A21_-_W91QVN-16-T-0156_Final.pdf

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SEE ADDENDUM

(No Collect Calls)

W91QVN-16-T-0156 09-Sep-2016

b. TELEPHONE NUMBER

02-7914-7275

8. OFFER DUE DATE/LOCAL TIME

01:00 PM 14 Sep 2016

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.

W91QVN9. ISSUED BY

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

7. FOR SOLICITATION

INFORMATION CALL:

a. NAME

MS. KANG, MYONG-HUI

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

0010901259

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 ORX

SMALL BUSINESS

17a.CONTRACTOR/ CODE FACILITY

OFFEROR CODE

411TH CONTRACTING SUPPORT BRIGADE, KOREA

RCC YONGSAN, UNIT #15289

APO AP 96205-5289

UNITED STATES OF AMERICA (THE)

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 WT4R44 16. ADMINISTERED BY

12. DISCOUNT TERMS11. DELIVERY FOR FOB DESTINA-

TION UNLESS BLOCK IS

MARKED

SEE SCHEDULE

14. METHOD OF SOLICITATION

RFQ IFB RFPX

SONG, KI PO, DSN 732-5896

SONG, KI PO, DSN 732-5896

BLDG# S-2530, CPBO, 403RD, AFSB

UNIT# 15707 APO AP 96258-5707

TEL: FAX:

FAX:

TEL: SERVICE-DISABLED

VETERAN-OWNED

SMALL BUSINESS

8(A)

HUBZONE SMALL

BUSINESS

SIZE STANDARD:

NAICS:

424340

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 OF65

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.

W91QVN-16-T-0156

Section SF 1449 - CONTINUATION SHEET

ITEM NO SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT

0001 2 Pair Men's Steel Toe Boot, size 7W

FFP

Minimum toe protection Alloy or Greater Has Shank for support Cushioning for comfort Slip resistant non-marking rubber outsole Consistent static-dissipative performance or better Single shoe weight for size 9: 570 grams/1.26 pounds (weight +/- 5% variance) Color: Black (See attahed picture for color and shape)

MFR #: A16NN001

MFR: Timberland (Brand name or equal)

FOB: Destination

PURCHASE REQUEST NUMBER: 0010901259

NET AMT

0002 6 Pair Men's Steel ToeBoot, size 7.5W

FFP

Minimum toe protection Alloy or Greater Has Shank for support Cushioning for comfort Slip resistant non-marking rubber outsole Consistent static-dissipative performance or better Single shoe weight for size 9: 570 grams/1.26 pounds (weight +/- 5% variance) Color: Black (See attahed picture for color and shape)

MFR #: A16NN001

MFR: Timberland (Brand name or equal)

0003 10 Pair Men's Steel Toe Boot A, size 8W

FFP

Minimum toe protection Alloy or Greater Has Shank for support Cushioning for comfort Slip resistant non-marking rubber outsole Consistent static-dissipative performance or better Single shoe weight for size 9: 570 grams/1.26 pounds (weight +/- 5% variance) Color: Black (See attahed picture for color and shape)

MFR #: A16NN001

MFR: Timberland (Brand name or equal)

0004 4 Pair Men's Steel ToeBoot A size 8.5W

FFP

Minimum toe protection Alloy or Greater Has Shank for support Cushioning for comfort Slip resistant non-marking rubber outsole Consistent static-dissipative performance or better Single shoe weight for size 9: 570 grams/1.26 pounds (weight +/- 5% variance) Color: Black (See attahed picture for color and shape)

MFR #: A16NN001

MFR: Timberland (Brand name or equal)

0005 2 Pair Men's Steel ToeBoot Asize 9.5W

FFP

Minimum toe protection Alloy or Greater Has Shank for support Cushioning for comfort Slip resistant non-marking rubber outsole Consistent static-dissipative performance or better Single shoe weight for size 9: 570 grams/1.26 pounds (weight +/- 5% variance) Color: Black (See attahed picture for color and shape)

MFR #: A16NN001

MFR: Timberland (Brand name or equal)

0006 4 Pair Men's SteelToeBoot A size 10.5W

FFP

Minimum toe protection Alloy or Greater Has Shank for support Cushioning for comfort Slip resistant non-marking rubber outsole Consistent static-dissipative performance or better Single shoe weight for size 9: 570 grams/1.26 pounds (weight +/- 5% variance) Color: Black (See attahed picture for color and shape)

MFR #: A16NN001

MFR: Timberland (Brand name or equal)

0007 4 Pair Men's SteelToeBoot size 6.5W

FFP

ANSI/ASTM I75 & C75 Approved Leather or Fabric/Leather upper Water resistant Has Shank for support Durable outsole Electrical Hazard Rated Amber or Brown in Color (See attahed picture for color and shape)

