W912NW-19-T-0041.pdf

(No Collect Calls)

(TYPE OR PRINT)

(TYPE OR PRINT)

31b. NAME OF CONTRACTING OFFICER

31a.UNITED STATES OF AMERICA

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

EMAIL:

TEL:

31c. DATE SIGNED

(Print)

(Location)

(YY/MM/DD)

Definitions.

Small business concern

Tie bid priority for labor surplus area concerns.

The offeror shall enter the names of each of the HUBZone small business concerns participating in the HUBZone joint venture

The offeror shall check the category in which its ownership falls

Affirmative Action Compliance

Certification Regarding Payments to Influence Federal Transactions

Buy American Certificate.

i.e.

Buy American -- Free Trade Agreements -- Israeli Trade Act Certificate

List as necessary i.e.

Buy American—Free Trade Agreements—Israeli Trade Act Certificate, Alternate I

[List as necessary]

Buy American—Free Trade Agreements—Israeli Trade Act Certificate, Alternate II.

List as necessary

Buy American—Free Trade Agreements—Israeli Trade Act Certificate, Alternate III.

Trade Agreements Certificate

Certification Regarding Responsibility Matters (Executive Order 12689)

The tax liability is finally determined.

The taxpayer is delinquent in making payment.

Place of manufacture.

Taxpayer identification number (TIN) (26 U.S.C. 6109, 31 U.S.C. 7701)

Restricted business operations in Sudan

_X__

Field Name in WAWF Data to be entered in WAWF