT 2018 52.204-16 Commercial and Government Entity Code Reporting AUG 2020 52.204-18 Commercial and Government Entity Code Maintenance AUG 2020 52.204-24 Representation Regarding Certain Telecommunications and

Video Surveillance Services or Equipment

NOV 2021

52.204-26 Covered Telecommunications Equipment or Services-- Representation.

OCT 2020

52.209-10 Prohibition on Contracting With Inverted Domestic Corporations

NOV 2015

52.212-4 Contract Terms and Conditions--Commercial Products and Commercial Services

NOV 2023

52.229-11 Tax on Certain Foreign Procurements--Notice and Representation

JUN 2020

252.203-7000 Requirements Relating to Compensation of Former DoD Officials

SEP 2011

252.203-7002 Requirement to Inform Employees of Whistleblower Rights DEC 2022 252.204-7004 Antiterrorism Awareness Training for Contractors JAN 2023 252.204-7012 Safeguarding Covered Defense Information and Cyber

Incident Reporting

MAY 2024

252.204-7015 Notice of Authorized Disclosure of Information for Litigation Support

JAN 2023

252.204-7018 Prohibition on the Acquisition of Covered Defense Telecommunications Equipment or Services

JAN 2023

252.211-7003 Item Unique Identification and Valuation JAN 2023 252.223-7008 Prohibition of Hexavalent Chromium JAN 2023 252.225-7056 Prohibition Regarding Business Operations with the Maduro

Regime

JAN 2023

252.225-7060 Prohibition on Certain Procurements from the Xinjiang Uyghur Autonomous Region

JUN 2023

252.232-7003 Electronic Submission of Payment Requests and Receiving Reports

DEC 2018

252.232-7010 Levies on Contract Payments DEC 2006 252.237-7010 Prohibition on Interrogation of Detainees by Contractor

Personnel

JAN 2023

252.244-7000 Subcontracts for Commercial Products or Commercial Services

NOV 2023

252.247-7023 Transportation of Supplies by Sea OCT 2024

CLAUSES INCORPORATED BY FULL TEXT

52.212-1 INSTRUCTIONS TO OFFERORS--COMMERCIAL PRODUCTS AND COMMERCIAL SERVICES

(SEP 2023)

(a) North American Industry Classification System (NAICS) code and small business size standard. The NAICS code(s) and small business size standard(s) for this acquisition appear elsewhere in the solicitation. However, the small business size standard for a concern that submits an offer, other than on a construction or service acquisition, but proposes to furnish an end item that it did not itself manufacture, process, or produce is 500 employees, or 150 employees for information technology value-added resellers under NAICS code 541519, if the acquisition--

(1) Is set aside for small business and has a value above the simplified acquisition threshold;

(2) Uses the HUBZone price evaluation preference regardless of dollar value, unless the offeror waives the price evaluation preference; or

(3) Is an 8(a), HUBZone, service-disabled veteran-owned, economically disadvantaged women-owned, or women-owned small business set-aside or sole-source award regardless of dollar value.

(b) Submission of offers. Submit signed and dated offers to the office specified in this solicitation at or before the exact time specified in this solicitation. Offers may be submitted on the SF 1449, letterhead stationery, or as otherwise specified in the solicitation. As a minimum, offers must show--

(1) The solicitation number;

(2) The time specified in the solicitation for receipt of offers;

(3) The name, address, and telephone number of the offeror;

(4) A technical description of the items being offered in sufficient detail to evaluate compliance with the requirements in the solicitation. This may include product literature, or other documents, if necessary;

(5) Terms of any express warranty;

(6) Price and any discount terms;

(7) "Remit to" address, if different than mailing address;

(8) A completed copy of the representations and certifications at Federal Acquisition Regulation (FAR) 52.212-3 (see FAR 52.212-3(b) for those representations and certifications that the offeror shall complete electronically);

(9) Acknowledgment of Solicitation Amendments;

(10) Past performance information, when included as an evaluation factor, to include recent and relevant contracts for the same or similar items and other references (including contract numbers, points of contact with telephone numbers and other relevant information); and

(11) If the offer is not submitted on the SF 1449, include a statement specifying the extent of agreement with all terms, conditions, and provisions included in the solicitation. Offers that fail to furnish required representations or information, or reject the terms and conditions of the solicitation may be excluded from consideration.

(c) Period for acceptance of offers. The offeror agrees to hold the prices in its offer firm for 30 calendar days from the date specified for receipt of offers, unless another time period is specified in an addendum to the solicitation.