MFR #: TM90646

MFR: Timberland (Brand name or equal)

0008 12 Pair Men's SteelToeBoot size 7.5W

FFP

ANSI/ASTM I75 & C75 Approved Leather or Fabric/Leather upper Water resistant Has Shank for support Durable outsole Electrical Hazard Rated Amber or Brown in Color (See attahed picture for color and shape)

MFR #: TM90646

MFR: Timberland (Brand name or equal)

0009 6 Pair Men's SteelToeBoot size 8.5W

FFP

ANSI/ASTM I75 & C75 Approved Leather or Fabric/Leather upper Water resistant Has Shank for support Durable outsole Electrical Hazard Rated Amber or Brown in Color (See attahed picture for color and shape)

MFR #: TM90646

MFR: Timberland (Brand name or equal)

0010 8 Pair Men's SteelToeBoot A size 8W

FFP

Minimum toe protection Alloy or Greater Has Shank for support Cushioning for comfort Slip resistant non-marking rubber outsole Consistent static-dissipative performance or better Single shoe weight for size 9: 570 grams/1.26 pounds (weight +/- 5% variance) Color: Black (See attahed picture for color and shape)

MFR #: A16NN001

MFR: Timberland (Brand name or equal)

0011 6 Pair Men's SteelToeBoot A size 8.5W

FFP

Minimum toe protection Alloy or Greater Has Shank for support Cushioning for comfort Slip resistant non-marking rubber outsole Consistent static-dissipative performance or better Single shoe weight for size 9: 570 grams/1.26 pounds (weight +/- 5% variance) Color: Black (See attahed picture for color and shape)

MFR #: A16NN001

MFR: Timberland (Brand name or equal)

0012 10 Pair Men's SteelToeBoot size 6.5W

FFP

ANSI/ASTM I75 & C75 Approved Leather or Fabric/Leather upper Water resistant Has Shank for support Durable outsole Electrical Hazard Rated Amber or Brown in Color (See attahed picture for color and shape)

MFR #: TM90646

MFR: Timberland (Brand name or equal)

0013 10 Pair Men's SteelToeBoot size 7W

FFP

ANSI/ASTM I75 & C75 Approved Leather or Fabric/Leather upper Water resistant Has Shank for support Durable outsole Electrical Hazard Rated Amber or Brown in Color (See attahed picture for color and shape)

MFR #: TM90646

MFR: Timberland (Brand name or equal)

0014 12 Pair Men's SteelToeBoot size 7.5W

FFP

ANSI/ASTM I75 & C75 Approved Leather or Fabric/Leather upper Water resistant Has Shank for support Durable outsole Electrical Hazard Rated Amber or Brown in Color (See attahed picture for color and shape)

MFR #: TM90646

MFR: Timberland (Brand name or equal)

0015 6 Pair Men's SteelToeBoot size 8W

FFP

ANSI/ASTM I75 & C75 Approved Leather or Fabric/Leather upper Water resistant Has Shank for support Durable outsole Electrical Hazard Rated Amber or Brown in Color (See attahed picture for color and shape)

MFR #: TM90646

MFR: Timberland (Brand name or equal)

0016 2 Pair Men's SteelToeBoot size 8.5W

FFP

ANSI/ASTM I75 & C75 Approved Leather or Fabric/Leather upper Water resistant Has Shank for support Durable outsole Electrical Hazard Rated Amber or Brown in Color (See attahed picture for color and shape)

MFR #: TM90646

MFR: Timberland (Brand name or equal)

0017 2 Pair Men SteelToeBoot Size7D

FFP

ANSI/ASTM I75 & C75 Approved has shank for support Cushioning for comfort Oil and slip resistant rubber outsole Electrical Hazard Rated Color - Peacoat/Dark Grey (See attahed picture for color and shape) MFR #: Z-Keen-1007010 MFR: Keen (Brand name or equal)

0018 4 Pair Men SteelToeBoot Size7.5D

FFP

ANSI/ASTM I75 & C75 Approved has shank for support Cushioning for comfort Oil and slip resistant rubber outsole Electrical Hazard Rated Color - Peacoat/Dark Grey (See attahed picture for color and shape) MFR #: Z-Keen-1007010 MFR: Keen (Brand name or equal)

0019 6 Pair Men SteelToeBoot Size 8D

FFP

ANSI/ASTM I75 & C75 Approved has shank for support Cushioning for comfort Oil and slip resistant rubber outsole Electrical Hazard Rated Color - Peacoat/Dark Grey (See attahed picture for color and shape) MFR #: Z-Keen-1007010 MFR: Keen (Brand name or equal)

