Page 1of 12 SUPPLIER RFQ# P/N# ATTACHMENT A SUPPLIER CERTIFICATIONS PACKAGE FORM $25,000 $100,000 $650,000 1. Cost Accounting Standards and Notices X 2. Certification Regarding Responsibility Matters X X X 3. Buy American Act - Balance of Payments Program Certificate X X X 4. Prohibition on Conducting Restricted Business Operations in Sudan X X X 5. Offeror s Assertion of Commerciality (Applicable X X X if offeror is asserting item to be supplied is commercial as defined in FAR 2.101.) NOTE: Suppliers must be registered within the Central Contractor Registry (http://www.ccr.gov). Additionally, applicable certifications and representations must be submitted via the Online Representations and Certifications (ORCA) website. Such application is valid for a one year period, and must be renewed annually. Please indicate ORCA validity dates: (https://orca.bpn.gov) ORCA certification is valid from to. Supplier is requested to return the completed forms with the Request for Quote when proposed dollar value exceeds the thresholds listed above. Additional certifications may be required.
Page 2 of 12 FAR 52.230-1 Cost Accounting Standards Notices and Certification (OCT 2008) Note: This notice does not apply to small businesses or foreign governments. This notice is in three parts, identified by Roman numerals I through III. Offerors shall examine each part and provide the requested information in order to determine Cost Accounting Standards (CAS) requirements applicable to any resultant contract. If the offeror is an educational institution, Part II does not apply unless the contemplated contract will be subject to full or modified CAS coverage pursuant to 48 CFR 9903.201 2(c)(5) or 9903.201 2(c)(6), respectively. I. Disclosure Statement Cost Accounting Practices and Certification (a) Any contract in excess of $650,000 resulting from this solicitation will be subject to the requirements of the Cost Accounting Standards Board (48 CFR Chapter 99), except for those contracts which are exempt as specified in 48 CFR 9903.201 1. (b) Any offeror submitting a proposal which, if accepted, will result in a contract subject to the requirements of 48 CFR chapter 99 must, as a condition of contracting, submit a Disclosure Statement as required by 48 CFR 9903.202. When required, the Disclosure Statement must be submitted as a part of the offeror's proposal under this solicitation unless the offeror has already submitted a Disclosure Statement disclosing the practices used in connection with the pricing of this proposal. If an applicable Disclosure Statement has already been submitted, the offeror may satisfy the requirement for submission by providing the information requested in paragraph (c) of Part I of this provision. CAUTION: In the absence of specific regulations or agreement, a practice disclosed in a Disclosure Statement shall not, by virtue of such disclosure, be deemed to be a proper, approved, or agreed-to practice for pricing proposals or accumulating and reporting contract performance cost data. (c) Check the appropriate box below: o (1) Certificate of Concurrent Submission of Disclosure Statement. The offeror hereby certifies that, as a part of the offer, copies of the Disclosure Statement have been submitted as follows: (i) original and one copy to the cognizant Administrative Contracting Officer (ACO) or cognizant Federal agency official authorized to act in that capacity (Federal official), as applicable, and (ii) one copy to the cognizant Federal auditor. (Disclosure must be on Form No. CASB DS 1 or CASB DS 2, as applicable. Forms may be obtained from the cognizant ACO or Federal official and/or from the loose-leaf version of the Federal Acquisition Regulation.) Date of Disclosure Statement: Name and Address of Cognizant ACO or Federal Official Where Filed: The offeror further certifies that the practices used in estimating costs in pricing this proposal are consistent with the cost accounting practices disclosed in the Disclosure Statement. o (2) Certificate of Previously Submitted Disclosure Statement. The offeror hereby certifies that the required Disclosure Statement was filed as follows:
Page 3 of 12 Date of Disclosure Statement: Name and Address of Cognizant ACO or Federal Official Where Filed: The offeror further certifies that the practices used in estimating costs in pricing this proposal are consistent with the cost accounting practices disclosed in the applicable Disclosure Statement. o (3) Certificate of Monetary Exemption. The offeror hereby certifies that the offeror, together with all divisions, subsidiaries, and affiliates under common control, did not receive net awards of negotiated prime contracts and subcontracts subject to CAS totaling $50 million or more in the cost accounting period immediately preceding the period in which this proposal was submitted. The offeror further certifies that if such status changes before an award resulting from this proposal, the offeror will advise the Contracting Officer immediately. o (4) Certificate of Interim Exemption. The offeror hereby certifies that (i) the offeror first exceeded the monetary exemption for disclosure, as defined in (3) of this subsection, in the cost accounting period immediately preceding the period in which this offer was submitted and (ii) in accordance with 48 CFR 9903.202 1, the offeror is not yet required to submit a Disclosure Statement. The offeror further certifies that if an award resulting from this proposal has not been made within 90 days after the end of that period, the offeror will immediately submit a revised certificate to the Contracting Officer, in the form specified under subparagraph (c)(1) or (c)(2) of Part I of this provision, as appropriate, to verify submission of a completed Disclosure Statement. CAUTION: Offerors currently required to disclose because they were awarded a CAS-covered prime contract or subcontract of $50 million or more in the current cost accounting period may not claim this exemption (4). Further, the exemption applies only in connection with proposals submitted before expiration of the 90-day period following the cost accounting period in which the monetary exemption was exceeded. II. Cost Accounting Standards Eligibility for Modified Contract Coverage If the offeror is eligible to use the modified provisions of 48 CFR 9903.201 2(b) and elects to do so, the offeror shall indicate by checking the box below. Checking the box below shall mean that the resultant contract is subject to the Disclosure and Consistency of Cost Accounting Practices clause in lieu of the Cost Accounting Standards clause. o The offeror hereby claims an exemption from the Cost Accounting Standards clause under the provisions of 48 CFR 9903.201 2(b) and certifies that the offeror is eligible for use of the Disclosure and Consistency of Cost Accounting Practices clause because during the cost accounting period immediately preceding the period in which this proposal was submitted, the offeror received less than $50 million in awards of CAS-covered prime contracts and subcontracts. The offeror further certifies that if such status changes before an award resulting from this proposal, the offeror will advise the Contracting Officer immediately. CAUTION: An offeror may not claim the above eligibility for modified contract coverage if this proposal is expected to result in the award of a CAS-covered contract of $50 million or more or if, during its current cost accounting period, the offeror has been awarded a single CAS-covered prime contract or subcontract of $50 million or more.
Page 4 of 12 III. Additional Cost Accounting Standards Applicable to Existing Contracts The offeror shall indicate below whether award of the contemplated contract would, in accordance with subparagraph (a)(3) of the Cost Accounting Standards clause, require a change in established cost accounting practices affecting existing contracts and subcontracts. o Yes o No (End of provision) Alternate I (APR 1996). As prescribed in 30.201 3(b), add the following subparagraph (c)(5) to Part I of the basic provision: o (5) Certificate of Disclosure Statement Due Date by Educational Institution. If the offeror is an educational institution that, under the transition provisions of 48 CFR 9903.202 1(f), is or will be required to submit a Disclosure Statement after receipt of this award, the offeror hereby certifies that (check one and complete): o (i) A Disclosure Statement Filing Due Date of has been established with the cognizant Federal agency. (ii) The Disclosure Statement will be submitted within the 6-month period ending months after receipt of this award. Name and Address of Cognizant ACO or Federal Official Where Disclosure Statement is to be Filed:
Page 5 of 12 52.209-5 Certification Regarding Responsibility Matters (DEC 2008). (a)(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; (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; (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 subdivision (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. 6320 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. ( iii ) The taxpayer has entered into an installment agreement pursuant to I.R.C. 6159. 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 3-year period preceding this offer, had one or more contracts terminated for default by any Federal agency.