(d) Product samples. When required by the solicitation, product samples shall be submitted at or prior to the time specified for receipt of offers. Unless otherwise specified in this solicitation, these samples shall be submitted at no expense to the Government, and returned at the sender's request and expense, unless they are destroyed during preaward testing.

(e) Multiple offers. Offerors are encouraged to submit multiple offers presenting alternative terms and conditions, including alternative line items (provided that the alternative line items are consistent with FAR subpart 4.10), or alternative commercial products or commercial services for satisfying the requirements of this solicitation. Each offer submitted will be evaluated separately.

(f) Late submissions, modifications, revisions, and withdrawals of offers:

(1) Offerors are responsible for submitting offers, and any modifications, revisions, or withdrawals, so as to reach the Government office designated in the solicitation by the time specified in the solicitation. If no time is specified in the solicitation, the time for receipt is 4:30 p.m., local time, for the designated Government office on the date that offers or revisions are due.

(2)(i) Any offer, modification, revision, or withdrawal of an offer received at the Government office designated in the solicitation after the exact time specified for receipt of offers is “late” and will not be considered unless it is received before award is made, the Contracting Officer determines that accepting the late offer would not unduly delay the acquisition; and--

(A) If it was transmitted through an electronic commerce method authorized by the solicitation, it was received at the initial point of entry to the Government infrastructure not later than 5:00 p.m. one working day prior to the date specified for receipt of offers; or

(B) There is acceptable evidence to establish that it was received at the Government installation designated for receipt of offers and was under the Government's control prior to the time set for receipt of offers; or

(C) If this solicitation is a request for proposals, it was the only proposal received.

(ii) However, a late modification of an otherwise successful offer, that makes its terms more favorable to the Government, will be considered at any time it is received and may be accepted.

(3) Acceptable evidence to establish the time of receipt at the Government installation includes the time/date stamp of that installation on the offer wrapper, other documentary evidence of receipt maintained by the installation, or oral testimony or statements of Government personnel.

(4) If an emergency or unanticipated event interrupts normal Government processes so that offers cannot be received at the Government office designated for receipt of offers by the exact time specified in the solicitation, and urgent Government requirements preclude amendment of the solicitation or other notice of an extension of the closing date, the time specified for receipt of offers will be deemed to be extended to the same time of day specified in the solicitation on the first work day on which normal Government processes resume.

(5) Offers may be withdrawn by written notice received at any time before the exact time set for receipt of offers.

Oral offers in response to oral solicitations may be withdrawn orally. If the solicitation authorizes facsimile offers, offers may be withdrawn via facsimile received at any time before the exact time set for receipt of offers, subject to the conditions specified in the solicitation concerning facsimile offers. An offer may be withdrawn in person by an offeror or its authorized representative if, before the exact time set for receipt of offers, the identity of the person requesting withdrawal is established and the person signs a receipt for the offer.

(g) Contract award (not applicable to Invitation for Bids). The Government intends to evaluate offers and award a contract without discussions with offerors. Therefore, the offeror's initial offer should contain the offeror's best terms from a price and technical standpoint. However, the Government reserves the right to conduct discussions if later determined by the Contracting Officer to be necessary. The Government may reject any or all offers if such action is in the public interest; accept other than the lowest offer; and waive informalities and minor irregularities in offers received.

(h) Multiple awards. The Government may accept any item or group of items of an offer, unless the offeror qualifies the offer by specific limitations. Unless otherwise provided in the Schedule, offers may not be submitted for quantities less than those specified. The Government reserves the right to make an award on any item for a quantity less than the quantity offered, at the unit prices offered, unless the offeror specifies otherwise in the offer.

(i) Availability of requirements documents cited in the solicitation.

(1)(i) The GSA Index of Federal Specifications, Standards and Commercial Item Descriptions, FPMR Part 101-29, and copies of Federal specifications, standards, and product descriptions can be downloaded from the ASSIST website at https://assist.dla.mil.

(ii) If the General Services Administration, Department of Agriculture, or Department of Veterans Affairs issued this solicitation, a copy of specifications, standards, and commercial item descriptions cited in this solicitation may be obtained from the address in paragraph (i)(1)(i) of this provision.

(2) Most unclassified Defense specifications and standards may be downloaded from the ASSIST website at https://assist.dla.mil.

(3) Defense documents not available from the ASSIST website may be requested from the Defense Standardization Program Office by--

(i) Using the ASSIST feedback module (https://assist.dla.mil/feedback); or

(ii) Contacting the Defense Standardization Program Office by telephone at 571-767-6688 or email at assisthelp@dla.mil.