0020 2 Pair Men SteelToeBoot Size9D

FFP

ANSI/ASTM I75 & C75 Approved has shank for support Cushioning for comfort Oil and slip resistant rubber outsole Electrical Hazard Rated Color - Peacoat/Dark Grey (See attahed picture for color and shape) MFR #: Z-Keen-1007010 MFR: Keen (Brand name or equal)

0021 2 Pair Men's SteelToeBoot size 7W

FFP

ANSI/ASTM I75 & C75 Approved Leather or Fabric/Leather upper Water resistant Has Shank for support Durable outsole Electrical Hazard Rated Amber or Brown in Color (See attahed picture for color and shape)

MFR #: TM90646

MFR: Timberland (Brand name or equal)

0022 10 Pair Men's SteelToeBoot size 7.5W

FFP

ANSI/ASTM I75 & C75 Approved Leather or Fabric/Leather upper Water resistant Has Shank for support Durable outsole Electrical Hazard Rated Amber or Brown in Color (See attahed picture for color and shape)

MFR #: TM90646

MFR: Timberland (Brand name or equal)

0023 26 Pair Men's SteelToeBoot size 8W

FFP

ANSI/ASTM I75 & C75 Approved Leather or Fabric/Leather upper Water resistant Has Shank for support Durable outsole Electrical Hazard Rated Amber or Brown in Color (See attahed picture for color and shape)

MFR #: TM90646

MFR: Timberland (Brand name or equal)

0024 18 Pair Men's SteelToeBoot size 8.5W

FFP

ANSI/ASTM I75 & C75 Approved Leather or Fabric/Leather upper Water resistant Has Shank for support Durable outsole Electrical Hazard Rated Amber or Brown in Color (See attahed picture for color and shape)

MFR #: TM90646

MFR: Timberland (Brand name or equal)

0025 20 Pair Men's SteelToeBoot size 9W

FFP

ANSI/ASTM I75 & C75 Approved Leather or Fabric/Leather upper Water resistant Has Shank for support Durable outsole Electrical Hazard Rated Amber or Brown in Color (See attahed picture for color and shape)

MFR #: TM90646

MFR: Timberland (Brand name or equal)

0026 2 Pair Men's SteelToeBoot size 9.5W

FFP

ANSI/ASTM I75 & C75 Approved Leather or Fabric/Leather upper Water resistant Has Shank for support Durable outsole Electrical Hazard Rated Amber or Brown in Color (See attahed picture for color and shape)

MFR #: TM90646

MFR: Timberland (Brand name or equal)

0027 2 Pair Men's SteelToe Size7EE

FFP

ANSI/ASTM I75 & C75 Approved Water Resistant, Nubuc Leather Upper Steel toe Removable liner Midsole comfort technology Slip & Oil Resistant Outsole ESD/SD Rated Color -Brown (See attahed picture for color and shape) MFR #: Z-Keen-1007012 MFR: Keen (Brand name or equal)

0028 2 Pair Men's SteelToeSize 8EE

FFP

ANSI/ASTM I75 & C75 Approved Water Resistant, Nubuc Leather Upper Steel toe Removable liner Midsole comfort technology Slip & Oil Resistant Outsole ESD/SD Rated Color -Brown (See attahed picture for color and shape) MFR #: Z-Keen-1007012 MFR: Keen (Brand name or equal)

0029 2 Pair Men's SteelToe Size10EE

FFP

ANSI/ASTM I75 & C75 Approved Water Resistant, Nubuc Leather Upper Steel toe Removable liner Midsole comfort technology Slip & Oil Resistant Outsole ESD/SD Rated Color -Brown (See attahed picture for color and shape) MFR #: Z-Keen-1007012 MFR: Keen (Brand name or equal)

0030 1 Lot Delivery & Handling Charge

FFP

The offeror at their discretion may choose either shipping method, Option #1 or #2 to submit their most competitive price to the Government.(See Page 19, Shipping/Payment Information)

ADDENDUM TO FAR 52.212-1, INSTRUCTIONS TO THE OFFEROR(S)

BASIS OF AWARD

a) The Government will award a contract resulting from this solicitation to the responsible offeror having submitted the lowest-priced, technically acceptable quote that satisfies all terms and conditions of this solicitation. The following factors shall be used to evaluate quotations:

► Factor A. Technical: Specification for the proposed items (Brand name or equal). Quoter shall provide description and specification of each listed item including manufacturer name and model/part number. “The proposed product” must meet, or exceed, the salient physical, functional, or performance characteristic specified in the RFQ.

► Factor B. Price

Note 1: To be determined responsible, a prospective contractor must meet FAR 9.104-1 General Standards.

Note 2: To be determined technically acceptable, the submitted specification must meet salient characteristics stated in each line item of this RFQ.

Note 3: Partial quotation is not acceptable.

Note 4: Award will be based on all or none basis.

