FedBizOpps

Combined Synopsis/Solicitation Notice

CLASSIFICATION CODE * 65

SPYGLASS DIGITAL CONTROLLER

brand name or equal
SUBJECT * BOSTON SCIENTIFIC

GENERAL INFORMATION
CONTRACTING OFFICE'S * 14215
ZIP-CODE
SOLICITATION NUMBER * VA242-17-Q-0909

RESPONSE DATE (MM-DD-YYYY) 07-28-2017

ARCHIVE 10 DAYS AFTER THE RESPONSE DATE

RECOVERY ACT FUNDS N

SET-ASIDE

NAICS CODE * 339112

Department of Veterans Affairs

CONTRACTING OFFICE
Western New York Healthcare System
ADDRESS
3495 Bailey Ave.
Buffalo NY 14215

DESCRIPTION * See Attachment

DELENE KENDRICK
POINT OF CONTACT * CONTRACTING OFFICER
[email protected]
585-297-1460 x72474
(POC Information Automatically Filled from
User Profile Unless Entered)

PLACE OF PERFORMANCE
SYRACUSE VA MEDICAL CENTER
ADDRESS 800 IRVING AVE.
SYRACUSE, NY 13210

POSTAL CODE

COUNTRY

ADDITIONAL INFORMATION

AGENCY'S URL

URL DESCRIPTION

AGENCY CONTACT'S EMAIL

ADDRESS
 Statement of Work (SOW)

COMBINED SYNOPSIS/SOLICITATION
BOSTON SCIENTIFIC SPYGLASS DS DIGITAL CONTROLLER (or equal)
SYRACUSE VA MEDICAL CENTER

(i) This is a combined synopsis/solicitation for a commercial item prepared in accordance with the
format in FAR Subpart 12.6 and 13.106, as supplemented with additional information included in this
notice. This announcement constitutes the only solicitation; quotes are being requested and a separate
written solicitation will not be issued.

(ii) This solicitation is issued as a request for quote (RFQ). Request for Quote will be submitted through
fedbizopps.gov on RFQ reference number VA242-17-Q-0909.

(iii) This solicitation document and incorporated provisions and clauses are those in effect through
Federal Acquisition Circular 2005-95.

(iv) This procurement is being issued as 100% set-aside for SERVICE DISABLED VETERAN OWNED
SMALL BUSINESSES (SDVOSB). It is the Government’s intent to issue a firm fixed price, single
award as a result of this solicitation. The North American Industry Classification System (NAICS)
code is 339912, Electromedical and Electrotherapeutic Apparatus Manufacturing, with a small
business size standard of 1,000 employees. This solicitation is 100% set-aside for SDVOSBs.

(v) The Contractor shall provide all parts and labor necessary to deliver a SpyGlassTM DS-Digital
Controller (p/n M00546650) as manufactured by Boston Scientific or equal product. All products
shall be delivered in new and unused/unopened condition.

(vi) Description of requirement:

The Syracuse VA Medical Center has a requirement for:

(1) ea. Boston Scientific SpyGlass DS- Digital Controller (p/n M00546650) or equal product
The SpyGlass™ DS Digital Controller is intended to provide illumination and receive, process,
and output images from the SpyScope™ DS Access and Delivery Catheter for diagnostic and
therapeutic applications during endoscopic procedures in the pancreatico-biliary system including
the hepatic ducts. Any proposed “or equal” product must be intended for this same function, as
well as compatible with the Boston Scientific peripheral components.

Delivery to: SYRACUSE VA Medical Center: 800 Irving Ave. Syracuse, NY 13210; FOB
DESTINATION

(vii) EVALUATION: Quotes will be evaluated based upon lowest price technically acceptable.

Vendor shall be an Original Equipment Manufacturer (OEM) authorized dealer, authorized distributor or
authorized reseller for the proposed equipment/system such that OEM warranty and service are provided

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 Statement of Work (SOW)

and maintained by the OEM. All software licensing, warranty and service associated with the
equipment/system shall be in accordance with the OEM terms and conditions.

Contract Administration: All contract administration matters will be handled by the following
individuals:

a. CONTRACTOR:

b. GOVERNMENT: Contracting Officer 36C242

Delene Kendrick, [email protected], 585-297-1460 x72474

(viii) CONTRACTOR REMITTANCE ADDRESS: All payments by the Government to the contractor
will be made in accordance with 52.232-34, Payment by Electronic Funds Transfer—Other Than System
For Award Management,

(ix) INVOICES: Invoices shall be submitted upon final installation of goods

(x) GOVERNMENT INVOICE ADDRESS: All Invoices from the contractor shall be submitted
electronically in accordance with VAAR Clause 852.232-72 Electronic Submission of Payment Requests.

Tungsten Network

http://www.tungsten-network.com/us/en/veterans-affairs

(xi) ACKNOWLEDGMENT OF AMENDMENTS: The offeror acknowledges receipt of amendments to

the Solicitation numbered and dated as follows:

AMENDMENT NO DATE

Quote packages must include the following or responses will be considered non-responsive:
1. Pricing
2. Certificate of Manufacturer distribution authorization.

(xii) Quotes are required to be received NO LATER THAN 10:00 AM EST, Friday, July 28, 2017.
Quotes and supporting documentation must be e-mailed to Delene Kendrick at
[email protected].

(xiii) Direct your questions in writing to Delene Kendrick, Contracting Specialist at:
[email protected].

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VA242-17-Q-0909

THE FOLLOWING CLAUSES AND PROVISIONS ARE INCLUDED IN THIS COMBINED

SYNOPSIS SOLICITATION:

The provision at FAR 52.212-1, Instructions to Offerors-Commercial Items, applies to this

acquisition.

The clause at FAR 52.212-4, Contract Terms and Conditions-Commercial Items, applies to this
acquisition.

LIMITATIONS ON SUBCONTRACTING-- MONITORING AND COMPLIANCE (JUN

2011)
This solicitation includes clause 52.219-27. Accordingly, any contract resulting from this
solicitation will include this clause. The contractor is advised in performing contract
administration functions, the CO may use the services of a support contractor(s) retained by VA
to assist in assessing the contractor's compliance with the limitations on subcontracting or
percentage of work performance requirements specified in the clause. To that end, the support
contractor(s) may require access to contractor's offices where the contractor's business records or
other proprietary data are retained and to review such business records regarding the contractor's
compliance with this requirement. All support contractors conducting this review on behalf of
VA will be required to sign an “Information Protection and Non-Disclosure and Disclosure of
Conflicts of Interest Agreement” to ensure the contractor's business records or other proprietary
data reviewed or obtained in the course of assisting the CO in assessing the contractor for
compliance are protected to ensure information or data is not improperly disclosed or other
impropriety occurs. Furthermore, if VA determines any services the support contractor(s) will
perform in assessing compliance are advisory and assistance services as defined in FAR 2.101,
Definitions, the support contractor(s) must also enter into an agreement with the contractor to
protect proprietary information as required by FAR 9.505-4, obtaining access to proprietary
information, paragraph (b). The contractor is required to cooperate fully and make available any
records as may be required to enable the CO to assess the contractor's compliance with the
limitations on subcontracting or percentage of work performance requirement.