Page 6 of 12 (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 subsidiary, division, or business segment; and similar positions). (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)
Page 7 of 12 DFARS 252.225-7000 Buy American Act--Balance of Payments Program Certificate. (JAN 2009) (a) Definitions. Commercially available off-the-shelf (COTS) item, domestic end product, foreign end product, qualifying country, qualifying country end product, and United States have the meanings given in the Buy American Act and Balance of Payments Program clause of this solicitation. (b) Evaluation. The Government (1) Will evaluate offers in accordance with the policies and procedures of Part 225 of the Defense Federal Acquisition Regulation Supplement; and (2) Will evaluate offers of qualifying country end products without regard to the restrictions of the Buy American Act or the Balance of Payments Program. (c) Certifications and identification of country of origin. (1) For all line items subject to the Buy American Act and Balance of Payments Program clause of this solicitation, the offeror certifies that (i) Each end product, except those listed in paragraph (c)(2) or (3) of this provision, is a domestic end product; and (ii) For end products other than COTS items, components of unknown origin are considered to have been mined, produced, or manufactured outside the United States or a qualifying country. (2) The offeror certifies that the following end products are qualifying country end products: (Line Item Number) (Country of Origin) (3) The following end products are other foreign end products, including 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 (ii) of the definition of domestic end product : (Line Item Number) (Country of Origin (If known)) (End of provision)
Page 8 of 12 DFARS 252.225-7001 Buy American Act and Balance of Payments Program. (JAN 2009) (a) Definitions. As used in this clause (1) Commercially available off-the-shelf (COTS) item (i) Means any item of supply (including construction material) that is (A) A commercial item (as defined in paragraph (1) of the definition of commercial item in section 2.101 of the Federal Acquisition Regulation); (B) Sold in substantial quantities in the commercial marketplace; and (C) Offered to the Government, under a contract or subcontract at any tier, without modification, in the same form in which it is sold in the commercial marketplace; and (ii) Does not include bulk cargo, as defined in section 3 of the Shipping Act of 1984 (46 U.S.C. 40102), such as agricultural products and petroleum products. (2) Component means an article, material, or supply incorporated directly into an end product. (3) Domestic end product means (i) An unmanufactured end product that has been mined or produced in the United States; or (ii) An end product manufactured in the United States if (A) The cost of its qualifying country components and its components that are mined, produced, or manufactured in the United States exceeds 50 percent of the cost of all its components. The cost of components includes transportation costs to the place of incorporation into the end product and U.S. duty (whether or not a duty-free entry certificate is issued). Scrap generated, collected, and prepared for processing in the United States is considered domestic. A component is considered to have been mined, produced, or manufactured in the United States (regardless of its source in fact) if the end product in which it is incorporated is manufactured in the United States and the component is of a class or kind for which the Government has determined that (1) Sufficient and reasonably available commercial quantities of a satisfactory quality are not mined, produced, or manufactured in the United States; or (2) It is inconsistent with the public interest to apply the restrictions of the Buy American Act; or (B) The end product is a COTS item. (4) End product means those articles, materials, and supplies to be acquired under this contract for public use. (5) Foreign end product means an end product other than a domestic end product. (6) Qualifying country means any country set forth in subsection 225.872 1 of the Defense Federal Acquisition Regulation Supplement. (7) Qualifying country component means a component mined, produced, or manufactured in a qualifying country. (8) Qualifying country end product means (i) An unmanufactured end product mined or produced in a qualifying country; or
Page 9 of 12 (ii) An end product manufactured in a qualifying country if the cost of the following types of components exceeds 50 percent of the cost of all its components: (A) Components mined, produced, or manufactured in a qualifying country. (B) Components mined, produced, or manufactured in the United States. (C) Components of foreign origin of a class or kind for which the Government has determined that sufficient and reasonably available commercial quantities of a satisfactory quality are not mined, produced, or manufactured in the United States. (9) United States means the 50 States, the District of Columbia, and outlying areas. (b) This clause implements the Buy American Act (41 U.S.C. Section 10a d). In accordance with 41 U.S.C. 431, the component test of the Buy American Act is waived for an end product that is a COTS item (see section 12.505(a)(1) of the Federal Acquisition Regulation). Unless otherwise specified, this clause applies to all line items in the contract. (c) The Contractor shall deliver only domestic end products unless, in its offer, it specified delivery of other end products in the Buy American Act Balance of Payments Program Certificate provision of the solicitation. If the Contractor certified in its offer that it will deliver a qualifying country end product, the Contractor shall deliver a qualifying country end product or, at the Contractor's option, a domestic end product. (d) The contract price does not include duty for end products or components for which the Contractor will claim dutyfree entry. (End of clause)
Page 10 of 12 FAR 52.225-20 Prohibition on Conducting Restricted Business Operations in Sudan Certification (JUN 2008) (a) Definitions. As used in this provision Business operations means engaging in commerce in any form, including by acquiring, developing, maintaining, owning, selling, possessing, leasing, or operating equipment, facilities, personnel, products, services, personal property, real property, or any other apparatus of business or commerce. Marginalized populations of Sudan means (1) Adversely affected groups in regions authorized to receive assistance under section 8(c) of the Darfur Peace and Accountability Act (Pub. L. 109 344) (50 U.S.C. 1701 note); and (2) Marginalized areas in Northern Sudan described in section 4(9) of such Act. Person means (1) A Natural person, corporation, company, business association, partnership, society, trust, any other nongovernmental entity, organization, or group; (2) Any governmental entity or instrumentality of a government, including a multilateral development institution (as defined in section 1701(c)(3) of the International Financial Institutions Act (22 U.S.C. 262r(c)(3)); and (3) Any successor, subunit, parent company or subsidiary of any entity described in paragraphs (1) or (2) of this definition. 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 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. (b) Certification. By submission of its offer, the offeror certifies that it does not conduct any restricted business operations in Sudan.
