W91QVN-16-T-0231.doc

Section SF 1449 - CONTINUATION SHEET

HDT AIRBEAM TENT - BRAND NAME OR EQUAL

FFP

HDT SHELTER, AIRBEAM, 3236A, TAN

BRAND NAME OR EQUAL

Salient Characteristics:

- Must include (2) tapered end walls with doors

- Width: 32 - 35 feet

- Length: 58 - 72 feet

- Total useable area: 1422 ft2 - 1500 ft2

- Square feet interior: 1560 -1640

- Height: 16' - 18'5"

- Set up time: within 40 min

- Personnel to set up: 6-10

- Compatible with DRASH LRG and Med Tents

- Be able to transport with DRASH HP-8 Trailer

- Side ECU Ports

- 4 -6 windows

- Include internal liner

- Integrated Plenum

- Include Wiring Harness

- Tan color

- Removable floor

- Include sand bag flaps

- Anchor tie down points

- Include stake kits, stake plates, and repair kit

- Warranty 2 years

FOB: Destination

PURCHASE REQUEST NUMBER: 0010934592-0001

NET AMT

HDT AIRBEAM BOOT - BRAND NAME OR EQUAL

HDT BOOT, AIRBEAM TEMPER TO DRASH

BRAND NAME OR EQUAL

Salient Characteristics:

- 6 x Temper Adaptor Doors (2 doors each end, 2 side doors)

- Must be comatible between Air Beam Tents and DRASH LRG and MED Tents

- Tan colored

NET AMT

HDT COMPRESSOR - BRAND NAME OR EQUAL

HDT COMPRESSOR, AIR, DIESEL, 17CFM

BRAND NAME OR EQUAL

Salient Characteristics:

- Must be deployable in the following systems DRASH Trailer, LMPV, ISU90 or Connex.

- Neutral colored

NET AMT

FREIGHT

FREIGHT

NET AMT

ADDENDUM TO FAR 52.212-1

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

QUOTATION INFORMATION & REQUIREMENT

1. Quotations shall be submitted to the Federal Business Opportunities (FBO) website (https://www.fbo.gov/), or if FBO is not available, email to anna.w.lee.civ@mail.mil with the evidence document such as screen shot. The FBO unavailability is limited to ONLY FBO server problem not individual failure/problem. All questions should be emailed to anna.w.lee.civ@mail.mil within 1 day after the solicitation is issued. The electronic bid shall be submitted by the closing date and time of the solicitation. Partial quotation will not be acceptable.

2. The offeror(s) shall submit the following requirements IAW Para 1 above.

a. Technical Proposal:

i) Technical proposal shall contain description/specification of each listed item including manufacturer name and model/part number as applicable.

ii) The proposed “equal product” must meet, or exceed, the salient physical, functional, or performance characteristics specified in the solicitation including manufacturer name and model/part number as applicable. For equal product, without supporting information, only copy and paste of salient characteristics as listed in the solicitation with each item in the quotation is not acceptable, and will not be considered for an award.

iii) Even if the exact "brand name" is submitted, the offerer shall submit the respective specifications with their quotation.

b. Past Performance: Furnish information indicated below for contracts in progress and the three (3) most recent government and commercial contracts offeror has performed during the past three (3) years of the similar scope and similar dollar value as that contained in the solicitation.

i. Contract Number

ii. Contract Date

iii. Contract Amount

iv. Contracting Agency

v. Project Officer & Phone #

vi. Project Description

Satisfactory or higher past performance rating on the government and commercial projects similar in nature, scope and dollar value to the subject solicitation during the past three (3) years will be considered as “Acceptable Past Performance”.

If the offeror is a new entrant to the business and/or no past performance data is available, the offeror shall indicate “NEW ENTRANT” on the past performance proposal and the offeror will be considered to have “Neutral Rating.” . It will be considered to be “Acceptable”.