52.212-5 CONTRACT TERMS AND CONDITIONS REQUIRED TO

IMPLEMENT STATUTES OR EXECUTIVE ORDERS—COMMERCIAL ITEMS
(JAN 2017)
(a) The Contractor shall comply with the following Federal Acquisition Regulation (FAR) clauses,
which are incorporated in this contract by reference, to implement provisions of law or Executive orders
applicable to acquisitions of commercial items:

52.203-19, Prohibition on Requiring Certain Internal Confidentiality Agreements or Statements

(JAN 2017) (section 743 of Division E, Title VII, of the Consolidated and Further Continuing
Appropriations Act, 2015 (Pub. L. 113-235) and its successor provisions in subsequent appropriations
acts (and as extended in continuing resolutions)).

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52.209-10, Prohibition on Contracting with Inverted Domestic Corporations (NOV 2015).

52.233-3, Protest After Award (Aug 1996) (31 U.S.C. 3553).

52.233-4, Applicable Law for Breach of Contract Claim (Oct 2004) (Public Laws 108-77 and
108-78 (19 U.S.C. 3805 note)).

52.204–10, Reporting Executive Compensation and First-Tier Subcontract Awards (OCT 2016)
(Pub. L. 109–282) (31 U.S.C. 6101 note).

52.209-6, Protecting the Government's Interest When Subcontracting with Contractors Debarred,
Suspended, or Proposed for Debarment. (OCT 2015) (31 U.S.C. 6101 note).

52.219-28, Post Award Small Business Program Rerepresentation (Jul 2013) (15 U.S.C 632(a)
(2)).

52.222-3, Convict Labor (June 2003) (E.O. 11755).

52.222–19, Child Labor—Cooperation with Authorities and Remedies (OCT 2016) (E.O. 13126).

52.222-21, Prohibition of Segregated Facilities (APR 2015).

52.222–26, Equal Opportunity (SEP 2016) (E.O. 11246).

52.222-36, Equal Opportunity for Workers with Disabilities (JUL 2014) (29 U.S.C. 793).

52.222-50, Combating Trafficking in Persons (MAR 2015) (22 U.S.C. chapter 78 and E.O.
13627).

52.223-18, Encouraging Contractor Policies to Ban Text Messaging While Driving (AUG 2011)

52.225-3, Buy American Alternate II—Free Trade Agreements—Israeli Trade Act (MAY 2014)
(41 U.S.C. chapter 83, 19 U.S.C. 3301 note, 19 U.S.C. 2112 note, 19 U.S.C. 3805 note, 19 U.S.C. 4001
note, Pub. L. 103-182, 108-77, 108-78, 108-286, 108-302, 109-53, 109-169, 109-283, 110-138, 112-41,
112-42, and 112-43.

52.225-13, Restrictions on Certain Foreign Purchases (JUN 2008) (E.O.'s, proclamations, and
statutes administered by the Office of Foreign Assets Control of the Department of the Treasury).

52.232-34, Payment by Electronic Funds Transfer—Other than System for Award Management
(Jul 2013) (31 U.S.C. 3332).

(i) 52.247-64, Preference for Privately Owned U.S.-Flag Commercial Vessels (Feb 2006) (46
U.S.C. Appx. 1241(b) and 10 U.S.C. 2631).

(c) The Contractor shall comply with the FAR clauses in this paragraph (c), applicable to commercial
services, that the Contracting Officer has indicated as being incorporated in this contract by reference to
implement provisions of law or Executive orders applicable to acquisitions of commercial items: N/A

(d) Comptroller General Examination of Record. The Contractor shall comply with the provisions of
this paragraph (d) if this contract was awarded using other than sealed bid, is in excess of the simplified
acquisition threshold, and does not contain the clause at 52.215-2, Audit and Records—Negotiation.

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(1) The Comptroller General of the United States, or an authorized representative of the Comptroller
General, shall have access to and right to examine any of the Contractor's directly pertinent records
involving transactions related to this contract.

(2) The Contractor shall make available at its offices at all reasonable times the records, materials, and
other evidence for examination, audit, or reproduction, until 3 years after final payment under this
contract or for any shorter period specified in FAR Subpart 4.7, Contractor Records Retention, of the
other clauses of this contract. If this contract is completely or partially terminated, the records relating to
the work terminated shall be made available for 3 years after any resulting final termination settlement.
Records relating to appeals under the disputes clause or to litigation or the settlement of claims arising
under or relating to this contract shall be made available until such appeals, litigation, or claims are finally
resolved.

(3) As used in this clause, records include books, documents, accounting procedures and practices, and
other data, regardless of type and regardless of form. This does not require the Contractor to create or
maintain any record that the Contractor does not maintain in the ordinary course of business or pursuant
to a provision of law.

(e)(1) Notwithstanding the requirements of the clauses in paragraphs (a), (b), (c), and (d) of this clause,
the Contractor is not required to flow down any FAR clause, other than those in this paragraph (e)(1) in a
subcontract for commercial items. Unless otherwise indicated below, the extent of the flow down shall be
as required by the clause—

(i) 52.203-13, Contractor Code of Business Ethics and Conduct (OCT 2015) (41 U.S.C. 3509).

(ii) 52.203-19, Prohibition on Requiring Certain Internal Confidentiality Agreements or Statements

(JAN 2017) (section 743 of Division E, Title VII, of the Consolidated and Further Continuing
Appropriations Act, 2015 (Pub. L. 113-235) and its successor provisions in subsequent appropriations
acts (and as extended in continuing resolutions)).

(iii) 52.219-8, Utilization of Small Business Concerns (NOV 2016) (15 U.S.C. 637(d)(2) and (3)), in
all subcontracts that offer further subcontracting opportunities.

(iv) 52.222-17, Nondisplacement of Qualified Workers (MAY 2014) (E.O. 13495). Flow down
required in accordance with paragraph (l) of FAR clause 52.222-17.

(v) 52.222-21, Prohibition of Segregated Facilities (APR 2015).

(vi) 52.222–26, Equal Opportunity (SEP 2016) (E.O. 11246).

(vii) 52.222-35, Equal Opportunity for Veterans (OCT 2015) (38 U.S.C. 4212).

(viii) 52.222-36, Equal Opportunity for Workers with Disabilities (JUL 2014) (29 U.S.C. 793).