OFFEROR S ASSERTION OF COMMERCIALITY Page 11 of 12 Offeror Is Is Not asserting commerciality. Offeror, _ hereby asserts to AM General that the following items meet the definition provided in FAR 2.101 for a commercial item or service. (If more than one type of exception is included for multiple items or services, please indicate which item or service corresponds to each type of exception claimed): Identify item(s): Offeror asserts that the above items/services (please check any that apply): A. Are items that are not real property, are of a type customarily used by the general public, or by nongovernmental entities for purposes other than governmental purposes, and (i) has been sold, leased or licensed to the general public; of (ii) has been offered for sale, lease or license to the general public. OR B. Are items that have evolved through advances in technology or performance, from an item which fits the definition in paragraph A, are not yet available in the commercial marketplace, but will be available in the commercial marketplace in time to satisfy the delivery requirements of this purchase order; Identify original item, advances in technology and when item will be available within commercial marketplace. OR C. Are items that would satisfy a criterion expressed in paragraphs (A) or (B) above but for (check 1 or 2): (1) Modifications of a type customarily available in the commercial marketplace; Identify modification and where available within commercial marketplace: or (2) Minor modifications of a type not customarily available in the commercial marketplace made to meet Federal Government requirements. Minor modifications means modifications that do not significantly alter the nongovernmental function or essential physical characteristics of an item or component, or change the purpose of a process. Factors to be considered in determining whether a modification is minor include the value and size of the modification and the comparative value and size of the final product. Dollar values and percentages may be used as guideposts, but are not conclusive evidence that a modification is minor; Identify modification(s) and why item still fits definition of commercial item : OR D. Are combinations of items meeting the requirements of this definition that are of a type customarily combined and sold in combination to the general public Explain.
Page 11 of 12 OR E. Are installation services, maintenance services, repair services, training services, and other services if (i) Such services are procured for support of an item referred to in paragraph (A), (B), (C), or (D) of this definition, regardless of whether such services are provided by the same source or at the same time as the item; and (ii) the source of such services provides similar services contemporaneously to the general public under terms and conditions similar to those offered to the Federal Government; Explain. OR F. Are services of a type offered and sold competitively in 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. For purposes of these services (i) Catalog price means a price included in a catalog, price list, schedule, or other form that is regularly maintained by the manufacturer or vendor, is either published or otherwise available for inspection by customers, and states prices at which sales are currently, or were last, made to a significant number of buyers constituting the general public; and (ii) Market prices means current prices that are established in the course of ordinary trade between buyers and sellers free to bargain and that can be substantiated through competition or from sources independent of the offerors. Explain. Offeror further agrees that Offeror has on file, and will make available to AM General or the Government, upon request, documentary support for the assertions set forth above that is adequate to support those assertions to the satisfaction of AM General and the Government, and evidence of prices at which the same or similar items or services have been sold to the commercial market. Offeror grants AM General or the Government the right to examine, at any time before award, books, records, documents or other directly pertinent records to verify any request for an exception under the FAR s commercial item/services provision, and the reasonableness of price. Access does not extend to cost or profit information or other data relevant solely to the offeror s determination of the prices to be offered in the catalog or marketplace. This information will be provided in a format that is mutually acceptable to Offeror and AM General. Signature Date Printed Name Title NOTE: The prime contractor has the authority and responsibility for determining whether an item to be supplied by a subcontractor is a commercial item. The information provided above will be used to make such determination.