REPRESENTATIONS AND CERTIFICATIONS - PART A

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1 REPRESENTATIONS AND CERTIFICATIONS - PART A A SUBCONTRACT/PURCHASE ORDER WILL NOT BE ISSUED PRIOR TO THE RETURN OF THIS COMPLETED, SIGNED, AND DATED REPRESENTATIONS AND CERTIFICATIONS FORM. (Please type or legibly print each answer except where signature is required.) CERTIFICATION OF OFFEROR The undersigned, an authorized representative of the offeror, hereby certifies that to the best of my knowledge and belief, under penalty of perjury, that the Certifications and Representations made herein are true, accurate, and complete. Signature: Printed Name: Title of Signer: Effective Date: Business Legal Name: Business Contractual Address: Address as it should appear on the Subcontract or Purchase Order for Offeror s legal entity. Address City, State, Zip Business Main Telephone and Fax No. PH FAX Offeror s Business Size CAGE Code DUNS # CSR/Federal Employer Tax ID # The State in which Offeror is Incorporated Name of Individual Authorized to Sign Small Business Large Business Small Disadvantaged Business Veteran-owned Business Woman-owned Business Woman-owned Small Disadvantage Business Foreign-owned Business HUBzone Business Native American Business Nonprofit Business/Other 1 of 38

2 Authorized Signer s Title Authorized Signer s Address Will Offeror allow ARA access to proprietary books and records? Have Offeror s following business system s been reviewed by authorized representatives of the U.S. Government? Accounting System Yes No Our Business systems have not been reviewed. Some or all of our systems have been reviewed. (If have been reviewed, complete information below) Agency name: Address: Report number: Date of report: Results (adequate or inadequate) : If no, explain and/or state current status): Estimating System Agency name: Address: Report number: Date of report: Results (adequate or inadequate) : If no, explain and/or state current status): Billing System Agency name: Address: Report number: Date of report: Results (adequate or inadequate) : If no, explain and/or state current status): Purchasing System Agency name: Address: Report number: Date of report: Results (adequate or inadequate): If no, explain and/or state current status): 2 of 38

3 Government Property Control System Agency name: Address: Report number: Date of report: Results (adequate or inadequate) : If no, explain and/or state current status): Does Offeror have a facility clearance? (yes or no) If yes, state level of No Yes, level Does Offeror have an EEO policy? No Yes Does Offeror have a Safety policy? No Yes Does Offeror have an Ethics policy? No Yes What is Offeror s Fiscal year? Offeror s Contractual POC: Offeror s Alternate Contractual POC: Offeror s Financial POC: Name: Address: City, State, Zip: address: Phone: Fax: Name: Address: City, State, Zip: address: Phone: Fax: Name: Address: City, State, Zip: address: Phone: Fax: Does Offeror provide commercial services, as defined by FAR 2.101, (Services of a type offered and sold competitively n substantial quantities in the commercial marketplace based on established catalog or market prices for specific tasks performed or specific outcomes to be achieved and under standard commercial terms and conditions) in support of ARA? No Yes 3 of 38

4 Does Offeror hold any prime government contracts, or subcontracts under other government prime contractors, other than fixed price? (yes or no) If yes, state with whom, value, and period of performance of largest contract. Offeror certifies that a current Reps and Certs exists on the SAM website No Yes, SAM Reps and Certs is current. Effective date is: SAM Reps and Certs is NOT current. Anti-Corruption Law Certification 1 The undersigned company/consultant hereby certifies that the company/consultant, its directors, officers, employees, agents, and anyone acting on its behalf, in connection with all services provided on behalf of Applied Research Associates, Inc. (ARA), have not and will not corruptly to offer, pay, promise to pay, or authorize payment of money, or offer, give, promise to give, or authorize the giving of anything else of value, a foreign official, any foreign political party or official thereof, any candidate for foreign political office, or any person while knowing or being aware of a significant probability that all or a portion of such money or thing of value will be used for the purpose of: influencing any act or decision or inaction of the recipient, securing any improper advantage, or inducing the recipient to use their influence with a foreign government or instrumentality thereof to affect or influence any act or decision of such government or instrumentality, to assist in obtaining or retaining business for, with, or directing business to any person. The undersigned company/consultant further certifies that the company/consultant, its directors, officers, employees, agents, and anyone acting on its behalf, in connection with all services provided on behalf of ARA have not offered, promised, or paid and will not offer, promise, or 1 This certification applies to ARA subcontractors, consultants, agents, or representatives when they are engaged in sales to foreign entities, where foreign means outside the United States. 4 of 38

5 pay, any bribe or kickback to any employee or other member of a commercial enterprise to induce or reward improper performance. The undersigned company/consultant also certifies that it will instruct and adequately train its directors, officers, employees, agents, or anyone acting on its behalf to adhere to these requirements regarding illegal or improper payments, or facilitating such payments in connection with all services provided on behalf of ARA. The undersigned company/consultant agrees that if, after the date of this certification, it becomes aware of any information that would cause this certification to become inaccurate or incomplete, the company/consultant will immediately furnish ARA with a report detailing such circumstances. Name of Company/Consultant: Signature Date Printed/Typed Name Title 5 of 38