(ix) 52.222-37, Employment Reports on Veterans (FEB 2016) (38 U.S.C. 4212).

(x) 52.222-40, Notification of Employee Rights Under the National Labor Relations Act (DEC 2010)
(E.O. 13496). Flow down required in accordance with paragraph (f) of FAR clause 52.222-40.

(xi) 52.222-41, Service Contract Labor Standards (MAY 2014) (41 U.S.C. chapter 67).

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(xii)(A) 52.222-50, Combating Trafficking in Persons (MAR 2015) (22 U.S.C. chapter 78 and E.O.
13627).

(B) Alternate I (MAR 2015) of 52.222-50 (22 U.S.C. chapter 78 and E.O. 13627).

(xiii) 52.222-51, Exemption from Application of the Service Contract Labor Standards to Contracts
for Maintenance, Calibration, or Repair of Certain Equipment—Requirements (MAY 2014) (41 U.S.C.
chapter 67).

(xiv) 52.222-53, Exemption from Application of the Service Contract Labor Standards to Contracts
for Certain Services—Requirements (MAY 2014) (41 U.S.C. chapter 67).

(xv) 52.222-54, Employment Eligibility Verification (OCT 2015) (E. O. 12989).

(xvi) 52.222-55, Minimum Wages Under Executive Order 13658 (DEC 2015).

(xvii) 52.222-59, Compliance with Labor Laws (Executive Order 13673) (OCT 2016) (Applies at $50
million for solicitations and resultant contracts issued from October 25, 2016 through April 24, 2017;
applies at $500,000 for solicitations and resultant contracts issued after April 24, 2017).

Note to paragraph (e)(1)(xvii): By a court order issued on October 24, 2016, 52.222-59 is enjoined
indefinitely as of the date of the order. The enjoined paragraph will become effective immediately if the
court terminates the injunction. At that time, DoD, GSA, and NASA will publish a document in the
Federal Register advising the public of the termination of the injunction.

(xviii) 52.222-60, Paycheck Transparency (Executive Order 13673) (OCT 2016)).

(xix) 52.222-62 Paid Sick Leave Under Executive Order 13706 (JAN 2017) (E.O. 13706).

(xx)(A) 52.224-3, Privacy Training (JAN 2017) (5 U.S.C. 552a).

(B) Alternate I (JAN 2017) of 52.224-3.

(xxi) 52.225–26, Contractors Performing Private Security Functions Outside the United States (OCT
2016) (Section 862, as amended, of the National Defense Authorization Act for Fiscal Year 2008; 10
U.S.C. 2302 Note).

(xxii) 52.226-6, Promoting Excess Food Donation to Nonprofit Organizations (MAY 2014) (42
U.S.C. 1792). Flow down required in accordance with paragraph (e) of FAR clause 52.226-6.

(xxiii) 52.247-64, Preference for Privately Owned U.S.-Flag Commercial Vessels (Feb 2006) (46
U.S.C. Appx. 1241(b) and 10 U.S.C. 2631). Flow down required in accordance with paragraph (d) of
FAR clause 52.247-64.

(2) While not required, the Contractor may include in its subcontracts for commercial items a minimal
number of additional clauses necessary to satisfy its contractual obligations.

(End of Clause)

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SOLICITATION PROVISIONS

52.211-6 -- BRAND NAME OR EQUAL (AUG 1999)

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

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

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

(2) Clearly identify the item by—

(i) Brand name, if any; and

(ii) Make or model number;

(3) Include descriptive literature such as illustrations, drawings, or a clear reference to

previously furnished descriptive data or information available to the Contracting Officer;
and

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

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

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

(End of provision)

52.212-3 OFFEROR REPRESENTATIONS AND CERTIFICATIONS—COMMERCIAL

ITEMS (JAN 2017)
The Offeror shall complete only paragraph (b) of this provision if the Offeror has completed the
annual representations and certification electronically via the System for Award Management

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(SAM) Web site located at https://www.sam.gov/portal. If the Offeror has not completed the
annual representations and certifications electronically, the Offeror shall complete only
paragraphs (c) through (u) of this provision.

(a) Definitions. As used in this provision—

Administrative merits determination means certain notices or findings of labor law violations
issued by an enforcement agency following an investigation. An administrative merits
determination may be final or be subject to appeal or further review. To determine whether a
particular notice or finding is covered by this definition, it is necessary to consult section II.B. in
the DOL Guidance.

Arbitral award or decision means an arbitrator or arbitral panel determination that a labor law
violation occurred, or that enjoined or restrained a violation of labor law. It includes an award or
decision that is not final or is subject to being confirmed, modified, or vacated by a court, and
includes an award or decision resulting from private or confidential proceedings. To determine
whether a particular award or decision is covered by this definition, it is necessary to consult
section II.B. in the DOL Guidance.

Civil judgment means—

(1) In paragraph (h) of this provision: A judgment or finding of a civil offense by any court of
competent jurisdiction.

(2) In paragraph (s) of this provision: Any judgment or order entered by any Federal or State
court in which the court determined that a labor law violation occurred, or enjoined or restrained
a violation of labor law. It includes a judgment or order that is not final or is subject to appeal.
To determine whether a particular judgment or order is covered by this definition, it is necessary
to consult section II.B. in the DOL Guidance.

DOL Guidance means the Department of Labor (DOL) Guidance entitled: “Guidance for
Executive Order 13673, ‘Fair Pay and Safe Workplaces’ “. The DOL Guidance, dated August
25, 2016, can be obtained from www.dol.gov/fairpayandsafeworkplaces.

Economically disadvantaged women-owned small business (EDWOSB) concern means a small

business concern that is at least 51 percent directly and unconditionally owned by, and the
management and daily business operations of which are controlled by, one or more women who
are citizens of the United States and who are economically disadvantaged in accordance with 13
CFR part 127. It automatically qualifies as a women-owned small business eligible under the
WOSB Program.

