PART IV - SECTION K

**Representations, Certifications, and Other Statements of Offerors or
Quoters (Negotiated).**

1\. [REPRESENTATIONS AND CERTIFICATIONS]{.underline}

1.  FAR 52.203-2 Certification of Independent Price Determination

2.  FAR 52.203-11 Certification and Disclosure Regarding Payments to
    Influence Certain Federal Transactions (DEVIATION)

3.  FAR 52.204-3 Taxpayer Identification

4.  FAR 52.204-5 Women-Owned Business (Other Than Small Business)

5.  FAR 52.204-6 Data Universal Numbering System (DUNS) Number

6.  FAR 52.209-5 Certification Regarding Debarment, Suspension, Proposed
    Debarment and Other Responsibility Matters

7.  FAR 52.215-6 Place of Performance

8.  FAR 52.219-1 Small Business Program Representations

9.  FAR 52.219-19 Small Business Concern Representation for the Small
    Business Competitiveness Demonstration Program

10. FAR 52.219-21 Small Business Size Representation for Targeted
    Industry Categories Under the Small Business Competitiveness
    Demonstration Program

11. FAR 52.219-22 Small Disadvantaged Business Status

12. FAR 52.222-18 Certification Regarding Knowledge of Child Labor for
    Listed End Products

13. FAR 52.222-21 Certification of Nonsegregated Facilities

14. FAR 52.222-22 Previous Contracts and Compliance Reports

15. FAR 52.222-25 Affirmative Action Compliance

16. FAR 52.222-48 Exemption From Application of Service Contract Act
    Provisions

17. FAR 52.223-4 Recovered Material Certification

18. FAR 52.223-13 Certification of Toxic Chemical Release Reporting

19. FAR 52.225-2 Buy American Act\--Balance of Payments Program
    Certificate

20. FAR 52.225-4 Buy American Act\--North American Free Trade
    Agreement\--Israeli Trade Act\--Balance of Payments Program
    Certificate

21. FAR 52.225-6 Trade Agreements Certificate

22. FAR 52.226-2 Historically Black College or University and Minority
    Institution Representation

23. FAR 52.227-6 Royalty Information

24. FAR 52.230-1 Cost Accounting Standards Notices and Certification

25. \-\-\-\-- Certification Regarding Environmental Tobacco Smoke

26. \-\-\-\-- Certification of Institutional Policy on Conflict of
    Financial Interest

27. FAR 15.406-2 Certificate of Current Cost or Pricing Data

[To Be Completed by the Offeror:]{.underline} **(The Representations and
Certifications must be executed by an individual authorized to bind the
offeror.)** The offeror makes the following Representations and
Certifications as part of its proposal **(check/complete all appropriate
boxes or blanks on the following pages)**.

**(Name of Offeror)** **(RFP No.)**

**(Signature of Authorized Individual)** **(Date)**

**(Typed Name of Authorized Individual)**

Note: The penalty for making false statements in offers is prescribed in
18 U.S.C 1001.

1.  

**52.203-2 [CERTIFICATE OF INDEPENDENT PRICE DETERMINATION]{.underline}
(APRIL 1985)**

> **\[NOTE: This provision is applicable when a firm-fixed price or
> fixed-price with economic price adjustment contract is
> contemplated.\]**

\(a\) The offeror certifies that -

> \(1\) The prices in this offer have been arrived at independently,
> without, for the purpose of restricting competition, any consultation,
> communication, or agreement with any other offeror or competitor
> relating to (i) those prices, (ii) the intention to submit an offer,
> or (iii) the methods or factors used to calculate the prices offered;
>
> \(2\) The prices in this offer have not been and will not be knowingly
> disclosed by the offeror, directly or indirectly, to any other offeror
> or competitor before bid opening (in the case of a sealed bid
> solicitation) or contract award (in the case of a negotiated
> solicitation) unless otherwise required by law; and
>
> \(3\) No attempt has been made or will be made by the offeror to
> induce any other concern to submit or not to submit an offer for the
> purpose of restricting competition.