6 REPRESENTATIONS AND CERTIFICATIONS - PART B Date Submitted Amount of Subcontract Ceiling/Value $ Summary of Services (Products or Services/overall purpose/expected outcome or results) Subcontract # with Applied Research Associates, Inc. Start Date of Subcontract (MM/DD/YYYY) FAR Reporting Executive Compensation and First-Tier Subcontract Awards (FEB 2012) Section 2(d)(2) of the Federal Funding Accountability and Transparency Act of 2006 (Public Law ), as amended by section 6202 of the Government Funding Transparency Act of 2008 (Public law ) requires contractors to report subcontract/purchase order award data and the total compensation of the five most highly compensated executives of the supplier when certain criteria are met. The law requires all reported information be made public; therefore, the information provided to Applied Research Associates, Inc. (ARA) will be made public. As a supplier or potential supplier to ARA, unless otherwise directed by a contracting officer, ARA shall report the following information in accordance with the FAR clause at SYSTEM FOR AWARD MANAGEMENT (SAM) REGISTRATION It is is not registered in the System for Award Management (SAM) database. 2. DUNS NUMBER. (Provide as it appears in SAM.) Its DUNS number is: Its DUNS Plus 4 number is: or a DUNS Plus 4 number is not applicable. 3. PARENT DUNS NUMBER It does, does not have a parent company. If it has a parent company, the parent company's DUNS number is: _ 4. NORTH AMERICAN INDUSTRY CLASSIFICATION SYSTEM (NAICS) Code of work performed 6 of 38

7 5. LEGAL BUSINESS NAME (Provide as it appears in SAM.) Its legal business name by which it is incorporated and pays taxes is: 6. DOING BUSINESS AS (DBA) (Provide as it appears in SAM.) It commonly uses another name, does not commonly use another name. If it commonly uses another name, the name is 7. SUBCONTRACTOR'S PHYSICAL ADDRESS (P. O. Box or c/o may not be used. Provide as it appears in SAM.) Street Address: City: State: Zip Code + 4 (nine digits required): Congressional district (required if in the United States): 8. PRIMARY PERFORMANCE LOCATION OF THE SUBCONTRACT WORK (IF DIFFERENT) (P. O. Box or c/o may not be used.) Street Address: City: State: Zip Code + 4 (nine digits required): Congressional district (required if in the United States): 9. PLEASE CERITY THE FOLLOWING: Yes No - The annual gross revenues for my organization during the previous Fiscal Year exceeded $300,000. If you answered NO to the above question, no further information is required for Representations and Certifications PART B. Yes No - Information regarding the names and total compensation of each of the most highly compensated executives is not made available via periodic reports filed under section 13(a) or 15(d) of the Securities Exchange Act of 1934 (15 U.S.C.78m(a), 78o(d)), or section 6104 of the Internal Revenue Code of (To determine if the public has access to the 7 of 38

8 compensation information, see U.S. Security and Exchange Commission total compensation filings at And Yes No - During the preceding fiscal year, 80 percent or more of your organization s annual gross revenues were received from Federal contracts (and subcontracts), loans, grants (and sub grants) and cooperative agreements. And Yes No - During the preceding fiscal year $25,000,000 or more in annual gross revenues were received from federal contracts (and subcontracts), loans, grants (and sub grants) and cooperative agreements. If the answer is YES to all the above statements, you must complete the information on Executive Compensation. 10. EXECUTIVE COMPENSATION ("Total Compensation" means the complete pay package of subcontractor employees, including all forms of monthly, benefits, services, and in-kind payments, consistent with the regulations of the Securities and Exchange Commission at 17 CFR Executive means officers, managing partners, or any other employees in management positions.) Information is required for the company s five most-highly compensated employees. NAME TITLE TOTAL COMPENSATION NOTICE: By signing below, the Subcontractor/Supplier represents and certifies that this certification is accurate, current, and complete and that the signer is duly authorized to make such certification on behalf of the Subcontractor/Supplier. Signature Date Printed/Typed Name Title 8 of 38