(b) 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, may result in a binding contract without further action by either party. Before the offer's specified expiration time, the Government may accept an offer, whether or not there are negotiations after its receipt, unless a written notice of withdrawal is received before award.

INSTRUCTION TO OFFEROR(S)

1. Quotations shall be submitted electronically to Federal Business Opportunities website (https://fbo.gov) within the date and time of the Request for Quotation (RFQ) (Korea Standard Time). All questions should be emailed to myonghui.kang1.ln@mail.mil within 3 days after the solicitation is issued. The electronic bid shall be submitted by 1300 hours (Korea Standard Time) on the closing date of RFQ.

2. Quotation shall include/address the following: Quotation(s) shall contain price(s) and detailed specification of the items (including quoting on brand name items) in the RFQ. Offeror shall not copy, paste, and provide the salient characteristics of the items in the RFQ as the required descriptions/ technical specification

a. Technical: Specification for the proposed items (Brand name or equal) . Quoter shall provide description/specification of each listed item including manufacturer name and model/part number. “The proposed product” must meet, or exceed, the salient physical, functional, or performance characteristic specified in the

RFQ.

b. Price Schedule.

Failure to submit the above requirements may indicate that the offeror fails to understand the requirement, and may be grounds for determining the proposal to be non-responsive and ineligible for contract award in accordance with Basis of Award of this solicitation.

3. All items are “Brand name or equal”.

4. Partial quoation is not acceptable.

5. Award shall be based on ALL or NONE basis.

6. Addendum to local clause 5152.204-4032, FAR 52.212-1 and 2: The terms “Quotation” and “Quoter” shall be substituted for “Offer” and “Offeror.”

7. Local clause 5152.204-4032 shall be submitted upon request from the Contract Specialist. The tax exemptions stated in Clause 5152.204-4032, Representations & Certification will be reviewed by the contracting officer for reasonableness and necessity to complete the work. The contracting officer may reject a proposal if the offeror appears to improperly overstate any proposed tax exemptions or submitted pricing and cost data that appear to be unreasonable.

8. In accordance with FAR 25.1002, solicitations for contracts to be entered into and performed in Korea, to ensure a fair evaluation of offers, the Government will use the Korea Exchange Bank conversion rate on the date specified for receipt of proposal.

9. FOB Destination.

SHIPPING/PAYMENT INSTRUCTIONS

ADDENDUM TO FAR 52.212-4 CONTRACT TERMS AND CONDITIONS—COMMERCIAL ITEMS

1. The offeror at their discretion may choose either shipping method, Option #1 or #2 to submit their most competitive price to the Government.

Option #1 (Door-to-Door Shipping) (Note: This address shall be matched with Option #2, d.)

Door-to-Door delivery to the following address within 30 calendar days or sooner after receipt of order of Modification, FOB: Destination.

Deliver to address indicated as below of this order if 70 lbs or less. The purchase order number (To be determined later ) must be included in the shipping address.

USAG Red Cloud and Area 1 S-2530 Cp Stanly, CPBO, LRC-RC, 403rd AFSB Unit #10624, APO AP 96258- 5707, ATTN: Mr. Song, Ki Po, 732-5896 (DSN)/011-82-503-332-5896, 011-82-31-670-5896 (Commercial)

Option #2 (To Tracy Depot, CA)

a. Point of Embarkation (POE) Designation (Over 70 lbs) is Tracy CA: The POE will be within the 48 contiguous states. The contractor should contact the transportation officer at their local Defense Contract Management Agency Office (DCMAO) for cargo booking and shipping instructions when the cargo does not meet the rules specified in the above information or exceeds the limitations for Cargo Excluded from DLA Consolidation and Containerization Activities paragraph listed below. Partial delivery is not authorized.

b. Delivery to Government POE: The contractor shall deliver items within 30 calendar days to the Government POE as:

Freight Shipping Address: SW3225 Defense Logistics Agency Defense Distribution Depot San Joaquin (DDJC)

TCN: W81BA3-6188-N006XXX

Tracy Depot Bldg 30, CCP 25600 South Chrisman Road Tracy, CA 95304-9150

Commercial Number: (209) 839-4307 or 5597 or 4105 For follow up delivery information, send email to dlacontactcenter@dla.mil or call 1-877-352-2255

Mailing Address:

Defense Logistics Agency Defense Distribution Depot San Joaquin Bldg 30, CCP PO Box 960001 Stockton, CA 95296-0113

Defense Distribution Region West, Tracy, CA 96376 (Delivery Hours 07:00 – 14:30, M-F)

c. FOR GOVERNMENT USE ONLY:

M/F: To be Determined (contract number)

TRANSPORATION CONTROL NUMBER (TCN): W81BA3-6188-N006XXX

REQUIRED DELIVERY (POE):