\(b\) Each signature on the offer is considered to be a certification by
the signatory that the signatory\--

> \(1\) Is the person in the offeror\'s organization responsible for
> determining the prices being offered in this bid or proposal, and that
> the signatory has not participated and will not participate in any
> action contrary to subparagraphs (a)(1) through (a)(3) above; or

\(2\) (i) Has been authorized in writing, to act as agent for the
following principals in certifying that those principals have not
participated, and will not participate in any action contrary to
subparagraphs (a)(1) through (a)(3) above

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> **\[insert full name of person(s) in the offeror\'s organization
> responsible for determining the prices offered in this bid or
> proposal, and the title of his or her position in the offeror\'s
> organization\];**
>
> \(ii\) As an authorized agent, does certify that the principals named
> in subdivision (b)(2)(i) above have not participated, and will not
> participate, in any action contrary to subparagraphs (a)(1) through
> (a)(3) above; and
>
> \(iii\) As an agent, has not personally participated, and will not
> participate, in any action contrary to subparagraphs (a)(1) through
> (a)(3) above.

\(c\) If the offeror deletes or modifies subparagraph (a)(2) above, the
offeror must furnish with its offer a signed statement setting forth in
detail the circumstances of the disclosure.

2.  **52.203-11 [CERTIFICATION AND DISCLOSURE REGARDING PAYMENTS TO
    INFLUENCE CERTAIN FEDERAL TRANSACTIONS (DEVIATION)]{.underline}**

\(a\) The definitions and prohibitions contained in the clause, at FAR
52.203-12, Limitations on Payments to Influence Certain Federal
Transactions, included in this solicitation, are hereby incorporated by
reference in paragraph (b) of this certification.

\(b\) The offeror, by signing its offer, hereby certifies to the best of
his or her knowledge and belief that on or after December 23, 1989 -

> \(1\) 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 awarding of a contract resulting from
> this solicitation.

\(2\) If any funds other than Federal appropriated funds (including
profit or fee received under a covered Federal transaction) 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 this solicitation, the offeror
shall complete and submit with its offer, OMB Standard Form-LLL,
\"Disclosure of Lobbying Activities\", to the Contracting Officer, and

\(3\) He or she will include the language of this certification in all
subcontract awards at any tier and require that all recipients of
subcontract awards in excess of \$100,000 shall certify and disclose
accordingly.

\(c\) Submission of this certification and disclosure is a prerequisite
for making or entering into this contract imposed by section 1352, Title
31, United States Code. Any person who makes an expenditure prohibited
under this provision or who fails to file or amend the disclosure form
to be filed or amended by this provision, shall be subject to a civil
penalty of not less than \$10,000, and not more than \$100,000, for each
such failure.

3.  **52.204-3 [TAXPAYER IDENTIFICATION]{.underline} (OCTOBER 1998)**

    a.  Definitions.

> ***Common parent***, as used in this provision, means that corporate
> entity that owns or controls an affiliated group of corporations that
> files its Federal income tax returns on a consolidated basis, and of
> which the offeror is a member.
>
> ***Taxpayer Identification Number (TIN)***, as used in this provision,
> means the number required by the Internal Revenue Service (IRS) to be
> used by the offeror in reporting income tax and other returns. The TIN
> may be either a Social Security Number or an Employer Identification
> Number.

b.  All offerors must submit the information required in paragraphs (d)
    through (f) of this provision to comply with debt collection
    requirements of 31 U.S.C. 7701(c) and 3325(d), reporting
    requirements of 26 U.S.C. 6041, 6041A, and 6050M, and implementing
    regulations issued by the IRS. If the resulting contract is subject
    to the payment reporting requirements described in Federal
    Acquisition Regulation (FAR) 4.904, the failure or refusal by the
    offeror to furnish the information may result in a 31 percent
    reduction of payments otherwise due under the contract.

c.  The TIN may be used by the Government to collect and report on any
    delinquent amounts arising out of the offeror\'s relationship with
    the Government (31 U.S.C. 7701(c)(3)). If the resulting contract is
    subject to the payment reporting requirements described in FAR
    4.904, the TIN provided hereunder may be matched with IRS records to
    verify the accuracy of the offeror\'s TIN.

d.  Taxpayer Identification Number (TIN).

\[ \] TIN:

\[ \] TIN has been applied for.