9 REPRESENTATIONS AND CERTIFICATIONS - PART C TABLE OF CONTENTS K.1 CERTIFICATE OF INDEPENDENT PRICE DETERMINATION (FAR )(APR 1985) 11 K.2 CERTIFICATION AND DISCLOSURE REGARDING PAYMENTS TO INFLUENCE CERTAIN FEDERAL TRANSACTIONS 12 ( ) (Sept 2007) 12 K.3 CONTACT INFORMATION 13 K.4 TAXPAYER IDENTIFICATION ( ) (Oct 1998) 13 K.5 WOMEN-OWNED BUSINESS (OTHER THAN SMALL BUSINESS)( ) (MAY 1999) 15 K.6 ECONOMIC PURCHASE QUANTITY SUPPLIES ( ) (AUG 1987) 15 K.7 PROHIBITION ON CONTRACTING WITH INVERTED DOMESTIC CORPORATIONS ( ) (May 2011) 16 K.8 CERTIFICATION REGARDING RESPONSIBILITY MATTERS ( ) (April 2010) 16 K.9 NOTICE OF PRIORITY RATING FOR NATIONAL DEFENSE EMERGENCY PREPAREDNEDD, AND ENERGY PROGRAM USE ( ) (April 2008) 19 K.10 PLACE OF PERFORMANCE ( ) (OCT 1997) 19 K.11 AUTHORIZED NEGOTIATORS 19 K.12 SMALL BUSINESS PROGRAM REPRESENTATIONS ( ) (APRIL 2012). 20 K.13 PREVIOUS CONTRACTS AND COMPLIANCE REPORTS ( ) (FEB 1999) 23 K.14 AFFIRMATIVE ACTION COMPLIANCE ( ) (APR 1984) 24 K.15 CERTIFICATION OF TOXIC CHEMICAL RELEASE REPORTING (AUG 2003)( ) REMOVED JULY K.16 BUY AMERICAN ACT CERTIFICATE ( ) (FEBRUARY 2009) 24 K.17 BUY AMERICAN ACT FREE TRADE AGREEMENTS ISRAELI TRADE ACT CERTIFICATE ( ) (NOV 2012) 25 K.18 TRADE AGREEMENTS CERTIFICATE ( ) (JAN 2005) 27 K.19 ROYALTY INFORMATION (FAR ) (APR 1984) 28 9 of 38

10 K.20 REPRESENTATION OF LIMITED RIGHTS DATA AND RESTRICTED COMPUTER SOFTWARE ( ) (Dec 2007) 28 K.21 COST ACCOUNTING STANDARDS NOTICES AND CERTIFICATION ( ) (May 2012) 29 K.22 PATENTS -- NOTICE OF GOVERNMENT LICENSEE ( ) (APR 1984) 32 K.23 MANAGEMENT OF GOVERNMENT PROPERTY IN OFFEROR'S POSSESSION (FAR SUBPART 45.5) 33 K.24 RECOVERED MATERIAL CERTIFICATION ( ) (May 2008) 33 K.25 ESTIMATE OF PERCENTAGE OF RECOVERED MATERIAL CONTENT FOR EPA- DESIGNATED PRODUCTS ( ) (MAY 2008) 33 K.26 DISCLOSURE OF OWNERSHIP OR CONTROL BY THE GOVERNMENT OF A TERRORIST COUNTRY (Jan 2009) 35 K.27 REPRESENTATION OF EXTENT OF TRANSPORTATION BY SEA (DFARS ) (AUG 1992) 36 K.28 REQUIREMENT FOR TECHNICAL DATA CERTIFICATION (DoD FAR ) (JUNE 1995) 36 K.29 DISCLOSURE OF OWNERSHIP OR CONTROL BY A FOREIGN GOVERNMENT ( ) (June 2010) 37 NOTICE All such certifications and representations herein shall, with respect to the rights, duties and obligations of ARA and Subcontractor, be interpreted and construed in such manner as to recognize and give effect to the contractual relationship between ARA and the Subcontractor under this Subcontract and the rights of the US Government. As used therein the term "the Contractor" shall mean the Subcontractor and the terms "the Government" and "the Contracting Officer" and equivalent terms shall include ARA and ARA's authorized representative hereunder, respectively, except the terms Government and Contracting Officer do not change: (1) in the phrases Government Property, Government Furnished Property, Government-Owned Property, Government Equipment, and Government-Owned Equipment, (2) when a right, act, authorization or obligation can be granted or performed only by the Government of the Prime Contract Contracting Officer or his duly authorized representative, (3) when access to proprietary financial information or other proprietary data is required, (4) when title to property is to be transferred directly to the Government, (5) where specifically modified as noted below, and (6) in FAR s , , and and DFARS and 252, in which case the terms "the Government" and "the Contracting Officer" shall mean the US Government and the Contracting Officer under the Prime Contract, respectively. In no case shall ARA have access to the Subcontractor's proprietary books and records. Such access shall be limited to authorized Government representatives. Additionally, the date of the provision referenced shall remain fixed. 10 of 38

11 SECTION K REPRESENTATIONS, CERTIFICATIONS AND OTHER STATEMENTS OF OFFERORS The offeror represents and certifies as part of its proposal/quotation that: (Check AND complete all applicable boxes or blocks.) K.1 CERTIFICATE OF INDEPENDENT PRICE DETERMINATION (FAR )(APR 1985) (Applicable to Fixed Price Contracts over $100,000) (a) The offeror certifies that: (1) The prices in its offer have been arrived at independently, without, for the purpose of restricting competition, any consultation, communication, or agreement with any other offeror or competitor relating to: (i) those prices, (ii) the intention of submit an offer, or (iii) the methods or factors used to calculate the prices offered; (2) The prices in its offer have not been and will not be knowingly disclosed by the offeror, directly or indirectly, to any other offeror or competitor before bid opening (in the case of a sealed bid solicitation) or contract award (in the case of a negotiated solicitation) unless otherwise required by law; and (3) No attempt has been made or will be made by the offeror to induce any other concern to submit or not to submit an offer for the purpose of restricting competition. (b) Each signature on the offer is considered to be a certification by the signatory that the signatory: (1) Is the person in the offeror's organization responsible for determining the prices being offered in its bid or proposal, and that the signatory has not participated and will not participate in any action contrary to subparagraphs (a)(1) through (a)(3) of this provision; or (2) (i) Has been authorized, in writing, to act as agent for the following principals in certifying that those principals have not participated, and will not participate in any action contrary to paragraphs (a)(1) through (a)(3) of this provision. 11 of 38