Enforcement agency means any agency granted authority to enforce the Federal labor laws. It
includes the enforcement components of DOL (Wage and Hour Division, Office of Federal
Contract Compliance Programs, and Occupational Safety and Health Administration), the Equal
Employment Opportunity Commission, the Occupational Safety and Health Review
Commission, and the National Labor Relations Board. It also means a State agency designated to

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administer an OSHA-approved State Plan, but only to the extent that the State agency is acting in
its capacity as administrator of such plan. It does not include other Federal agencies which, in
their capacity as contracting agencies, conduct investigations of potential labor law violations.
The enforcement agencies associated with each labor law under E.O. 13673 are—

(1) Department of Labor Wage and Hour Division (WHD) for—

(i) The Fair Labor Standards Act;

(ii) The Migrant and Seasonal Agricultural Worker Protection Act;

(iii) 40 U.S.C. chapter 31, subchapter IV, formerly known as the Davis-Bacon Act;

(iv) 41 U.S.C. chapter 67, formerly known as the Service Contract Act;

(v) The Family and Medical Leave Act; and

(vi) E.O. 13658 of February 12, 2014 (Establishing a Minimum Wage for Contractors);

(2) Department of Labor Occupational Safety and Health Administration (OSHA) for—

(i) The Occupational Safety and Health Act of 1970; and

(ii) OSHA-approved State Plans;

(3) Department of Labor Office of Federal Contract Compliance Programs (OFCCP) for—

(i) Section 503 of the Rehabilitation Act of 1973;

(ii) The Vietnam Era Veterans' Readjustment Assistance Act of 1972 and the Vietnam Era
Veterans' Readjustment Assistance Act of 1974; and

(iii) E.O. 11246 of September 24, 1965 (Equal Employment Opportunity);

(4) National Labor Relations Board (NLRB) for the National Labor Relations Act; and

(5) Equal Employment Opportunity Commission (EEOC) for—

(i) Title VII of the Civil Rights Act of 1964;

(ii) The Americans with Disabilities Act of 1990;

(iii) The Age Discrimination in Employment Act of 1967; and

(iv) Section 6(d) of the Fair Labor Standards Act (Equal Pay Act).

Forced or indentured child labor means all work or service—

(1) Exacted from any person under the age of 18 under the menace of any penalty for its
nonperformance and for which the worker does not offer himself voluntarily; or

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(2) Performed by any person under the age of 18 pursuant to a contract the enforcement of
which can be accomplished by process or penalties.

Highest-level owner means the entity that owns or controls an immediate owner of the offeror,
or that owns or controls one or more entities that control an immediate owner of the offeror. No
entity owns or exercises control of the highest level owner.

Immediate owner means an entity, other than the offeror, that has direct control of the offeror.
Indicators of control include, but are not limited to, one or more of the following: Ownership or
interlocking management, identity of interests among family members, shared facilities and
equipment, and the common use of employees.

Inverted domestic corporation means a foreign incorporated entity that meets the definition of
an inverted domestic corporation under 6 U.S.C. 395(b), applied in accordance with the rules and
definitions of 6 U.S.C. 395(c).

Labor compliance agreement means an agreement entered into between a contractor or

subcontractor and an enforcement agency to address appropriate remedial measures, compliance
assistance, steps to resolve issues to increase compliance with the labor laws, or other related
matters.

Labor laws means the following labor laws and E.O.s:

(1) The Fair Labor Standards Act.

(2) The Occupational Safety and Health Act (OSHA) of 1970.

(3) The Migrant and Seasonal Agricultural Worker Protection Act.

(4) The National Labor Relations Act.

(5) 40 U.S.C. chapter 31, subchapter IV, formerly known as the Davis-Bacon Act.

(6) 41 U.S.C. chapter 67, formerly known as the Service Contract Act.

(7) E.O. 11246 of September 24, 1965 (Equal Employment Opportunity).

(8) Section 503 of the Rehabilitation Act of 1973.

(9) The Vietnam Era Veterans' Readjustment Assistance Act of 1972 and the Vietnam Era
Veterans' Readjustment Assistance Act of 1974.

(10) The Family and Medical Leave Act.

(11) Title VII of the Civil Rights Act of 1964.

(12) The Americans with Disabilities Act of 1990.

(13) The Age Discrimination in Employment Act of 1967.

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(14) E.O. 13658 of February 12, 2014 (Establishing a Minimum Wage for Contractors).

(15) Equivalent State laws as defined in the DOL Guidance. (The only equivalent State laws
implemented in the FAR are OSHA-approved State Plans, which can be found at
www.osha.gov/dcsp/osp/approved_state_plans.html).

Labor law decision means an administrative merits determination, arbitral award or decision, or
civil judgment, which resulted from a violation of one or more of the laws listed in the definition
of “labor laws”.

Manufactured end product means any end product in product and service codes (PSCs) 1000-
9999, except—

(1) PSC 5510, Lumber and Related Basic Wood Materials;

(2) Product or Service Group (PSG) 87, Agricultural Supplies;

(3) PSG 88, Live Animals;

(4) PSG 89, Subsistence;

(5) PSC 9410, Crude Grades of Plant Materials;

(6) PSC 9430, Miscellaneous Crude Animal Products, Inedible;

(7) PSC 9440, Miscellaneous Crude Agricultural and Forestry Products;

(8) PSC 9610, Ores;

(9) PSC 9620, Minerals, Natural and Synthetic; and

(10) PSC 9630, Additive Metal Materials.

Place of manufacture means the place where an end product is assembled out of components, or
otherwise made or processed from raw materials into the finished product that is to be provided
to the Government. If a product is disassembled and reassembled, the place of reassembly is not
the place of manufacture.

Predecessor means an entity that is replaced by a successor and includes any predecessors of
the predecessor.

Restricted business operations means business operations in Sudan that include power
production activities, mineral extraction activities, oil-related activities, or the production of
military equipment, as those terms are defined in the Sudan Accountability and Divestment Act
of 2007 (Pub. L. 110-174). Restricted business operations do not include business operations that
the person (as that term is defined in Section 2 of the Sudan Accountability and Divestment Act
of 2007) conducting the business can demonstrate—

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(1) Are conducted under contract directly and exclusively with the regional government of
southern Sudan;

(2) Are conducted pursuant to specific authorization from the Office of Foreign Assets Control
in the Department of the Treasury, or are expressly exempted under Federal law from the
requirement to be conducted under such authorization;

(3) Consist of providing goods or services to marginalized populations of Sudan;

(4) Consist of providing goods or services to an internationally recognized peacekeeping force

or humanitarian organization;

(5) Consist of providing goods or services that are used only to promote health or education;
or

(6) Have been voluntarily suspended.

“Sensitive technology”—

(1) Means hardware, software, telecommunications equipment, or any other technology that is
to be used specifically—

(i) To restrict the free flow of unbiased information in Iran; or

(ii) To disrupt, monitor, or otherwise restrict speech of the people of Iran; and

(2) Does not include information or informational materials the export of which the President
does not have the authority to regulate or prohibit pursuant to section 203(b)(3) of the
International Emergency Economic Powers Act (50 U.S.C. 1702(b)(3)).

Service-disabled veteran-owned small business concern—

(1) Means a small business concern—

(i) Not less than 51 percent of which is owned by one or more service-disabled veterans or, in
the case of any publicly owned business, not less than 51 percent of the stock of which is owned
by one or more service-disabled veterans; and

(ii) The management and daily business operations of which are controlled by one or more
service-disabled veterans or, in the case of a service-disabled veteran with permanent and severe
disability, the spouse or permanent caregiver of such veteran.