\[ \] TIN is not required because:

\[ \] Offeror is a nonresident alien, foreign corporation, or foreign
partnership that does not have income effectively connected with the
conduct of a trade or business in the United States and does not have an
office or place of business or a fiscal paying agent in the United
States;

\[ \] Offeror is an agency or instrumentality of a foreign government;

\[ \] Offeror is an agency or instrumentality of the Federal Government.

e.  Type of organization.

\[ \] Sole proprietorship;

\[ \] Partnership;

\[ \] Corporate entity (not tax-exempt);

\[ \] Corporate entity (tax-exempt);

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

\[ \] Foreign government;

\[ \] International organization per 26 CFR 1.6049-4;

\[ \] Other

f.  Common parent.

\[ \] Offeror is not owned or controlled by a common parent as defined
in paragraph (a) of this provision.

\[ \] Name and TIN of common parent:

> Name
>
> TIN

4.  **52.204-5 [WOMEN-OWNED BUSINESS (Other Than Small
    Business)]{.underline} (MAY 1999)**

\(a\) *Definition*. Women-owned business concern, as used in this
provision, means a concern that is at least 51 percent owned by one or
more women; or in the case of any publicly owned business, at least 51
percent of its stock is owned by one or more women; and whose management
and daily business operations are controlled by one or more women.

\(b\) *Representation*. \[*Complete only if the offeror is a women-owned
business concern and has not represented itself as a small business
concern in paragraph (b)(1) of FAR 52.219-1, Small Business Program
Representations, of this solicitation*.\]

The offeror represents that it **\[ \]** is a women-owned business
concern.

5.  **52.204-6 [DATA UNIVERSAL NUMBERING SYSTEM (DUNS)
    NUMBER]{.underline} (JUNE 1999)**

\(a\) The offeror shall enter, in the block with its name and address on
the cover page of its offer, the annotation \"DUNS\" followed by the
DUNS number that identifies the offeror\'s name and address exactly as
stated in the offer. The DUNS number is a nine-digit number assigned by
Dun and Bradstreet Information Services.

\(b\) If the offeror does not have a DUNS number, it should contact Dun
and Bradstreet directly to obtain one. A DUNS number will be provided
immediately by telephone at no charge to the offeror. For information on
obtaining a DUNS number, if located within the United States, the
offeror should call Dun and Bradstreet at 1-800-333-0505. The offeror
should be prepared to provide the following information:

\(1\) Company name.

\(2\) Company address.

\(3\) Company telephone number.

\(4\) Line of business.

\(5\) Chief executive officer/key manager.

\(6\) Date the company was started.

\(7\) Number of people employed by the company.

\(8\) Company affiliation.

\(c\) Offerors located outside the United States may obtain the location
and phone number of the local Dun and Bradstreet Information Services
office from the Internet home page at
http://www.customerservice@dnb.com. If an offeror is unable to locate a
local service center, it may send an e-mail to Dun and Bradstreet at
[[globalinfo@mail.dnb.com.]{.underline}](mailto:globalinfo@mail.dnb.com.)

6.  **52.209-5 [CERTIFICATION REGARDING DEBARMENT, SUSPENSION, PROPOSED
    SUSPENSION, PROPOSED DEBARMENT AND OTHER RESPONSIBILITY
    MATTERS]{.underline} (APRIL 2001)**

> **(NOTE: Applies to contracts expected to exceed \$100,000.)**

\(a\) (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 the 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, 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 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, or
receiving stolen property; and

\(E\) 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
(9a)(1)(i)(B) of this provision.

\(ii\) (A) The offeror, aside from the offenses enumerated in paragraphs
(a)(1)(i)(A), (B), and (C) of this provision, has **\[ \]** has not **\[
\]** within the past three years, relative to tax, labor and employment,
environmental, antitrust, or consumer protections laws\--

\(1\) Been convicted of a Federal or state felony (or has any Federal or
state felony indictments currently pending against them); or

\(2\) Had a Federal court judgment in a civil case brought by the United
States rendered against them; or

\(3\) Had an adverse decision by a Federal administrative law judge,
board, or commission indicating a willful violation of law.

\(B\) If the offeror has responded affirmatively, the offeror shall
provide additional information if requested by the Contracting Officer;
and

\(iii\) The Offeror has **\[ \]**, has not **\[ \]**, within a
three-year period preceding this offer, had one or more contracts
terminated for default by any Federal agency.