TRANSPORTATION ACCOUNT CODE (TAC): AZC6

PROJECT: NA

TRANSPORTATION PRIORITY: 02

SUPPLEMENTAL ADDRESS: Y00000

SIGNAL: A

d. END USER DELIVERY INFORMATION:

MARK FOR: USAG Red Cloud and Area 1 S-2530 Cp Stanly, CPBO, LRC-RC, 403rd AFSB Unit #10624, APO AP 96258-5707, ATTN: Mr. Song, Ki Po, 732-5896 (DSN)/011-82-503-332- 5896, 011-82-31-670-5896 (Commercial)

DLA CONSOLIDATION AND CONTAINERIZATION ACTIVITY POINTS OF CONTACT

DDSP – New Cumberland Facility DDJC – Sharpe Facility DSN Voice/FAX 977-6393/8660 DSN Voice/FAX 462-3381/3273

Com Voice/FAX 717/770-6393/8660 Com Voice/FAX 209/982-3381/3273

THE VENDOR MUST INCLUDE A COPY OF THE CONTRACT (SF 1449 OR DD 1155) IN THE

PACKING LIST ATTACHED TO EACH BOX OR CONTAINER.

e. DLA CONSOLIDATION AND CONTAINERIZATION ACTIVITIES i). General: Material advanced to a DLA transshipment activity for movement to an OCONUS activity by surface or air movement, especially hazardous material, must be palletized, properly packed, marked and addressed at point of origin for the ultimate consignee and certified for shipment in accordance with selected mode. Those shipments subject DoD or Service established “Air Challenge” criteria must be “offered and cleared” prior to shipment to the DLA consolidation activity. Shipments downgraded to surface must be marked “Air Denied”. Air-eligible shipments containing hazardous material must be shipped directly to the MILSTAMP designated Aerial Port of Embarkation.

ii) Distribution Depot San Joaquin CA (DDJC) SW3225, formerly W62N2A, accepts surface shipments, except as excluded below, for Army, Air Force and Navy activities located in Hawaii and throughout the Pacific;

Army customers in Alaska; and Marine Corps customers in Okinawa and Saudi Arabia. DDJC also accepts cleared, air-eligible shipments, except as excluded below, for Army activities throughout the Pacific and Alaska and for Navy OCONUS shipments, except CASREP shipments, throughout the Pacific and Hawaii under BBP code 307.

iii). Distribution Depot Susquehanna PA (DDSP) SW3123, formerly W25N14, accepts surface shipments, except as excluded below, for Army and Air Force activities located in Northern and Southern Europe, Africa, South America, Central America. DDSP also accepts cleared, air-eligible shipments, except as excluded below, for Army activities throughout Northern and Southern Europe, Africa, South and Central America.

f. CARGO EXCLUDED FROM DLA CONSOLIDATION AND CONTAINERIZATION

ACTIVITIES

The following material and/ or shipment types should not be routed to a DLA consolidation and containerization activity:

i) Release unit (RU) shipment or combination of LRU’s which economically (by cube or weight) fill a seavan for a single consignee or overseas breakbulk activity.

ii) Single items oversize to a forty-foot seavan (maximum item dimensions L= 456” x W = 89” x H = 88”, or occupying 75 percent or more of the floor space in a 40-foot seavan).

iii) Air –eligible item(s) outsized to a single 463L pallet (L = 96” x W = 87” x H = 90”); or over 10,000 lbs.; or containing hazardous material.

iv) Navy CASREPS and Air Force and Marine Corps high-priority (TP1 or TP2 designated 999, 777, 555, N__, and E__, or RDD under 21 days (60 days USMC) which have not been downgraded to surface.

v) Foreign Military Sales (FMS) shipments (except authorized special projects).

vi) Shipments consisting of material categorized as follows:

ITEM WATER

COMMODITY CODE

Aircraft, unboxed……………………………..…………………………………..…………..(990-999) Arms, ammunition, explosives and radioactive waste…..…………………….…(40X-499;680-686) Baggage/household goods…..……………………………………………………………..…(360-399) Boats..(DDJC & DDSP can accept boats within the limits of paragraph 1b.)……………(640-642) Bulk cargo, unpacked, dry or liquid……………………………………………….………..(200-299)

Classified or intelligence mat’l………………………………………………………….………….NA Controlledsubstances………………………………………………………..……(532/33;537-540/42) Mail..…………………………………………………………………………………………..(610-619) Privately owned vehicles………………………………….………………………………….(300-359) Radioactive material(MILSTAMP Code A)……………………………………………………….NA Refrigerated cargo………………………………………………………………..…………..(100-199) Special cargo…………………………………………………………………………………..(800-899) DDJC & DDSP accept vehicles (except POVs) that can be loaded into a seavan or onto a flatrack.