(2) Service-disabled veteran means a veteran, as defined in 38 U.S.C. 101(2), with a disability
that is service-connected, as defined in 38 U.S.C. 101(16).

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

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Small disadvantaged business concern, consistent with 13 CFR 124.1002, means a small
business concern under the size standard applicable to the acquisition, that—

(1) Is at least 51 percent unconditionally and directly owned (as defined at 13 CFR 124.105)
by—

(i) One or more socially disadvantaged (as defined at 13 CFR 124.103) and economically
disadvantaged (as defined at 13 CFR 124.104) individuals who are citizens of the United States;
and

(ii) Each individual claiming economic disadvantage has a net worth not exceeding $750,000
after taking into account the applicable exclusions set forth at 13 CFR 124.104(c)(2); and

(2) The management and daily business operations of which are controlled (as defined at
13.CFR 124.106) by individuals, who meet the criteria in paragraphs (1)(i) and (ii) of this
definition.

Subsidiary means an entity in which more than 50 percent of the entity is owned—

(1) Directly by a parent corporation; or

(2) Through another subsidiary of a parent corporation.

Successor means an entity that has replaced a predecessor by acquiring the assets and carrying
out the affairs of the predecessor under a new name (often through acquisition or merger). The
term “successor” does not include new offices/divisions of the same company or a company that
only changes its name. The extent of the responsibility of the successor for the liabilities of the
predecessor may vary, depending on State law and specific circumstances.

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

(1) Not less than 51 percent of which is owned by one or more veterans (as defined at 38
U.S.C. 101(2)) or, in the case of any publicly owned business, not less than 51 percent of the
stock of which is owned by one or more veterans; and

(2) The management and daily business operations of which are controlled by one or more
veterans.

Women-owned business concern means a concern which is at least 51 percent owned by one or
more women; or in the case of any publicly owned business, at least 51 percent of its stock is
owned by one or more women; and whose management and daily business operations are
controlled by one or more women.

Women-owned small business concern means a small business concern—

(1) That is at least 51 percent owned by one or more women; or, in the case of any publicly
owned business, at least 51 percent of the stock of which is owned by one or more women; and

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(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.

Note to paragraph (a): By a court order issued on October 24, 2016, the following definitions
in this paragraph (a) are enjoined indefinitely as of the date of the order: “Administrative merits
determination”, “Arbitral award or decision”, paragraph (2) of “Civil judgment”, “DOL
Guidance”, “Enforcement agency”, “Labor compliance agreement”, “Labor laws”, and “Labor
law decision”. The enjoined definitions will become effective immediately if the court terminates
the injunction. At that time, DoD, GSA, and NASA will publish a document in the Federal
Register advising the public of the termination of the injunction.

(b)(1) Annual Representations and Certifications. Any changes provided by the offeror in
paragraph (b)(2) of this provision do not automatically change the representations and
certifications posted on the SAM website.

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

(c) Offerors must complete the following representations when the resulting contract will be
performed in the United States or its outlying areas. Check all that apply.

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

(2) Veteran-owned small business concern. [Complete only if the offeror represented itself as
a small business concern in paragraph (c)(1) of this provision.] The offeror represents as part of
its offer that it [ ] is, [ ] is not a veteran-owned small business concern.

(3) Service-disabled veteran-owned small business concern. [Complete only if the offeror
represented itself as a veteran-owned small business concern in paragraph (c)(2) of this
provision.] The offeror represents as part of its offer that it [ ] is, [ ] is not a service-disabled
veteran-owned small business concern.

(4) Small disadvantaged business concern. [Complete only if the offeror represented itself as
a small business concern in paragraph (c)(1) of this provision.] The offeror represents that it [ ]
is, [ ] is not a small disadvantaged business concern as defined in 13 CFR 124.1002.

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(5) Women-owned small business concern. [Complete only if the offeror represented itself as
a small business concern in paragraph (c)(1) of this provision.] The offeror represents that it [ ]
is, [ ] is not a women-owned small business concern.

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

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

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

(7) Economically disadvantaged women-owned small business (EDWOSB) concern.

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

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

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

(10) HUBZone small business concern. [Complete only if the offeror represented itself as a
small business concern in paragraph (c)(1) of this provision.] The offeror represents, as part of
its offer, that—

(i) It [ ] is, [ ] is not a HUBZone small business concern listed, on the date of this
representation, on the List of Qualified HUBZone Small Business Concerns maintained by the
Small Business Administration, and no material change in ownership and control, principal
office, or HUBZone employee percentage has occurred since it was certified by the Small
Business Administration in accordance with 13 CFR Part 126; and

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

(d) Representations required to implement provisions of Executive Order 11246—

(1) Previous contracts and compliance. The offeror represents that—

(i) It [ ] has, [ ] has not participated in a previous contract or subcontract subject to the
Equal Opportunity clause of this solicitation; and

(ii) It [ ] has, [ ] has not filed all required compliance reports.

(2) Affirmative Action Compliance. The offeror represents that—

(i) It [ ] has developed and has on file, [ ] has not developed and does not have on file, at
each establishment, affirmative action programs required by rules and regulations of the
Secretary of Labor (41 CFR parts 60-1 and 60-2), or

(ii) It [ ] has not previously had contracts subject to the written affirmative action programs
requirement of the rules and regulations of the Secretary of Labor.

(e) Certification Regarding Payments to Influence Federal Transactions (31 U.S.C. 1352).
(Applies only if the contract is expected to exceed $150,000.) By submission of its offer, the
offeror 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 his or her behalf in connection with the award of any
resultant contract. 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.

(f) Buy American Certificate. (Applies only if the clause at Federal Acquisition Regulation
(FAR) 52.225-1, Buy American—Supplies, is included in this solicitation.)

(1) The offeror certifies that each end product, except those listed in paragraph (f)(2) 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

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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—Supplies.”

(2) Foreign End Products:

Line Item No Country of Origin

______________ _________________

______________ _________________

______________ _________________

[List as necessary]

(3) The Government will evaluate offers in accordance with the policies and procedures of
FAR Part 25.

(g)(1) Buy American—Free Trade Agreements—Israeli Trade Act Certificate. (Applies only if
the clause at FAR 52.225-3, Buy American—Free Trade Agreements—Israeli Trade Act, is
included in this solicitation.)

(i) The offeror certifies that each end product, except those listed in paragraph (g)(1)(ii) or
(g)(1)(iii) 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 (COTS) 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—Free Trade Agreements—
Israeli Trade Act.”

(ii) 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—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

______________ _________________

______________ _________________

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VA242-17-Q-0909

______________ _________________

[List as necessary]

(iii) The offeror shall list those supplies that are foreign end products (other than those listed
in paragraph (g)(1)(ii) of this provision) as defined in the clause of this solicitation entitled “Buy
American—Free Trade Agreements—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
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]

(iv) The Government will evaluate offers in accordance with the policies and procedures of
FAR Part 25.