\(2\) \"Principals\" for the purposes of this certification, means
officers; directors; owners; partners; and, persons 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).

> **THIS CERTIFICATION CONCERNS A MATTER WITHIN THE JURISDICTION OF AN
> AGENCY OF THE UNITED STATES AND THE MAKING OF A FALSE, FICTITIOUS, OR
> FRAUDULENT CERTIFICATION MAY RENDER THE MAKER SUBJECT TO PROSECUTION
> UNDER SECTION 1001, TITLE 18, UNITED STATES CODE.**

\(b\) The Offeror shall provide immediate written notice to the
Contracting Officer if, at any time prior to contract award, the Offeror
learns that its certification was erroneous when submitted or has become
erroneous by reason of changed circumstances.

\(c\) A certification that any of the items in paragraph (a) of this
provision exists will not necessarily result in withholding of an award
under this solicitation. However, the certification will be considered
in connection with a determination of the Offeror\'s responsibility.
Failure of the Offeror to furnish a certification or provide such
additional information as requested by the Contracting Officer may
render the Offeror nonresponsible.

\(d\) Nothing contained in the foregoing shall be construed to require
establishment of a system of records in order to render, in good faith,
the certification required by paragraph (a) of this provision. The
knowledge and information of an Offeror is not required to exceed that
which is normally possessed by a prudent person in the ordinary course
of business dealings.

\(e\) The certification in paragraph (a) of this provision is a material
representation of fact upon which reliance was placed when making an
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.

7.  **52.215-6 [PLACE OF PERFORMANCE]{.underline} (OCTOBER 1997)**

\(a\) The offeror or respondent, in the performance of any contract
resulting from this solicitation, **\[ \]** intends, **\[ \]** does not
intend **(check applicable block)** to use one or more plants or
facilities located at a different address from the address of the
offeror or respondent as indicated in this proposal or response to
request for information.

\(b\) If the offeror or respondent checks \"intends\" in paragraph (a)
of this provision, it shall insert in the following spaces the required
information:

**Place of Performance** (Street Address **Name and Address of Owner and
Operator of the Plant**

(City, State, County, Zip Code) **or Facility if Other than Offeror or
Respondent**

8.  **52.219-1 [SMALL BUSINESS PROGRAM REPRESENTATIONS]{.underline} (MAY
    2001)**

> ([Note: This provision applies to solicitations exceeding the
> micro-purchase threshold when the contract is to be performed in the
> United States, its territories or possessions, Puerto Rico, the Trust
> Territory of the Pacific Islands, or the District of
> Columbia.)]{.underline}

\(a\) (1) The North American Industry Classification System (NAICS) code
for this acquisition is [\[INSERT NAICS CODE\]]{.underline} .

\(2\) The small business size standard is [\[INSERT SIZE
STANDARD\]]{.underline} .

\(3\) The small business size standard for a concern which submits an
offer in its own name, other than on a construction or service contract,
but which proposes to furnish a product which it did not itself
manufacture, is 500 employees.

\(b\) **Representations**.

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

\(2\) (**Complete only if the offeror represented itself as a small
business concern in** **paragraph (b)(1) of this provision**.) The
offeror represents, for general statistical purposes, that it **\[ \]**
is, **\[ \]** is not a small disadvantaged business concern as defined
in 13 CFR 124.1002.

\(3\) (**Complete only if the offeror represented itself as a small
business concern in paragraph (b)(1) of this provision**.) The offeror
represents as part of its offer that it **\[ \]** is, **\[ \]** is not a
women-owned small business concern.

\(4\) (**Complete only if the offeror represented itself as a small
business concern in paragraph (b)(1) of this provision**.) The offeror
represents as part of its offer that it **\[ \]** is, **\[ \]** is not a
veteran-owned small business concern.

\(5\) (**Complete only if the offeror represented itself as a
veteran-owned small business concern in paragraph (b)(4) of this
provision**.) The offeror represents as part of its offer that it **\[
\]** is, **\[ \]** is not a service-disabled veteran-owned small
business concern.