12 (Insert full name of person(s) in the offeror s organization responsible for determining the prices offered in this bid or proposal, and the title of his or her position in the offeror s organization); (ii) As an authorized agent, does certify that the principals named in subdivision (b) (2) (I) of this provision have not participated, and will not participate, in any action contrary to paragraphs (a) (1) through (a) (3) of this provision; and (iii) As an agent, has not personally participated, and will not participate, in any action contrary to paragraphs (a) (1) through (a) (3) of this provision. (c) If the offeror deletes or modifies paragraph (a) (2) of this provision, the offeror must furnish with its offer a signed statement setting forth in detail the circumstances of the disclosure. K.2 CERTIFICATION AND DISCLOSURE REGARDING PAYMENTS TO INFLUENCE CERTAIN FEDERAL TRANSACTIONS ( ) (Sept 2007) (Applicable to all orders over $100,000) a) Definitions. As used in this provision Lobbying contact has the meaning provided at 2 U.S.C. 1602(8). The terms agency, influencing or attempting to influence, officer or employee of an agency, person, reasonable compensation, and regularly employed are defined in the FAR clause of this solicitation entitled Limitation on Payments to Influence Certain Federal Transactions ( ). b) Prohibition. The prohibition and exceptions contained in the FAR clause of this solicitation entitled Limitation on Payments to Influence Certain Federal Transactions ( ) are hereby incorporated by reference in this provision. The offeror, by signing its offer, hereby certifies to the best of his or her knowledge and belief that on or after December 23, 1989, -- c) Certification. The offeror, by signing its offer, hereby certifies to the best of its knowledge and belief that no Federal appropriated funds have been paid or will be paid to any person for influencing or attempting to influence an officer or employee of any agency, a Member of Congress, an officer or employee of Congress, or an employee of a Member of Congress on its behalf in connection with the awarding of this contract. d) Disclosure. If any registrants under the Lobbying Disclosure Act of 1995 have made a lobbying contact on behalf of the offeror with respect to this contract, the offeror shall complete and submit, with its offer, OMB Standard Form LLL, Disclosure of Lobbying Activities, to provide the name of the registrants. The offeror need not report regularly employed officers or employees of the offeror to whom payments of reasonable compensation were made. 12 of 38

13 e) Penalty. Submission of this certification and disclosure is a prerequisite for making or entering into this contract imposed by 31 U.S.C Any person who makes an expenditure prohibited under this provision or who fails to file or amend the disclosure required to be filed or amended by this provision, shall be subject to a civil penalty of not less than $10,000, and not more than $100,000, for each such failure. K.3 CONTACT INFORMATION (Applicable to all orders) (a) Name and address of offeror's cognizant Government Security Office (if classified work is involved). (Name of Cognizant Government Security Office) (Street Address) (City) (State) (Zip Code) (b) Name and address of offeror's cognizant Government Defense Contract Audit Agency (DCAA) Office. (Name of Cognizant Government DCAA Office) (Street Address) (City) (State) (Zip Code) (c) Name and address of offeror's cognizant Government Defense Contract Management Agency (DCMA) Office. (Name of Cognizant Government DCMA Office) (Street Address) (City) (State) (Zip Code) K.4 TAXPAYER IDENTIFICATION ( ) (Oct 1998) (Applicable to all orders) (a) Definitions. 13 of 38

14 Common parent, as used in this provision, means that corporate entity that owns or controls an affiliated group of corporations that files its Federal income tax returns on a consolidated basis, and of which the offeror is a member. Taxpayer Identification Number (TIN), as used in this provision, means the number required by the Internal Revenue Service (IRS) to be used by the offeror in reporting income tax and other returns. The TIN may be either a Social Security Number or an Employer Identification Number. (b) All offerors must submit the information required in paragraphs (d) through (f) of this provision to comply with debt collection requirements of 31 U.S.C.7701(c) and 3325(d), reporting requirements of 26 U.S.C.6041, 6041A, and 6050M, and implementing regulations issued by the IRS. If the resulting contract is subject to the payment reporting requirements described in Federal Acquisition Regulation (FAR) 4.904, the failure or refusal by the offeror to furnish the information may result in a 31 percent reduction of payments otherwise due under the contract. (c) The TIN may be used by the Government to collect and report on any delinquent amounts arising out of the offeror's relationship with the Government (31 U.S.C.7701(c)(3)). If the resulting contract is subject to the payment reporting requirements described in FAR 4.904, the TIN provided hereunder may be matched with IRS records to verify the accuracy of the offeror's TIN. (d) Taxpayer Identification Number (TIN). TIN: TIN has been applied for. TIN is not required because: Offeror is a nonresident alien, foreign corporation, or foreign partnership that does not have income effectively connected with the conduct of a trade or business in the United States and does not have an office or place of business or a fiscal paying agent in the United States; Offeror is an agency or instrumentality of a foreign government; Offeror is an agency or instrumentality of the Federal Government. (e) Type of organization. Sole proprietorship; Partnership; Corporate entity (not tax-exempt); Corporate entity (tax-exempt); Government entity (Federal, State, or local); Foreign government; 14 of 38