(4) Nongovernment (voluntary) standards must be obtained from the organization responsible for their preparation, publication, or maintenance.

(j) Unique entity identifier. (Applies to all offers that exceed the micro-purchase threshold, and offers at or below the micro-purchase threshold if the solicitation requires the Contractor to be registered in the System for Award

Management (SAM).) The Offeror shall enter, in the block with its name and address on the cover page of its offer, the annotation "Unique Entity Identifier" followed by the unique entity identifier that identifies the Offeror's name and address. The Offeror also shall enter its Electronic Funds Transfer (EFT) indicator, if applicable. The EFT indicator is a four-character suffix to the unique entity identifier. The suffix is assigned at the discretion of the Offeror to establish additional SAM records for identifying alternative EFT accounts (see FAR subpart 32.11) for the same entity. If the Offeror does not have a unique entity identifier, it should contact the entity designated at www.sam.gov for unique entity identifier establishment directly to obtain one. The Offeror should indicate that it is an offeror for a Government contract when contacting the entity designated at www.sam.gov for establishing the unique entity identifier.

(k) Reserved.

(l) Debriefing. If a post-award debriefing is given to requesting offerors, the Government shall disclose the following information, if applicable:

(1) The agency's evaluation of the significant weak or deficient factors in the debriefed offeror's offer.

(2) The overall evaluated cost or price and technical rating of the successful and the debriefed offeror and past performance information on the debriefed offeror.

(3) The overall ranking of all offerors, when any ranking was developed by the agency during source selection.

(4) A summary of the rationale for award;

(5) For acquisitions of commercial products, the make and model of the product to be delivered by the successful offeror.

(6) Reasonable responses to relevant questions posed by the debriefed offeror as to whether source-selection procedures set forth in the solicitation, applicable regulations, and other applicable authorities were followed by the agency.

(End of provision)

52.212-2 EVALUATION--COMMERCIAL PRODUCTS AND COMMERCIAL SERVICES (NOV 2021)

(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:

The lowest price technically acceptable.

Technical and past performance, when combined, are equally as important but not as much as price.

(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.

52.212-3 OFFEROR REPRESENTATIONS AND CERTIFICATIONS--COMMERCIAL PRODUCTS AND

COMMERCIAL SERVICES (MAY 2024) ALTERNATE I (FEB 2024)

The Offeror shall complete only paragraph (b) of this provision if the Offeror has completed the annual representations and certification electronically in the System for Award Management (SAM) accessed through https://www.sam.gov. If the Offeror has not completed the annual representations and certifications electronically, the Offeror shall complete only paragraphs (c) through (v) of this provision.

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

"Covered telecommunications equipment or services" has the meaning provided in the clause 52.204-25, Prohibition on Contracting for Certain Telecommunications and Video Surveillance Services or Equipment.

"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, and the concern is certified by SBA or an approved third-party certifier in accordance with 13 CFR 127.300. 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.

"Predecessor" means an entity that is replaced by a successor and includes any predecessors of the predecessor.

"Reasonable inquiry" has the meaning provided in the clause 52.204-25, Prohibition on Contracting for Certain Telecommunications and Video Surveillance Services or Equipment.

"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 (SDVOSB) concern" means a small business concern--

(1)(i) Not less than 51 percent of which is owned and controlled 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; or

(2) A small business concern eligible under the SDVOSB Program in accordance with 13 CFR part 128 (see subpart 19.14).

(3) Service-disabled veteran, as used in this definition, 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), and who is registered in the Beneficiary Identification and Records Locator Subsystem, or successor system that is maintained by the Department of Veterans Affairs' Veterans Benefits Administration, as a service-disabled veteran.

"Service-disabled veteran-owned small business (SDVOSB) concern eligible under the SDVOSB Program" means an SDVOSB concern that--

(1) Effective January 1, 2024, is designated in the System for Award Management (SAM) as certified by the Small Business Administration (SBA) in accordance with 13 CFR 128.300; or

(2) Has represented that it is an SDVOSB concern in SAM and submitted a complete application for certification to SBA on or before December 31, 2023.

"Service-disabled veteran-owned small business (SDVOSB) Program" means a program that authorizes contracting officers to limit competition, including award on a sole-source basis, to SDVOSB concerns eligible under the SDVOSB Program.

"Small business concern"--

(1) Means a concern, including its affiliates, that is independently owned and operated, not dominant in its field of operation, and qualified as a small business under the criteria in 13 CFR part 121 and size standards in this solicitation.