Subsistence, perishable…………………………………………………………………….…(500-529) MILSTAMP “Type Cargo” code (APPENDIX F20-16)…………………...…A, C, D, F, I, J, P & S

MILSTAMP “Special Handling” codes – Single Handling Condition(APPENDIX F20-18)2, 3, 4, 5, 6,& 7

vii) SHIPPING LABEL

The following may be cut out and used as a shipping label:

W81BA3-6188-N006XXX/TP_/RDD/

DDJC CCP M/F: To be determined later

25600 S CHRISMAN RD WHSE 30

TRACY CA 95304-9150

All lines of the address above must be used.

The TCN number, ending in XXX, is applicable to movement of the material in one complete shipment only.

The XXX denotes a total order, which has not been split. If shipment is made in two or more increments, the first increment shall bear the TCN followed by AXX in lieu of XXX. Subsequent shipments shall be marked with the same TCN followed by BXX, CXX, etc., with the final increment bearing a ZXX.

(Example: Two increments would be AXX and ZXX) Multiple boxes shipped at the same time must be labeled 1 of___(total of boxes) 2 of _____, etc.

2. INSPECTION AND ACCEPTANCE: Inspection for condition, quality count and final acceptance of the supplies delivered under this purchase/delivery order shall be conducted by Receiving Officer or his authorized representative at the final destination point in Korea. After final acceptance of all items, the payment will be made.

3. PAYMENT: All requests for payment, invoice, and payment status will be referred to address in block 18a on SF1449 or block 15 on DD1155. All problems with payment of accounts will be directed to the same office.

Telephone inquiries may be made between 8 am and 11 am, Monday through Friday. Phone: (011-822) 7913-4587.

Payment will be made NET 30 days from date of receipt of invoice in paying office or acceptance of materials/services by the Receiving Officer in Korea, whichever is later.

4. NOTICE TO RECEIVING OFFICER (KOREA); Upon receipt and acceptance of supplies, the receiving report shall be submitted electronically through Wide Area Work Flow – Receipt and Acceptance (WAWF) at the web site https://wawf.eb.mil

CAUTION: Failure to provide completed receiving report on a timely basis may result in a loss of discount, in which event the Receiving Officer is required to furnish reasons for delay so that proper documentation maybe made to explain the loss.

5. RECEIVING OFFICER’S NOTIFICATION TO PURCHASING ACTIVITY OF NON-RECEIPT,

DAMAGE OR NON-CONFORMANCE: The Receiving Officer shall notify the Purchasing Office promptly after date of delivery specifies in the order, of supplies not received, damaged in transit, or not conforming to specifications of the purchase order. Only under extenuating circumstances should such notification be made later than 15 days after specified date of delivery.

6. Partial delivery and partial payment are not authorized.

7. INVOICE SUBMITTAL: IAW FAR 52.232-33, Payment by Electronic Funds Transfer and DFARS 252.232- 7003, Electronic Submission of Payment Requests and Receiving Reports, invoices shall be submitted to the DoDAAC identified in Block #15 of the resultant order through Wide Area Work Flow (WAWF) at https://wawf.eb.mil.

The vendor shall self-register at the web site https://wawf.eb.mil. Vendor training is available on the internet at https://wawftraining.eb.mil. If you are experiencing technical problems with Wide Area Workflow, please contact below service center.

Customer Service Center

CONUS ONLY: 1-866-618-5988

COMMERCIAL: 801-605-7095

DSN: 388-7095

FAX COMMERCIAL: 801-605-7453

FAX DSN: 388-7453

CSCASSIG@CSD.DISA.MIL

A separate invoice will be prepared for every modification.

WIDE AREA WORK FLOW (WAWF) ARMY ELECTRONIC INVOICING INSTRUCTIONS

Invoices for goods received or services rendered under this contract shall be submitted electronically through Wide Area Work Flow – Receipt and Acceptance (WAWF):

The vendor shall self-register at the web site https://wawf.eb.mil. Vendor training is available on the internet at https://wawftraining.eb.mil. If you are experiencing technical problems with Wide Area Workflow, please contact below service center.

Customer Service Center

CONUS ONLY: 1-866-618-5988

COMMERCIAL: 801-605-7095

DSN: 388-7095

FAX COMMERCIAL: 801-605-7453

FAX DSN: 388-7453

CSCASSIG@CSD.DISA.MIL

A separate invoice will be prepared for every modification.

For Supplies: Select the Create Invoice and Receiving Report COMBO within WAWF as the invoice type. The Invoice and Receiving Report COMBO prepares the Material Inspection and Receiving Report, DD Form 250, and the Invoice at the same time.

Select the invoice type within WAWF as specified below. Back up documentation (such as timesheets, etc.) can be included and attached to the invoice in WAWF.