15 International organization per 26 CFR ; Other (f) Common parent. Offeror is not owned or controlled by a common parent as defined in paragraph (a) of this provision. Name and TIN of common parent: Name TIN (End of Provision) K.5 WOMEN-OWNED BUSINESS (OTHER THAN SMALL BUSINESS)( ) (MAY 1999) (Applicable for orders that are not set aside for small business concerns and that exceed $100,000, when the subcontract/order is to be performed inside the United States) Women-Owned Business (Other Than Small Business) (May 1999) (a) Definition. Women-owned business concern, as used in this provision, means a concern 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 its stock is owned by one or more women; and whose management and daily business operations are controlled by one or more women. (b) Representation. [Complete only if the offeror is a women-owned business concern and has not represented itself as a small business concern in paragraph (b)(1) of FAR , Small Business Program Representations, of this solicitation.] The offeror represents that it (End of Provision) is a women-owned business concern. K.6 ECONOMIC PURCHASE QUANTITY SUPPLIES ( ) (AUG 1987) (Applicable to all orders that include providing for supplies - Proposals to include Offeror's opinion and recommendations) (a) Offerors are invited to state an opinion on whether the quantity(ies) of supplies on which bids, proposals or quotes are requested in this solicitation is (are) economically advantageous to the Government. (b) Each Offeror who believes that acquisitions in different quantities would be more advantageous is invited to recommend an economic purchase quantity. If different quantities are 15 of 38

16 recommended, a total and a unit price must be quoted for applicable items. An economic purchase quantity is that quantity at which a significant price break occurs. If there are significant price breaks at different quantity points, this information is desired as well. Item Price Quotation OFFEROR RECOMMENDATIONS Quantity Total (c) The information requested in this provision is being solicited to avoid acquisitions in disadvantageous quantities and to assist the Government in developing a data base for future acquisitions of these items. However, ARA reserves the right to amend or cancel the solicitation and re-solicit with respect to any individual item in the event quotations received and the Government's requirements indicate that different quantities should be acquired. K.7 PROHIBITION ON CONTRACTING WITH INVERTED DOMESTIC CORPORATIONS ( ) (May 2011) (a) Definitions. Inverted domestic corporation and subsidiary have the meaning given in the clause of this contract entitled Prohibition on Contracting with Inverted Domestic Corporations ( ). (b) Relation to Internal Revenue Code. An inverted domestic corporation as herein defined does not meet the definition of an inverted domestic corporation as defined by the Internal Revenue Code at 26 U.S.C (c) Representation. By submission of its offer, the offeror represents that (1) It is not an inverted domestic corporation: and (2) It is not a subsidiary of an inverted domestic corporation. (End of provision) K.8 CERTIFICATION REGARDING RESPONSIBILITY MATTERS ( ) (April 2010) (a) (Applicable to all orders over $100,000) (1) The Offeror certifies, to the best of its knowledge and belief, that -- (i) The Offeror and/or any of its Principals -- (A) Are are not presently debarred, suspended, proposed for debarment, or declared ineligible for the award of contracts by any Federal agency; 16 of 38

17 (B) Have have not, within a three-year period preceding this offer, been convicted of or had a civil judgment rendered against them for: commission of fraud or a criminal offense in connection with obtaining, attempting to obtain, or performing a public (Federal, State, or local) contract or subcontract; violation of Federal or State antitrust statutes relating to the submission of offers; or commission of embezzlement, theft, forgery, bribery, falsification or destruction of records, making false statements, tax evasion, violating Federal criminal tax laws, or receiving stolen property (if offeror checks have, the offeror shall also see , if included in this solicitation); and (C) Are are not presently indicted for, or otherwise criminally or civilly charged by a governmental entity with, commission of any of the offenses enumerated in paragraph (a)(1)(i)(b) of this provision; and (D) Have have not, within a three-year period preceding this offer, been notified of any delinquent Federal taxes in an amount that exceeds $3,000 for which the liability remains unsatisfied. (1) Federal taxes are considered delinquent if both of the following criteria apply: (i) The tax liability is finally determined. The liability is finally determined if it has been assessed. A liability is not finally determined if there is a pending administrative or judicial challenge. In the case of a judicial challenge to the liability, the liability is not finally determined until all judicial appeal rights have been exhausted. (ii) The taxpayer is delinquent in making payment. A taxpayer is delinquent if the taxpayer has failed to pay the tax liability when full payment was due and required. A taxpayer is not delinquent in cases where enforced collection action is precluded. (2) Examples. (i) The taxpayer has received a statutory notice of deficiency, under I.R.C. 6212, which entitles the taxpayer to seek Tax Court review of a proposed tax deficiency. This is not a delinquent tax because it is not a final tax liability. Should the taxpayer seek Tax Court review, this will not be a final tax liability until the taxpayer has exercised all judicial appeal rights. (ii) The IRS has filed a notice of Federal tax lien with respect to an assessed tax liability, and the taxpayer has been issued a notice under I.R.C entitling the taxpayer to request a hearing with the IRS Office of Appeals contesting the lien filing, and to further appeal to the Tax Court if the IRS determines to sustain the lien filing. In the course of the hearing, the taxpayer is entitled to contest the underlying tax liability because the taxpayer has had no prior opportunity to contest the liability. This is not a delinquent tax because it is not a final tax liability. Should the taxpayer seek tax court review, this will not be a final tax liability until the taxpayer has exercised all judicial appeal rights. 17 of 38