(2) Affiliates, as used in this definition, means business concerns, one of whom directly or indirectly controls or has the power to control the others, or a third party or parties control or have the power to control the others. In determining whether affiliation exists, consideration is given to all appropriate factors including common ownership, common management, and contractual relationships. SBA determines affiliation based on the factors set forth at 13

CFR 121.103.

"Small disadvantaged business concern, consistent with 13 CFR 124.1001", 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 the threshold at 13 CFR 124.104(c)(2) 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.

"Successor" means an entity that has replaced a predecessor by acquiring the assets and carrying out the affairs of the predecessor under a new name (often through acquisition or merger). The term "successor" does not include new offices/divisions of the same company or a company that only changes its name. The extent of the responsibility of the successor for the liabilities of the predecessor may vary, depending on State law and specific circumstances.

"Veteran-owned small business concern" means a small business concern--

(1) Not less than 51 percent of which is owned and controlled 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 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, and the concern is certified by SBA or an approved third-party certifier in accordance with 13 CFR 127.300.

(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 in SAM.

(2) The offeror has completed the annual representations and certifications electronically in SAM accessed through http://www.sam.gov. After reviewing SAM information, the Offeror verifies by submission of this offer that the representations and certifications currently posted electronically at FAR 52.212-3, Offeror Representations and Certifications--Commercial Products and Commercial Services, have been entered or updated in the last 12 months, are current, accurate, complete, and applicable to this solicitation (including the business size standard(s) applicable to the NAICS code(s) referenced for this solicitation), at the time this offer is submitted and are incorporated in this offer by reference (see FAR 4.1201), except for paragraphs ___

[Offeror to identify the applicable paragraphs at (c) through (v) 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 for supplies to be delivered or services to be performed in the United States or its outlying areas, or when the contracting officer has applied part 19 in accordance with 19.000(b)(1)(ii). Check all that apply.

(1) Small business concern. The offeror represents as part of its offer that--

(i) It [ ___ ] is, [ ___ ] is not a small business concern; or

(ii) It [ ___ ] is, [ ___ ] is not a small business joint venture that complies with the requirements of 13 CFR 121.103(h) and 13 CFR 125.8(a) and (b). [The offeror shall enter the name and unique entity identifier of each party to the joint venture: ___ ]

(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) SDVOSB 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 that it [ ___ ] is, [ ___ ] is not an SDVOSB concern.

(4) SDVOSB concern joint venture eligible under the SDVOSB Program. The offeror represents that it [ ___ ] is, [ ___ ] is not an SDVOSB joint venture eligible under the SDVOSB Program that complies with the requirements of 13 CFR 128.402. [Complete only if the offeror represented itself as an SDVOSB concern in paragraph (c)(3) of this provision.] [The offeror shall enter the name and unique entity identifier of each party to the joint venture:

(5) 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 124.1001.

(6) 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.

(7) WOSB joint venture eligible under the WOSB Program. The offeror represents that it [ ___ ] is, [ ___ ] is not a joint venture that complies with the requirements of 13 CFR 127.506(a) through (c). [The offeror shall enter the name and unique entity identifier of each party to the joint venture: ___ .]

(8) Economically disadvantaged women-owned small business (EDWOSB) joint venture. The offeror represents that it [ ___ ] is, [ ___ ] is not a joint venture that complies with the requirements of 13 CFR 127.506(a) through (c).

[The offeror shall enter the name and unique entity identifier of each party to the joint venture: ___ .]

Note to paragraphs (c)(9) and (10): Complete paragraphs (c)(9) and (10) only if this solicitation is expected to exceed the simplified acquisition threshold.

(9) 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.

(10) 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: _________

(11) 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, as having been certified by SBA as a HUBZone small business concern in the Dynamic Small Business Search and SAM, and will attempt to maintain an employment rate of HUBZone residents of 35 percent of its employees during performance of a HUBZone contract (see 13 CFR 126.200(e)(1)); and

(ii) It [ ___ ] is, [ ___ ] is not a HUBZone joint venture that complies with the requirements of 13 CFR 126.616(a) through (c). [The offeror shall enter the name and unique entity identifier of each party to the joint venture: ___ .] Each HUBZone small business concern participating in the HUBZone joint venture shall provide representation of its HUBZone status.

(12) (Complete if the offeror has represented itself as disadvantaged in paragraph (c)(5) of this provision.)

___ Black American.

___ Hispanic American.

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

___ Asian-Pacific American (persons with…