Each offeror shall submit any known adverse past performance information including all relevant supporting details with their proposal. Each offeror shall provide a copy of any cure notices or show cause letters received on each contract listed and a description of any corrective action by the offeror. The offeror shall also provide the information listed above on any contract that has been terminated, in whole or in part, for default during the past three (3) years, or any contracts which are currently in the process of such termination. This information is required for any contract, whether similar or not to the proposed effort. If the contract is awarded based on the false information, the contract will be terminated for cause of the contractor.

The Government reserves right to conduct investigation of the offeror’s past performances, not limited to the listed past performances on the Past Performance proposal.

c. Price Schedule.

3. Failure to submit the above requirements may be grounds for determining the proposal to be non-compliant and not eligible to be considered for award.

4. The terms “Quotation” and “Quoter” shall be substituted for “Offer” and “Offeror” in this solicitation.

5. 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 Government current fiscal year conversion rate.

(End of Summary of Changes)

BASIS OF AWARD

BASIS OF AWARD

Award will be made to the responsible offeror(s) submitting the lowest priced, technically acceptable (LPTA) offer(s) that satisfies all terms and conditions of this solicitation. The following evaluation factors will be used to evaluate each offer: Each non-price factor will be rated as either acceptable or unacceptable. If any of factor is rated as unacceptable, the overall factor rating is unacceptable and the entire proposal is unacceptable.

Factor A: Technical

The Government will evaluate the offeror’s proposal against Government’s minimum requirements as specified on the solicitation to determine whether the proposal is acceptable or unacceptable using the ratings and descriptions outlined in table below.

Technical Acceptable/Unacceptable Ratings

Factor B: Past Performance The Government will evaluate the offeror’s record of past and current performance to ascertain the probability of successfully performing the required efforts of the solicitation requirements. This factor will be evaluated on an “acceptable” or “unacceptable” basis using the ratings in below table. Past Performance will be evaluated based upon offeror’s client’s satisfaction on similar projects within the last 3 years. In determining the acceptability, each offeror shall be required to submit Past Performance Information within the last three (3) years in accordance with responses received to the Proposal Instruction (Addendum to FAR 52.212-1, Instructions to the offeror(s)). The Government reserves the right to obtain past performance from any reasonable source available, including Government databases in order to evaluate past performance.

Past Performance Evaluation Ratings

* Note: In the case of an offeror without a record of relevant past performance or for whom information on past performance is not available or so sparse that no meaningful past performance rating can be reasonably assigned, the offeror may not be evaluated favorably or unfavorably on past performance (see FAR 15.305 (a)(2)(iv)). Therefore, the offeror shall be determined to have unknown past performance. “Unknown” will be considered “acceptable.”

Factor C: Price (Price will be evaluated in accordance with FAR 15.404.)

SHIPPING INSTRUCTIONS

ADDENDUM TO FAR 52.212-4 Contract Terms and Conditions—Commercial Items

1. SHIPPING INSTRUCTIONS:

To Tracy Depot, CA

a. Deliver to address indicated in block 15 of this order if 70 lbs or less. A Return Receipt should be purchased for the proof of delivery. The Receiving Officer’s name is stated in block 15 of this order. The purchase order number (W91QVN-09-P-XXXX/W807YL-XXXX-XXXX ) must be included in the shipping address.

b. 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.

c. 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: TBD

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)

d. FOR GOVERNMENT USE ONLY:

M/F: To be Determined (contract number)

TRANSPORATION CONTROL NUMBER (TCN): TBD

REQUIRED DELIVERY (POE):

TRANSPORTATION ACCOUNT CODE (TAC): TBD

PROJECT: NA

TRANSPORTATION PRIORITY: 02

SUPPLEMENTAL ADDRESS: Y00000

SIGNAL: A

e. END USER DELIVERY INFORMATION:

MARK FOR: Department of the Army, Korea

TBD

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.

f. 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.

g. 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:

TBD

DDJC CCP M/F: TBD

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. Invoice Submittal:

The Contractor shall submit the invoice IAW DFARs 252.232-7003 Electronic Submission of Payment Requests and Receiving Reports. Upon notification from the Receiving Officer, the invoice shall be submitted electronically through Wide Area Work Flow – Receipt and Acceptance (WAWF) at the web site https://wawf.eb.mil .