Attachments created in any Microsoft Office product are attachable to the invoice in WAWF.

The following information, regarding invoice routine DODAAC’s, must be e entered for completion of the invoice in WAWF:

WAWF Invoice Type: COMBO

Issuing Office DODAAC

W91QVN

Admin Office DODAAC

W91QVN

Inspector DODAAC (if applicable)

WT4R44

Ship To DODAAC (for Combo), WT4R44

Service Acceptor DODAAC (for 2 in 1), Service Approver DODAAC (for Cost Voucher) (if applicable)

Acceptor DODAAC (if applicable)

WT4R44

Paying Office DODAAC

W56GBU

CLAUSES INCORPORATED BY REFERENCE

52.212-1 Instructions to Offerors--Commercial Items OCT 2015 52.212-4 Contract Terms and Conditions--Commercial Items MAY 2015 52.247-34 F.O.B. Destination NOV 1991 252.225-7041 Correspondence in English JUN 1997 252.233-7001 Choice of Law (Overseas) JUN 1997 252.243-7001 Pricing Of Contract Modifications DEC 1991

CLAUSES INCORPORATED BY FULL TEXT

52.203-3 GRATUITIES (APR 1984)

(a) The right of the Contractor to proceed may be terminated by written notice if, after notice and hearing, the agency head or a designee determines that the Contractor, its agent, or another representative--

(1) Offered or gave a gratuity (e.g., an entertainment or gift) to an officer, official, or employee of the Government;

and

(2) Intended, by the gratuity, to obtain a contract or favorable treatment under a contract.

(b) The facts supporting this determination may be reviewed by any court having lawful jurisdiction.

(c) If this contract is terminated under paragraph (a) of this clause, the Government is entitled--

(1) To pursue the same remedies as in a breach of the contract; and

(2) In addition to any other damages provided by law, to exemplary damages of not less than 3 nor more than 10 times the cost incurred by the Contractor in giving gratuities to the person concerned, as determined by the agency head or a designee. (This subparagraph (c)(2) is applicable only if this contract uses money appropriated to the Department of Defense.)

(d) The rights and remedies of the Government provided in this clause shall not be exclusive and are in addition to any other rights and remedies provided by law or under this contract.

(End of clause)

52.211-6 BRAND NAME OR EQUAL (AUG 1999)

(a) If an item in this solicitation is identified as “brand name or equal,” the purchase description reflects the characteristics and level of quality that will satisfy the Government's needs. The salient physical, functional, or performance characteristics that “equal” products must meet are specified in the solicitation.

(b) To be considered for award, offers of “equal” products, including “equal” products of the brand name manufacturer, must--

(1) Meet the salient physical, functional, or performance characteristic specified in this solicitation;

(2) Clearly identify the item by--

(i) Brand name, if any; and

(ii) Make or model number;

(3) Include descriptive literature such as illustrations, drawings, or a clear reference to previously furnished descriptive data or information available to the Contracting Officer; and

(4) Clearly describe any modifications the offeror plans to make in a product to make it conform to the solicitation requirements. Mark any descriptive material to clearly show the modifications.

(c) The Contracting Officer will evaluate “equal” products on the basis of information furnished by the offeror or identified in the offer and reasonably available to the Contracting Officer. The Contracting Officer is not responsible for locating or obtaining any information not identified in the offer.

(d) Unless the offeror clearly indicates in its offer that the product being offered is an “equal” product, the offeror shall provide the brand name product referenced in the solicitation.

(End of provision)

52.212-2 EVALUATION--COMMERCIAL ITEMS (OCT 2014)

(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:

(Contracting Officer shall insert the significant evaluation factors, such as (i) technical capability of the item offered to meet the Government requirement; (ii) price; (iii) past performance (see FAR 15.304); and include them in the relative order of importance of the evaluation factors, such as in descending order of importance.)

Technical and past performance, when combined, are . (Contracting Officer state, in accordance with FAR 15.304, the relative importance of all other evaluation factors, when combined, when compared to 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 ITEMS (JUL 2016)

ALTERNATE I (OCT 2014)

The offeror shall complete only paragraphs (b) of this provision if the Offeror has completed the annual representations and certification electronically via the System for Award Management (SAM) Web site located at https://www.sam.gov/portal . If the Offeror has not completed the annual representations and certifications electronically, the Offeror shall complete only paragraphs (c) through (r) of this provision.

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

“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. 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.

“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 concern”—

(1) Means a small business concern—

(i) Not less than 51 percent of which is owned 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.

(2) Service-disabled veteran 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).

“Small business concern” means a concern, including its affiliates, that is independently owned and operated, not dominant in the field of operation in which it is bidding on Government contracts, and qualified as a small business under the criteria in 13 CFR Part 121 and size standards in this solicitation.