(2) Buy American—Free Trade Agreements—Israeli Trade Act Certificate, Alternate I. If

Alternate I to the clause at FAR 52.225-3 is included in this solicitation, substitute the following
paragraph (g)(1)(ii) for paragraph (g)(1)(ii) of the basic provision:

(g)(1)(ii) The offeror certifies that the following supplies are Canadian end products as defined
in the clause of this solicitation entitled “Buy American—Free Trade Agreements—Israeli Trade
Act”:

Canadian End Products:

Line Item No.

__________________________________________

__________________________________________

__________________________________________

[List as necessary]

(3) Buy American—Free Trade Agreements—Israeli Trade Act Certificate, Alternate II. If
Alternate II to the clause at FAR 52.225-3 is included in this solicitation, substitute the following
paragraph (g)(1)(ii) for paragraph (g)(1)(ii) of the basic provision:

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(g)(1)(ii) 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—Free Trade
Agreements—Israeli Trade Act”:

Canadian or Israeli End Products:

Line Item No. Country of Origin

______________ _________________

______________ _________________

______________ _________________

[List as necessary]

(4) Buy American—Free Trade Agreements—Israeli Trade Act Certificate, Alternate III. If
Alternate III to the clause at FAR 52.225-3 is included in this solicitation, substitute the
following paragraph (g)(1)(ii) for paragraph (g)(1)(ii) of the basic provision:

(g)(1)(ii) 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—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

______________ _________________

______________ _________________

______________ _________________

[List as necessary]

(5) Trade Agreements Certificate. (Applies only if the clause at FAR 52.225-5, Trade
Agreements, is included in this solicitation.)

(i) The offeror certifies that each end product, except those listed in paragraph (g)(5)(ii) of
this provision, is a U.S.-made or designated country end product, as defined in the clause of this
solicitation entitled “Trade Agreements”.

(ii) The offeror shall list as other end products those end products that are not U.S.-made or
designated country end products.

Other End Products:

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VA242-17-Q-0909

Line Item No. Country of Origin

______________ _________________

______________ _________________

______________ _________________

[List as necessary]

(iii) The Government will evaluate offers in accordance with the policies and procedures of
FAR Part 25. 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 statute. 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 such products are insufficient to fulfill the
requirements of the solicitation.

(h) Certification Regarding Responsibility Matters (Executive Order 12689). (Applies only if
the contract value is expected to exceed the simplified acquisition threshold.) The offeror
certifies, to the best of its knowledge and belief, that the offeror and/or any of its principals—

(1) [ ] Are, [ ] are not presently debarred, suspended, proposed for debarment, or declared
ineligible for the award of contracts by any Federal agency;

(2) [ ] 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 Federal, state or local
government 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;

(3) [ ] Are, [ ] are not presently indicted for, or otherwise criminally or civilly charged by a
Government entity with, commission of any of these offenses enumerated in paragraph (h)(2) of
this clause; and

(4) [ ] Have, [ ] have not, within a three-year period preceding this offer, been notified of any
delinquent Federal taxes in an amount that exceeds $3,500 for which the liability remains
unsatisfied.

(i) Taxes are considered delinquent if both of the following criteria apply:

(A) 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.

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(B) 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.

(ii) Examples.

(A) The taxpayer has received a statutory notice of deficiency, under I.R.C. Sec. 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.

(B) 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. Sec. 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.

(C) The taxpayer has entered into an installment agreement pursuant to I.R.C. Sec. 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.

(D) 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).

(i) Certification Regarding Knowledge of Child Labor for Listed End Products (Executive
Order 13126).

(1) Listed end products.

Listed End Product Listed Countries of Origin

(2) Certification. [If the Contracting Officer has identified end products and countries of
origin in paragraph (i)(1) of this provision, then the offeror must certify to either (i)(2)(i) or (i)
(2)(ii) by checking the appropriate block.]

[ ] (i) The offeror will not supply any end product listed in paragraph (i)(1) of this provision
that was mined, produced, or manufactured in the corresponding country as listed for that
product.

[ ] (ii) The offeror may supply an end product listed in paragraph (i)(1) of this provision that
was mined, produced, or manufactured in the corresponding country as listed for that product.
The offeror certifies that it has made a good faith effort to determine whether forced or

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indentured child labor was used to mine, produce, or manufacture any such end product
furnished under this contract. On the basis of those efforts, the offeror certifies that it is not
aware of any such use of child labor.

(j) Place of manufacture. (Does not apply unless the solicitation is predominantly for the
acquisition of manufactured end products.) For statistical purposes only, the offeror shall indicate
whether the place of manufacture of the end products it expects to provide in response to this
solicitation is predominantly—

(1) __ In the United States (Check this box if the total anticipated price of offered end
products manufactured in the United States exceeds the total anticipated price of offered end
products manufactured outside the United States); or

(2) __ Outside the United States.

(k) Certificates regarding exemptions from the application of the Service Contract Labor
Standards. (Certification by the offeror as to its compliance with respect to the contract also
constitutes its certification as to compliance by its subcontractor if it subcontracts out the exempt
services.)

[] (1) Maintenance, calibration, or repair of certain equipment as described in FAR 22.1003-

4(c)(1). The offeror [ ] does [ ] does not certify that—

(i) The items of equipment to be serviced under this contract are used regularly for other than
Governmental purposes and are sold or traded by the offeror (or subcontractor in the case of an
exempt subcontract) in substantial quantities to the general public in the course of normal
business operations;

(ii) The services will be furnished at prices which are, or are based on, established catalog or
market prices (see FAR 22.1003- 4(c)(2)(ii)) for the maintenance, calibration, or repair of such
equipment; and

(iii) The compensation (wage and fringe benefits) plan for all service employees performing
work under the contract will be the same as that used for these employees and equivalent
employees servicing the same equipment of commercial customers.

[] (2) Certain services as described in FAR 22.1003- 4(d)(1). The offeror [ ] does [ ] does not
certify that—

(i) The services under the contract are offered and sold regularly to non-Governmental
customers, and are provided by the offeror (or subcontractor in the case of an exempt
subcontract) to the general public in substantial quantities in the course of normal business
operations;

(ii) The contract services will be furnished at prices that are, or are based on, established
catalog or market prices (see FAR 22.1003-4(d)(2)(iii));

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(iii) Each service employee who will perform the services under the contract will spend only
a small portion of his or her time (a monthly average of less than 20 percent of the available
hours on an annualized basis, or less than 20 percent of available hours during the contract
period if the contract period is less than a month) servicing the Government contract; and

(iv) The compensation (wage and fringe benefits) plan for all service employees performing
work under the contract is the same as that used for these employees and equivalent employees
servicing commercial customers.