7. Partial delivery and partial payment are not authorized.

CLAUSES INCORPORATED BY REFERENCE

CLAUSES INCORPORATED BY FULL TEXT

52.252-1 SOLICITATION PROVISIONS INCORPORATED BY REFERENCE (FEB 1998)

This solicitation incorporates one or more solicitation provisions by reference, with the same force and effect as if they were given in full text. Upon request, the Contracting Officer will make their full text available. The offeror is cautioned that the listed provisions may include blocks that must be completed by the offeror and submitted with its quotation or offer. In lieu of submitting the full text of those provisions, the offeror may identify the provision by paragraph identifier and provide the appropriate information with its quotation or offer. Also, the full text of a solicitation provision may be accessed electronically at this/these address(es):

http://acquisition.gov/far/index.html http://www.acq.osd.mil/dpap/dars/dfars/

(End of provision)

52.252-2 CLAUSES INCORPORATED BY REFERENCE (FEB 1998)

This contract incorporates one or more clauses by reference, with the same force and effect as if they were given in full text. Upon request, the Contracting Officer will make their full text available. Also, the full text of a clause may be accessed electronically at this/these address(es):

http://acquisition.gov/far/index.html http://www.acq.osd.mil/dpap/dars/dfars/

(End of clause)

252.225-7043 ANTITERRORISM/FORCE PROTECTION POLICY FOR DEFENSE CONTRACTORS OUTSIDE THE UNITED STATES (JUN 2015)

(a) Definition. United States, as used in this clause, means, the 50 States, the District of Columbia, and outlying areas.

(b) Except as provided in paragraph (c) of this clause, the Contractor and its subcontractors, if performing or traveling outside the United States under this contract, shall--

(1) Affiliate with the Overseas Security Advisory Council, if the Contractor or subcontractor is a U.S. entity;

(2) Ensure that Contractor and subcontractor personnel who are U.S. nationals and are in-country on a non-transitory basis, register with the U.S. Embassy, and that Contractor and subcontractor personnel who are third country nationals comply with any security related requirements of the Embassy of their nationality;

(3) Provide, to Contractor and subcontractor personnel, antiterrorism/force protection awareness information commensurate with that which the Department of Defense (DoD) provides to its military and civilian personnel and their families, to the extent such information can be made available prior to travel outside the United States; and

(4) Obtain and comply with the most current antiterrorism/force protection guidance for Contractor and subcontractor personnel.

(c) The requirements of this clause do not apply to any subcontractor that is--

(1) A foreign government;

(2) A representative of a foreign government; or

(3) A foreign corporation wholly owned by a foreign government.

(d) Information and guidance pertaining to DoD antiterrorism/force protection can be obtained from HQDA-AT;

telephone, DSN 222-9832 or commercial (703) 692-9832.

(End of clause)

252.232-7006 WIDE AREA WORKFLOW PAYMENT INSTRUCTIONS (MAY 2013)

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

Department of Defense Activity Address Code (DoDAAC) is a six position code that uniquely identifies a unit, activity, or organization.

Document type means the type of payment request or receiving report available for creation in Wide Area WorkFlow (WAWF).

Local processing office (LPO) is the office responsible for payment certification when payment certification is done external to the entitlement system.

(b) Electronic invoicing. The WAWF system is the method to electronically process vendor payment requests and receiving reports, as authorized by DFARS 252.232-7003, Electronic Submission of Payment Requests and Receiving Reports.

(c) WAWF access. To access WAWF, the Contractor shall--

(1) Have a designated electronic business point of contact in the System for Award Management at https://www.acquisition.gov; and

(2) Be registered to use WAWF at https://wawf.eb.mil/ following the step-by-step procedures for self-registration available at this Web site.

(d) WAWF training. The Contractor should follow the training instructions of the WAWF Web-Based Training Course and use the Practice Training Site before submitting payment requests through

WAWF. Both can be accessed by selecting the “Web Based Training” link on the WAWF home page at https://wawf.eb.mil/.

(e) WAWF methods of document submission. Document submissions may be via Web entry, Electronic Data Interchange, or File Transfer Protocol.