“Small disadvantaged business concern, consistent with 13 CFR 124.1002,” 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 $750,000 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.

“Veteran-owned small business concern” means a small business concern—

(1) Not less than 51 percent of which is owned 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 the 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.

(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 posted on the SAMwebsite.

(2) The offeror has completed the annual representations and certifications electronically via the SAM website accessed through https://www.acquisition.gov. After reviewing the SAM database information, the offeror verifies by submission of this offer that the representation and certifications currently posted electronically at FAR 52.212-3, Offeror Representations and Certifications—Commercial Items, have been entered or updated in the last 12 months, are current, accurate, complete, and applicable to this solicitation (including the business size standard applicable to the NAICS code referenced for this solicitation), as of the date of this offer and are incorporated in this offer by reference (see FAR 4.1201), except for paragraphs ___ . [Offeror to identify the applicable paragraphs at (c) through (q) 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 to be performed in the United States or its outlying areas. Check all that apply.

(1) Small business concern. The offeror represents as part of its offer that it [ ___ ] is, [ ___ ] is not a small business concern.

(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) Service-disabled veteran-owned small business 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 as part of its offer that it [ ___ ] is, [ ___ ] is not a service-disabled veteran-owned small business concern.

(4) 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 124.1002.

(5) 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.

Note: Complete paragraphs (c)(8) and (c)(9) only if this solicitation is expected to exceed the simplified acquisition threshold.

(6) WOSB concern eligible under the WOSB Program. [Complete only if the offeror represented itself as a women-owned small business concern in paragraph (c)(5) of this provision.] The offeror represents that—

(i) It [ ___ ] is, [ ___ ] is not a WOSB concern eligible under the WOSB Program, has provided all the required documents to the WOSB Repository, and no change in circumstances or adverse decisions have been issued that affects its eligibility; and

(ii) It [ ___ ] is, [ ___ ] is not a joint venture that complies with the requirements of 13 CFR part 127, and the representation in paragraph (c)(6)(i) of this provision is accurate for each WOSB concern eligible under the WOSB Program participating in the joint venture. [The offeror shall enter the name or names of the WOSB concern eligible under the WOSB Program and other small businesses that are participating in the joint venture: ___ .] Each WOSB concern eligible under the WOSB Program participating in the joint venture shall submit a separate signed copy of the WOSB representation.

(7) Economically disadvantaged women-owned small business (EDWOSB) concern. [Complete only if the offeror represented itself as a WOSB concern eligible under the WOSB Program in (c)(6) of this provision.] The offeror represents that—

(i) It [ ___ ] is, [ ___ ] is not an EDWOSB concern, has provided all the required documents to the WOSB Repository, and no change in circumstances or adverse decisions have been issued that affects its eligibility; and

(ii) It [ ___ ] is, [ ___ ] is not a joint venture that complies with the requirements of 13 CFR part 127, and the representation in paragraph (c)(7)(i) of this provision is accurate for each EDWOSB concern participating in the joint venture. [The offeror shall enter the name or names of the EDWOSB concern and other small businesses that are participating in the joint venture: ___ .] Each EDWOSB concern participating in the joint venture shall submit a separate signed copy of the EDWOSB representation.

(8) 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.

(9) 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:

(10) 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, on the List of Qualified HUBZone Small Business Concerns maintained by the Small Business Administration, and no material changes in ownership and control, principal office, or HUBZone employee percentage have occurred since it was certified in accordance with 13 CFR part 126; and

(ii) It [ ___ ] is, [ ___ ] is not a HUBZone joint venture that complies with the requirements of 13 CFR part 126, and the representation in paragraph (c)(10)(i) of this provision is accurate for each HUBZone small business concern participating in the HUBZone joint venture. [The offeror shall enter the names of each of the HUBZone small business concerns participating in the HUBZone joint venture: ___ .] Each HUBZone small business concern participating in the HUBZone joint venture shall submit a separate signed copy of the HUBZone representation.

(11) (Complete if the offeror has represented itself as disadvantaged in paragraph (c)(4) of this provision.)

[The offeror shall check the category in which its ownership falls]:

___ Black American.

___ Hispanic American.

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

___ Asian-Pacific American (persons with origins from Burma, Thailand, Malaysia, Indonesia, Singapore, Brunei, Japan, China, Taiwan, Laos, Cambodia (Kampuchea), Vietnam, Korea, The Philippines, Republic of Palau, Republic of the Marshall Islands, Federated States of Micronesia, the Commonwealth of the Northern Mariana Islands, Guam, Samoa, Macao, Hong Kong, Fiji, Tonga, Kiribati, Tuvalu, or Nauru).

___ Subcontinent Asian (Asian-Indian) American (persons with origins from…

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