(3) If paragraph (k)(1) or (k)(2) of this clause applies—

(i) If the offeror does not certify to the conditions in paragraph (k)(1) or (k)(2) and the
Contracting Officer did not attach a Service Contract Labor Standards wage determination to the
solicitation, the offeror shall notify the Contracting Officer as soon as possible; and

(ii) The Contracting Officer may not make an award to the offeror if the offeror fails to
execute the certification in paragraph (k)(1) or (k)(2) of this clause or to contact the Contracting
Officer as required in paragraph (k)(3)(i) of this clause.

(l) Taxpayer Identification Number (TIN) (26 U.S.C. 6109, 31 U.S.C. 7701). (Not applicable if
the offeror is required to provide this information to the SAM database to be eligible for award.)

(1) All offerors must submit the information required in paragraphs (l)(3) through (l)(5) 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 Internal Revenue Service (IRS).

(2) 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.

(3) 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.

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VA242-17-Q-0909

(4) Type of organization.

[ ] Sole proprietorship;

[ ] Partnership;

[ ] Corporate entity (not tax-exempt);

[ ] Corporate entity (tax-exempt);

[ ] Government entity (Federal, State, or local);

[ ] Foreign government;

[ ] International organization per 26 CFR 1.6049-4;

[ ] Other _________________________.

(5) Common parent.

[ ] Offeror is not owned or controlled by a common parent;

[ ] Name and TIN of common parent:

Name _____________________.

TIN _____________________.

(m) Restricted business operations in Sudan. By submission of its offer, the offeror certifies
that the offeror does not conduct any restricted business operations in Sudan.

(n) Prohibition on Contracting with Inverted Domestic Corporations.

(1) Government agencies are not permitted to use appropriated (or otherwise made available)
funds for contracts with either an inverted domestic corporation, or a subsidiary of an inverted
domestic corporation, unless the exception at 9.108-2(b) applies or the requirement is waived in
accordance with the procedures at 9.108-4.

(2) Representation. The Offeror represents that—

(i) It [ ] is, [ ] is not an inverted domestic corporation; and

(ii) It [ ] is, [ ] is not a subsidiary of an inverted domestic corporation.

(o) Prohibition on contracting with entities engaging in certain activities or transactions

relating to Iran.

(1) The offeror shall email questions concerning sensitive technology to the Department of
State at [email protected].

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(2) Representation and certifications. Unless a waiver is granted or an exception applies as

provided in paragraph (o)(3) of this provision, by submission of its offer, the offeror—

(i) Represents, to the best of its knowledge and belief, that the offeror does not export any
sensitive technology to the government of Iran or any entities or individuals owned or controlled
by, or acting on behalf or at the direction of, the government of Iran;

(ii) Certifies that the offeror, or any person owned or controlled by the offeror, does not
engage in any activities for which sanctions may be imposed under section 5 of the Iran
Sanctions Act; and

(iii) Certifies that the offeror, and any person owned or controlled by the offeror, does not
knowingly engage in any transaction that exceeds $3,500 with Iran’s Revolutionary Guard Corps
or any of its officials, agents, or affiliates, the property and interests in property of which are
blocked pursuant to the International Emergency Economic Powers Act (50 U.S.C. 1701 et seq.)
(see OFAC’s Specially Designated Nationals and Blocked Persons List at
http://www.treasury.gov/ofac/downloads/t11sdn.pdf).

(3) The representation and certification requirements of paragraph (o)(2) of this provision do
not apply if—

(i) This solicitation includes a trade agreements certification (e.g., 52.212–3(g) or a

comparable agency provision); and

(ii) The offeror has certified that all the offered products to be supplied are designated
country end products.

(p) Ownership or Control of Offeror. (Applies in all solicitations when there is a requirement to
be registered in SAM or a requirement to have a unique entity identifier in the solicitation).

(1) The Offeror represents that it [ ] has or [ ] does not have an immediate owner. If the
Offeror has more than one immediate owner (such as a joint venture), then the Offeror shall
respond to paragraph (2) and if applicable, paragraph (3) of this provision for each participant in
the joint venture.

(2) If the Offeror indicates “has” in paragraph (p)(1) of this provision, enter the following
information:

Immediate owner CAGE code: ____.

Immediate owner legal name: ____.

(Do not use a “doing business as” name)

Is the immediate owner owned or controlled by another entity: [ ] Yes or [ ] No.

(3) If the Offeror indicates “yes” in paragraph (p)(2) of this provision, indicating that the
immediate owner is owned or controlled by another entity, then enter the following information:

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VA242-17-Q-0909

Highest-level owner CAGE code: ____.

Highest-level owner legal name: ____.

(Do not use a “doing business as” name)

(q) Representation by Corporations Regarding Delinquent Tax Liability or a Felony

Conviction under any Federal Law.

(1) As required by sections 744 and 745 of Division E of the Consolidated and Further
Continuing Appropriations Act, 2015 (Pub. L. 113-235), and similar provisions, if contained in
subsequent appropriations acts, The Government will not enter into a contract with any
corporation that—

(i) Has any unpaid Federal tax liability that has been assessed, for which all judicial and
administrative remedies have been exhausted or have lapsed, and that is not being paid in a
timely manner pursuant to an agreement with the authority responsible for collecting the tax
liability, where the awarding agency is aware of the unpaid tax liability, unless an agency has
considered suspension or debarment of the corporation and made a determination that suspension
or debarment is not necessary to protect the interests of the Government; or

(ii) Was convicted of a felony criminal violation under any Federal law within the preceding
24 months, where the awarding agency is aware of the conviction, unless an agency has
considered suspension or debarment of the corporation and made a determination that this action
is not necessary to protect the interests of the Government.

(2) The Offeror represents that—

(i) It is [ ] is not [ ] a corporation that has any unpaid Federal tax liability that has been
assessed, for which all judicial and administrative remedies have been exhausted or have lapsed,
and that is not being paid in a timely manner pursuant to an agreement with the authority
responsible for collecting the tax liability; and

(ii) It is [ ] is not [ ] a corporation that was convicted of a felony criminal violation under a
Federal law within the preceding 24 months.

(r) Predecessor of Offeror. (Applies in all solicitations that include the provision at 52.204-16,
Commercial and Government Entity Code Reporting.)

(1) The Offeror represents that it [ ] is or [ ] is not a successor to a predecessor that held a
Federal contract or grant within the last three years.

(2) If the Offeror has indicated “is” in paragraph (r)(1) of this provision, enter the following
information for all predecessors that held a Federal contract or grant within the last three years (if
more than one predecessor, list in reverse chronological order):

Predecessor CAGE code: ____ (or mark “Unknown”).

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Predecessor legal name: ____.

(Do not use a “doing business as” name).