(f) WAWF payment instructions. The Contractor must use the following information when submitting payment requests and receiving reports in WAWF for this contract/order:

(1) Document type. The Contractor shall use the following document type(s).

COMBO

(2) Inspection/acceptance location. The Contractor shall select the following inspection/acceptance location(s) in WAWF, as specified by the contracting officer.

(Contracting Officer: Insert inspection and acceptance locations or “Not applicable”.)

(3) Document routing. The Contractor shall use the information in the Routing Data Table below only to fill in applicable fields in WAWF when creating payment requests and receiving reports in the system.

Routing Data Table*

Field Name in WAWF

Data to be entered in WAWF

Pay Official DoDAAC

W56GBU

Issue By DoDAAC

W91QVN

Admin DoDAAC

W91QVN

Inspect By DoDAAC

W81BA2

Ship To Code

W81BA2

Ship From Code

Mark For Code

Service Approver (DoDAAC)

Service Acceptor (DoDAAC)

Accept at Other DoDAAC

LPO DoDAAC

DCAA Auditor DoDAAC

Other DoDAAC(s)

(*Contracting Officer: Insert applicable DoDAAC information or “See schedule” if multiple ship to/acceptance locations apply, or “Not applicable.”)

(4) Payment request and supporting documentation. The Contractor shall ensure a payment request includes appropriate contract line item and subline item descriptions of the work performed or supplies delivered, unit price/cost per unit, fee (if applicable), and all relevant back-up documentation, as defined in DFARS Appendix F, (e.g. timesheets) in support of each payment request.

(5) WAWF email notifications. The Contractor shall enter the email address identified below in the “Send Additional Email Notifications” field of WAWF once a document is submitted in the system.

(Contracting Officer: Insert applicable email addresses or “Not applicable.”)

(g) WAWF point of contact. (1) The Contractor may obtain clarification regarding invoicing in WAWF from the following contracting activity's WAWF point of contact.

(Contracting Officer: Insert applicable information or “Not applicable.”)

(2) For technical WAWF help, contact the WAWF helpdesk at 866-618-5988.

(End of clause)

5152.204-4032 REPRESENTATIONS AND CERTIFICATIONS

(a) SUBCONTRACTING:

If the offeror contemplates subcontracting, it must obtain prior written approval of subcontractor from the PCO or ACO, and list below: (1) the names and addresses of the subcontractor(s), (2) the type of subcontracting, and (3) the estimated price for each subcontract.

(b) AFFILIATED OFFERORS:

(1) Business concerns are affiliates of each other when, either directly or indirectly, one concern controls or has the power to control the other, or a third party controls or has the power to control both.

(2) Each offeror shall furnish, below, the following information:

(i) Whether the offeror has any affiliates;

(ii) The names and addresses of all affiliates of the offeror; and

(iii) The names and addresses of all persons and concerns exercising control or ownership of the offeror and any or all of its affiliates, and whether they are common officers, directors, stockholders holding controlling interest, or otherwise.

AFFILIATED CONCERNS. : (Name, location and, in detail, controlling interest in each)

(c) PRINCIPAL OWNER(S) OR STOCKHOLDER(S):

Each offeror shall list below the name(s) and address(es) of the principal owner(s) or stockholder(s) of the company and percentage of ownership. If a major portion is publicly traded and/or otherwise widely distributed, state that, with the percentage so affected.

(d) STANDARDS OF CONDUCT CERTIFICATION:

This is to certify that, to the best of my knowledge and belief, except as described below, no representative of this firm who deals with US Government employees on any aspect of this procurement is a former US Government employee, to include former US military personnel. I understand that this certification is continuing in nature and places a duty on me and my firm to notify the Contracting Officer of any additional individual(s) who fit the above description prior to the individual's assuming duties.