18 (iii) The taxpayer has entered into an installment agreement pursuant to I.R.C The taxpayer is making timely payments and is in full compliance with the agreement terms. The taxpayer is not delinquent because the taxpayer is not currently required to make full payment. (iv) The taxpayer has filed for bankruptcy protection. The taxpayer is not delinquent because enforced collection action is stayed under 11 U.S.C. 362 (the Bankruptcy Code). (ii) The Offeror has has not, within a three-year period preceding this offer, had one or more contracts terminated for default by any Federal agency. (2) Principal, for the purposes of this certification, means an officer; director; owner; partner; or a person having primary management or supervisory responsibilities within a business entity (e.g., general manager; plant manager; head of a division or business segment; and similar positions). This Certification Concerns a Matter Within the Jurisdiction of an Agency of the United States and the Making of a False, Fictitious, or Fraudulent Certification May Render the Maker Subject to Prosecution Under Section 1001, Title 18, United States Code. (b) The Offeror shall provide immediate written notice to the Contracting Officer if, at any time prior to contract award, the Offeror learns that its certification was erroneous when submitted or has become erroneous by reason of changed circumstances. (c) A certification that any of the items in paragraph (a) of this provision exists will not necessarily result in withholding of an award under this solicitation. However, the certification will be considered in connection with a determination of the Offeror s responsibility. Failure of the Offeror to furnish a certification or provide such additional information as requested by the Contracting Officer may render the Offeror nonresponsible. (d) Nothing contained in the foregoing shall be construed to require establishment of a system of records in order to render, in good faith, the certification required by paragraph (a) of this provision. The knowledge and information of an Offeror is not required to exceed that which is normally possessed by a prudent person in the ordinary course of business dealings. (e) The certification in paragraph (a) of this provision is a material representation of fact upon which reliance was placed when making award. If it is later determined that the Offeror knowingly rendered an erroneous certification, in addition to other remedies available to the Government, the Contracting Officer may terminate the contract resulting from this solicitation for default. (End of Provision) 18 of 38

19 K.9 NOTICE OF PRIORITY RATING FOR NATIONAL DEFENSE EMERGENCY PREPAREDNEDD, AND ENERGY PROGRAM USE ( ) (April 2008) (Applicable to all orders where a rating is cited in the solicitation or the face of the order) Any contract awarded as a result of this solicitation will be DX rated order; DO rated order certified for national defense use under the Defense Priorities and Allocations System (DPAS) (15 CFR 700), and the Contractor will be required to follow all of the requirements of this regulation. [Contracting Officer check appropriate box.] (End of Provision) K.10 PLACE OF PERFORMANCE ( ) (OCT 1997) (Applicable to all orders) (a) The offeror or respondent, in the performance of any contract resulting from this solicitation, intends, does not intend [check applicable block] to use one or more plants or facilities located at a different address from the address of the offeror or respondent as indicated in this proposal or response to request for information. (b) If the offeror or respondent checks "intends" in paragraph (a) of this provision, it shall insert in the following spaces the required information: Place of Performance: Street Address (no PO Boxes) City: State: Zip: Name and Address of Owner and Operator of the Plant or Facility if Other Than Offeror or Respondent (End of Provision) K.11 AUTHORIZED NEGOTIATORS (Applicable to all orders) The Offeror represents that the following persons are authorized to negotiate on its behalf with the Contractor in connection with this request for proposals or quotations. (List names, titles, telephone numbers, and addresses of the Offeror s authorized negotiators.) 19 of 38

20 NAME TITLE PHONE NUMBER ADDRESS K.12 SMALL BUSINESS PROGRAM REPRESENTATIONS ( ) (APRIL 2012). (a) (1) The North American Industry Classification System (NAICS) code for this acquisition is [insert NAICS code]. (2) The small business size standard is [insert size standard]. (3) The small business size standard for a concern which submits an offer in its own name, other than on a construction or service contract, but which proposes to furnish a product which it did not itself manufacture, is 500 employees. (b) Representations. (1) The offeror represents as part of its offer that it is, is not a small business concern. (2) [Complete only if the offeror represented itself as a small business concern in paragraph (b)(1) of this provision.] The offeror represents, for general statistical purposes, that it is, is not, a small disadvantaged business concern as defined in 13 CFR (3) [Complete only if the offeror represented itself as a small business concern in paragraph (b)(1) of this provision.] The offeror represents as part of its offer that it is, is not a women-owned small business concern. (4) Women-owned small business (WOSB) concern eligible under the WOSB Program. [Complete only if the offeror represented itself as a women-owned small business concern in paragraph (b)(3) of this provision.] The offeror represents as part of its offer 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 (b)(4)(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:.] 20 of 38