(s) Representation regarding compliance with labor laws (Executive Order 13673). If the
offeror is a joint venture that is not itself a separate legal entity, each concern participating in the
joint venture shall separately comply with the requirements of this provision.

(1)(i) For solicitations issued on or after October 25, 2016 through April 24, 2017: The
Offeror [ ] does [ ] does not anticipate submitting an offer with an estimated contract value of
greater than $50 million.

(ii) For solicitations issued after April 24, 2017: The Offeror [ ] does [ ] does not anticipate
submitting an offer with an estimated contract value of greater than $500,000.

(2) If the Offeror checked “does” in paragraph (s)(1)(i) or (ii) of this provision, the Offeror
represents to the best of the Offeror's knowledge and belief [Offeror to check appropriate block]:

[ ](i) There has been no administrative merits determination, arbitral award or decision, or
civil judgment for any labor law violation(s) rendered against the offeror (see definitions in
paragraph (a) of this section) during the period beginning on October 25, 2015 to the date of the
offer, or for three years preceding the date of the offer, whichever period is shorter; or

[ ](ii) There has been an administrative merits determination, arbitral award or decision, or
civil judgment for any labor law violation(s) rendered against the Offeror during the period
beginning on October 25, 2015 to the date of the offer, or for three years preceding the date of
the offer, whichever period is shorter.

(3)(i) If the box at paragraph (s)(2)(ii) of this provision is checked and the Contracting Officer
has initiated a responsibility determination and has requested additional information, the Offeror
shall provide--

(A) The following information for each disclosed labor law decision in the System for
Award Management (SAM) at www.sam.gov, unless the information is already current, accurate,
and complete in SAM. This information will be publicly available in the Federal Awardee
Performance and Integrity Information System (FAPIIS):

(1) The labor law violated.

(2) The case number, inspection number, charge number, docket number, or other unique
identification number.

(3) The date rendered.

(4) The name of the court, arbitrator(s), agency, board, or commission that rendered the
determination or decision;

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(B) The administrative merits determination, arbitral award or decision, or civil judgment
document, to the Contracting Officer, if the Contracting Officer requires it;

(C) In SAM, such additional information as the Offeror deems necessary to demonstrate its
responsibility, including mitigating factors and remedial measures such as offeror actions taken
to address the violations, labor compliance agreements, and other steps taken to achieve
compliance with labor laws. Offerors may provide explanatory text and upload documents. This
information will not be made public unless the contractor determines that it wants the
information to be made public; and

(D) The information in paragraphs (s)(3)(i)(A) and (s)(3)(i)(C) of this provision to the
Contracting Officer, if the Offeror meets an exception to SAM registration (see FAR 4.1102(a)).

(ii)(A) The Contracting Officer will consider all information provided under (s)(3)(i) of this
provision as part of making a responsibility determination.

(B) A representation that any labor law decision(s) were rendered against the Offeror will
not necessarily result in withholding of an award under this solicitation. Failure of the Offeror to
furnish a representation or provide such additional information as requested by the Contracting
Officer may render the Offeror nonresponsible.

(C) The representation in paragraph (s)(2) 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 representation, in addition to other remedies available
to the Government, the Contracting Officer may terminate the contract resulting from this
solicitation in accordance with the procedures set forth in FAR 12.403.

(4) The Offeror shall provide immediate written notice to the Contracting Officer if at any
time prior to contract award the Offeror learns that its representation at paragraph (s)(2) of this
provision is no longer accurate.

(5) The representation in paragraph (s)(2) of this provision will be public information in the
Federal Awardee Performance and Integrity Information System (FAPIIS).

Note to paragraph (s): By a court order issued on October 24, 2016, this paragraph (s) is
enjoined indefinitely as of the date of the order. The enjoined paragraph will become effective
immediately if the court terminates the injunction. At that time, DoD, GSA, and NASA will
publish a document in the Federal Register advising the public of the termination of the
injunction.

(t) Public Disclosure of Greenhouse Gas Emissions and Reduction Goals. Applies in all
solicitations that require offerors to register in SAM (52.212-1(k)).

(1) This representation shall be completed if the Offeror received $7.5 million or more in
contract awards in the prior Federal fiscal year. The representation is optional if the Offeror
received less than $7.5 million in Federal contract awards in the prior Federal fiscal year.

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(2) Representation. [Offeror to check applicable block(s) in paragraph (t)(2)(i) and (ii)]. (i)
The Offeror (itself or through its immediate owner or highest-level owner) [ ] does, [ ] does not
publicly disclose greenhouse gas emissions, i.e., makes available on a publicly accessible Web
site the results of a greenhouse gas inventory, performed in accordance with an accounting
standard with publicly available and consistently applied criteria, such as the Greenhouse Gas
Protocol Corporate Standard.

(ii) The Offeror (itself or through its immediate owner or highest-level owner) [ ] does, [ ]
does not publicly disclose a quantitative greenhouse gas emissions reduction goal, i.e., make
available on a publicly accessible Web site a target to reduce absolute emissions or emissions
intensity by a specific quantity or percentage.

(iii) A publicly accessible Web site includes the Offeror’s own Web site or a recognized,
third-party greenhouse gas emissions reporting program.

(3) If the Offeror checked “does” in paragraphs (t)(2)(i) or (t)(2)(ii) of this provision,
respectively, the Offeror shall provide the publicly accessible Web site(s) where greenhouse gas
emissions and/or reduction goals are reported:_____.

(u)(1) In accordance with section 743 of Division E, Title VII, of the Consolidated and Further
Continuing Appropriations Act, 2015 (Pub. L. 113-235) and its successor provisions in
subsequent appropriations acts (and as extended in continuing resolutions), Government agencies
are not permitted to use appropriated (or otherwise made available) funds for contracts with an
entity that requires employees or subcontractors of such entity seeking to report waste, fraud, or
abuse to sign internal confidentiality agreements or statements prohibiting or otherwise
restricting such employees or subcontractors from lawfully reporting such waste, fraud, or abuse
to a designated investigative or law enforcement representative of a Federal department or
agency authorized to receive such information.

(2) The prohibition in paragraph (u)(1) of this provision does not contravene requirements
applicable to Standard Form 312 (Classified Information Nondisclosure Agreement), Form 4414
(Sensitive Compartmented Information Nondisclosure Agreement), or any other form issued by a
Federal department or agency governing the nondisclosure of classified information.

(3) Representation. By submission of its offer, the Offeror represents that it will not require its
employees or subcontractors to sign or comply with internal confidentiality agreements or
statements prohibiting or otherwise restricting such employees or subcontractors from lawfully
reporting waste, fraud, or abuse related to the performance of a Government contract to a
designated investigative or law enforcement representative of a Federal department or agency
authorized to receive such information (e.g., agency Office of the Inspector General).

(End of Provision)

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