(i) Name ______________________________________________

Former rank/grade ____________________________________

Last US Government position ___________________________

(ii) Name ______________________________________________

Former rank/grade ____________________________________

Last US Government position ___________________________

(iii) Name ______________________________________________

Former rank/grade ____________________________________

Last US Government position ___________________________

Firm ____________________________________________________

Name _____________________________________________________

Signature __________________________________________________

Title _____________________________________________________

Date of Execution ____________________________________________

(e) TAXES:

(1) References:

(i) Contract clause entitled "FAR 52.229-06 Taxes—Foreign Fixed-Price Contracts (Jan 1991)."

(ii) US-ROK Status of Forces Agreement (SOFA), Articles IX and XVI.

(iii) ROK Customs Law, Law No. 1976, promulgated on 29 November 1967, as amended.

(iv) ROK Value Added Tax Law, Law No. 2934, promulgated on 22 December 1976 (effective date 1 July 1977), as amended.

(v) ROK Special Excise Tax Law, Law No. 2935, promulgated on 22 December 1976 (effective date 1 July 1977), as amended.

(2) Contractor shall state the types and estimated amount of taxes that would normally apply to such transactions but are excluded from this proposal.

(i) Customs Tax (except for ROK MND-funded contracts or delivery orders):

Name Number Cost/Unit of Item of Units w/o Tax % of Tax Tax/Unit Tax Total

This item will be imported specifically for this contract? Yes _____ No _____

(ii) Special Excise Tax:

Name Number Cost/Unit of Item of Units w/o Tax % of Tax Tax/Unit Tax Total

Name of item manufacturer

(iii) Value Added Tax (VAT):

Input VAT on materials purchased for this contract. 10% _____

Input VAT on transportation leased/rented for this contract.10% _____

Input VAT on equipment leased/rented for this contract. 10% _____

Input VAT on services purchased for this contract. 10% _____

Output VAT on total contract amount. 10% _____

(iv) Special Excise (Petroleum) Tax:

No. of U/P

Liters w/o Tax Tax/Unit Total Tax Amount

Regular Gasoline ________ (L) ________ w________ w_____________

Premium Gasoline ________ (L) ________ w________ w_____________

Diesel ________ (L) ________ w________ w_____________

Other ________ (L) ________ w________ w_____________

(v) Education Tax.

(3) Name of the oil company from which POL products will be purchased:

Oil Company: _________________________________________ (Name only)

(4) I certify by this submission that all supplies and services to be purchased for this contract have been proposed exclusive of Value Added Tax, applicable Customs Tax (except ROK MND-funded contracts and delivery orders), Special Excise Tax, and Education Tax.

Signed (Chop)

(f) CERTIFICATIONS AND REPRESENTATIONS

By submitting an offer, each offeror agrees to be bound by all certifications and representations in this solicitation. The Government reserves the right to require any and all certifications and representations to be completed and signed in hard copy by the successful offeror prior to contract award. Failure of an offeror to complete the certifications and representations within the time directed by the Contracting Officer may result in a determination that the contractor is not a responsible offeror for this acquisition.

5152.233-4703 AMC-LEVEL PROTEST PROGRAM

If you have complaints about this procurement, it is preferable that you first attempt to resolve those concerns with the responsible contracting officer. However, you can also protest to Headquarters, AMC. The HQ, AMC-Level Protest Program is intended to encourage interested parties to seek resolution of their concerns within AMC as an Alternative Dispute Resolution forum, rather than filing a protest with the General Accounting Office or other external forum. Contract award or performance is suspended during the protest to the same extent, and within the same time periods, as if filed at the GAO. The AMC protest decision goal is to resolve protests within 20 working days from filing. To be timely, protests must be filed within the periods specified in FAR 33.103. If you want to file a protest under the AMC-Level Protest Program, the protest must request resolution under that program and be sent to the address below. All other agency-level protests should be sent to the contracting officer for resolution.

Headquarters U.S. Army Materiel Command

Office of Command Counsel

4400 Martin Road

Rm: A6SE040.001

Redstone Arsenal, AL 35898-5000

Facsimile number (256)450-8840

The AMC-Ievel protest procedures are found at:

http://www.amc.army.mil/pa/COMMANDCOUNSEL.asp If Internet access is not available, contact the contracting officer or HQ, AMC to obtain the AMC-Level Protest Procedures.

(End of Provision)