21 Each WOSB concern eligible under the WOSB Program participating in the joint venture shall submit a separate signed copy of the WOSB representation. (5) Economically disadvantaged women-owned small business (EDWOSB) concern. [Complete only if the offeror represented itself as a women-owned small business concern eligible under the WOSB Program in (b)(4) of this provision.] The offeror represents as part of its offer that-- (i) It is, is not an EDWOSB 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 (b)(5)(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. (6) [Complete only if the offeror represented itself as a small business concern in paragraph (b)(1) of this provision.] The offeror represents as part of its offer that it is, is not a veteran-owned small business concern. (7) [Complete only if the offeror represented itself as a veteran-owned small business concern in paragraph (b)(6) of this provision.] The offeror represents as part of its offer that is is, is not a service-disabled veteran-owned small business concern. (8) [Complete only if the offeror represented itself as a small business concern in paragraph (b)(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 (b)(8)(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. (c) 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 21 of 38

22 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 concern eligible under the WOSB Program. 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 servicedisabled 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 the size standard in paragraph (a) of this provision. 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 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. (d) Notice. 22 of 38

23 (1) If this solicitation is for supplies and has been set aside, in whole or in part, for small business concerns, then the clause in this solicitation providing notice of the set-aside contains restrictions on the source of the end items to be furnished. (2) Under 15 U.S.C. 645(d), any person who misrepresents a firm s status as a business concern that is small, HUBZone small, small disadvantaged, service-disabled veteran-owned small, economically disadvantaged women-owned small, or women-owned small eligible under the WOSB Program in order to obtain a contract to be awarded under the preference programs established pursuant to section 8, 9, 15, 31, and 36 of the Small Business Act or any other provision of Federal law that specifically references section 8(d) for a definition of program eligibility, shall -- (i) Be punished by imposition of fine, imprisonment, or both; (ii) Be subject to administrative remedies, including suspension and debarment; and (iii) Be ineligible for participation in programs conducted under the authority of the Act. (End of Provision) Alternate I (Apr 2011). As prescribed in (a)(2), add the following paragraph (b)(9) to the basic provision: (9) [Complete if offeror represented itself as disadvantaged in paragraph (b)(2) 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, U.S. Trust Territory of the Pacific Islands (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 India, Pakistan, Bangladesh, Sri Lanka, Bhutan, the Maldives Islands, or Nepal). Individual/concern, other than one of the preceding. K.13 PREVIOUS CONTRACTS AND COMPLIANCE REPORTS ( ) (FEB 1999) (Applicable to all orders over $10,000) The offeror represents that 23 of 38

24 (a) It has, has not participated in a previous contract or subcontract subject to the Equal Opportunity clause of this solicitation; (b) It has, has not filed all required compliance reports; and (c) Representations indicating submission of required compliance reports, signed by proposed subcontractors, will be obtained before subcontract awards. (End of Provision) K.14 AFFIRMATIVE ACTION COMPLIANCE ( ) (APR 1984) (Applicable to all orders over $10,000) The offeror represents that (a) it has developed and has on file, has not developed and does not have on file, at each establishment, affirmative action programs required by the rules and regulations of the Secretary of Labor (41 CFR 60-1 and 60-2), or (b) it has not previously had subcontracts subject to the written affirmative action programs requirement of the rules and regulations of the Secretary of Labor. K.15 CERTIFICATION OF TOXIC CHEMICAL RELEASE REPORTING (AUG 2003)( ) REMOVED JULY 2011 K.16 BUY AMERICAN ACT CERTIFICATE ( ) (FEBRUARY 2009) (Applies to orders for supplies over $2,500) (a) The offeror certifies that each end product, except those listed in paragraph (b) of this provision, is a domestic end product and that for other than COTS items, the offeror has considered components of unknown origin to have been mined, produced, or manufactured outside the United States. The offeror shall list as foreign end products those end products manufactured in the United States that do not qualify as domestic end products, i.e., an end product that is not a COTS item and does not meet the component test in paragraph (2) of the definition of domestic end product. The terms commercially available off-the-shelf (COTS) item, component, domestic end product, end product, foreign end product, and United States are defined in the clause of this solicitation entitled Buy American Act Supplies. (b) Foreign End Products: Line Item No.: Country of Origin: (List as necessary) (c) The Government will evaluate offers in accordance with the policies and procedures of Part 25 of the Federal Acquisition Regulation. 24 of 38

25 (End of provision) K.17 BUY AMERICAN ACT FREE TRADE AGREEMENTS ISRAELI TRADE ACT CERTIFICATE ( ) (NOV 2012) As prescribed in (b)(2)(i), insert the following provision: Buy American Act -- Free Trade Agreements--Israeli Trade Act Certificate (Jun 2009) (a) The offeror certifies that each end product, except those listed in paragraph (b) or (c) of this provision, is a domestic end product and that for other than COTS items, the offeror has considered components of unknown origin to have been mined, produced, or manufactured outside the United States. The terms Bahrainian, Moroccan, Omani, Panamanian, or Peruvian end product, commercially available off-the-shelf item, component, domestic end product, end product, foreign end product, Free Trade Agreement country, Free Trade Agreement country end product, Israeli end product, and United States are defined in the clause of this solicitation entitled Buy American Act Free Trade Agreements Israeli Trade Act. (b) The offeror certifies that the following supplies are Free Trade Agreement country end products (other than Bahrainian, Moroccan, Omani, Panamanian, or Peruvian end products) or Israeli end products as defined in the clause of this solicitation entitled Buy American Act-- Free Trade Agreements--Israeli Trade Act : Free Trade Agreement Country End Products (Other than Bahrainian, Moroccan, Omani, Panamanian, or Peruvian End Products) or Israeli End Products: Line Item No.: Country of Origin: [List as necessary] (c) The offeror shall list those supplies that are foreign end products (other than those listed in paragraph (b) of this provision) as defined in the clause of this solicitation entitled Buy American Act--Free Trade Agreement--Israeli Trade Act. The offeror shall list as other foreign end products those end products manufactured in the United States that do not qualify as 25 of 38

26 domestic end products, i.e., an end product that is not a COTS item and does not meet the component test in paragraph (2) of the definition of domestic end product. Other Foreign End Products: Line Item No.: Country of Origin: [List as necessary] (d) The Government will evaluate offers in accordance with the policies and procedures of Part 25 of the Federal Acquisition Regulation. (End of provision) Alternate I (Jan 2004). As prescribed in (b)(2)(ii), substitute the following paragraph (b) for paragraph (b) of the basic provision: (b) The offeror certifies that the following supplies are Canadian end products as defined in the clause of this solicitation entitled Buy American Act--Free Trade Agreements--Israeli Trade Act : Canadian End Products: Line Item No.: [List as necessary] Alternate II (Jan 2004). As prescribed in (b)(2)(iii), substitute the following paragraph (b) for paragraph (b) of the basic provision: (b) The offeror certifies that the following supplies are Canadian end products or Israeli end products as defined in the clause of this solicitation entitled Buy American Act-- Free Trade Agreements--Israeli Trade Act : Canadian or Israeli End Products 26 of 38

27 Line Item No.: Country of Origin: [List as necessary] Alternate III (Nov 2012). As prescribed in (b)(2)(iv), substitute the following paragraph (b) for paragraph (b) of the basic provision: (b) The offeror certifies that the following supplies are Free Trade Agreement country end products (other than Bahrainian, Korean, Moroccan, Omani, Panamanian, or Peruvian end products) or Israeli end products as defined in the clause of this solicitation entitled Buy American Act-- Free Trade Agreements--Israeli Trade Act ; Free Trade Agreement Country End Products (Other than Bahrainian, Korean, Moroccan, Omani, Panamanian, or Peruvian End Products) or Israeli End Products: Line Item No.: Country of Origin: K.18 TRADE AGREEMENTS CERTIFICATE ( ) (JAN 2005) (Applies when is included in solicitation for orders for supplies that exceed $177,000, if the act applies) (a) The offeror certifies that each end product, except those listed in paragraph (b) of this provision, is a U.S.-made or designated country end product, as defined in the clause of this solicitation entitled "Trade Agreements." (b) The offeror shall list as other end products those supplies that are not U.S.-made or designated country end products. Other End Products Line Item No.: Country of Origin: (List as necessary) 27 of 38

28 (c) The Government will evaluate offers in accordance with the policies and procedures of Part 25 of the Federal Acquisition Regulation. For line items covered by the WTO GPA, the Government will evaluate offers of U.S.-made or designated country end products without regard to the restrictions of the Buy American Act. The Government will consider for award only offers of U.S.-made or designated country end products unless the Contracting Officer determines that there are no offers for such products or that the offers for those products are insufficient to fulfill the requirements of this solicitation. K.19 ROYALTY INFORMATION (FAR ) (APR 1984) (Applicable to all orders when royalty information is provided or if Certified Cost or Pricing Data is required) (a) Cost or charges for royalties. When the response to this solicitation contains costs or charges for royalties totaling more than $250, the following information shall be included in the response relating to each separate item of royalty or license fee: (1) Name and address of licenser. (2) Date of license agreement. (3) Patent numbers, patent application serial numbers, or other basis on which the royalty is payable. (4) Brief description, including any part or model numbers of each contract item or component on which the royalty is payable. (5) Percentage or dollar rate of royalty per unit. (6) Unit price of contract item. (7) Number of units. (8) Total dollar amount of royalties. (b) Copies of current licenses. In addition, if specifically requested by Contracting Officer before execution of the contract, the offeror shall furnish a copy of the current license agreement and an identification of applicable claims of specific patents. K.20 REPRESENTATION OF LIMITED RIGHTS DATA AND RESTRICTED COMPUTER SOFTWARE ( ) (Dec 2007) (Applicable to all orders where technical data or computer software is to be delivered) (a) This solicitation sets forth the Government s known delivery requirements for data (as defined in the clause at , Rights in Data General). Any resulting contract may also provide the Government the option to order additional data under the Additional Data Requirements clause at , if included in the contract. Any data delivered under the resulting contract will be subject to the Rights in Data General clause at included in this contract. Under the latter clause, a Contractor may withhold from delivery data that qualify 28 of 38