\(c\) **Definitions**. As used in this provision\--

> **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 or which is owned by one
or more service-disabled veterans; and

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

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

> **Small business concern**, means a concern, including its affiliates,
> that is independently owned and operated, not dominant in the field of
> operation in which it is bidding on Government contracts, and
> qualified as a small business under the criteria in 13 CFR Part 121
> and the size standard in paragraph (a) of this provision.
>
> **Women-owned small business concern**, means a small business
> concern-

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

\(2\) Whose management and daily business operations are controlled by
one or more women.

> **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.

\(d\) **Notice**.

\(1\) If this solicitation is for supplies and has been set aside, in
whole or in part, for small business concerns, then the clause in this
solicitation providing notice of the set-aside contains restrictions on
the source of the end items to be furnished.

\(2\) Under 15 U.S.C. 645(d), any person who misrepresents a firm\'s
status as a small, HUBZone small, small disadvantaged, or women-owned
small business concern in order to obtain a contract to be awarded under
the preference programs established pursuant to section 8(a), 8(d), 9,
or 15 of the Small Business Act or any other provision of Federal law
that specifically references section 8(d) for a definition of program
eligibility, shall\--

\(i\) Be punished by imposition of fine, imprisonment, or both;

\(ii\) Be subject to administrative remedies, including suspension and
debarment; and

\(iii\) Be ineligible for participation in programs conducted under the
authority of the Act.

> **[ALTERNATE I]{.underline}** **(OCTOBER 2000)**. As prescribed in
> 19.307(a)(2), add the following paragraph (b)(6) to the basic
> provision:

\(6\) \[Complete only if offeror represented itself as a small business
concern in paragraph (b)(1) of this provision.\] The offeror represents,
as part of its offer, that\--

\(i\) It **\[ \]** is, **\[ \]** is not a HUBZone small business concern
listed, on the date of this representation, on the List of Qualified
HUBZone Small Business Concerns maintained by the Small Business
Administration, and no material 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

\(ii\) It **\[ \]** is, **\[ \]** is not a joint venture that complies
with the requirements of 13 CFR part 126, and the representation in
paragraph (b)(4)(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.

9.  **52.219-19 [SMALL BUSINESS CONCERN REPRESENTATION FOR THE SMALL
    BUSINESS COMPETITIVENESS DEMONSTRATION PROGRAM]{.underline} (OCTOBER
    2000)**

> (This representation must be completed if the acquisition is for one
> of the four designated industry groups of the Small Business
> Competitiveness Demonstration Program specified in FAR
> 19.1005(a)\[includes [Construction Contracts]{.underline} under NAICS
> codes that comprise Industry Subsectors 233, 234 and 235\].)

\(a\) **Definition**

> \"Emerging small business\" as used in this solicitation, means a
> small business concern whose size is no greater than 50 percent of the
> numerical size standard applicable to the North American Industry
> Classification System (NAICS) code assigned to a contracting
> opportunity.

\(b\) **(Complete only if offeror has represented itself under the
provision at FAR 52.219-1 as a small business concern under the size
standards of this solicitation.)**

> The Offeror **\[ \]** is, **\[ \]** is not an emerging small business.

\(c\) **(Complete only if the Offeror is a small business or an emerging
small business, indicating its size range.)**

> Offeror\'s number of employees for the past twelve months **(check
> this column if size standard stated in solicitation is expressed in
> terms of number of employees)** or Offeror\'s average annual gross
> revenue for the last 3 fiscal years **(Check this column if size
> standard stated in solicitation is expressed in terms of annual
> receipts). (Check one of the following.)**
>
> **[Number of Employees]{.underline} [Average Annual Gross
> Revenues]{.underline}**
>
> \[ \] 50 or fewer \[ \] \$1 million or less

\[ \] 51 - 100 \[ \] \$1,000,001 - \$2 million

> \[ \] 101 - 250 \[ \] \$2,000,001 - \$3.5 million

\[ \] 251 - 500 \[ \] \$3,500,001 - \$5 million

> \[ \] 501 - 750 \[ \] \$5,000,001 - \$10 million
>
> \[ \] 751 - 1,000 \[ \] \$10,000,001 - \$17 million
>
> \[ \] Over 1,000 \[ \] Over \$17 million

10. **52.219-21 [SMALL BUSINESS SIZE REPRESENTATION FOR TARGETED
    INDUSTRY CATEGORIES UNDER THE SMALL BUSINESS COMPETITIVENESS
    DEMONSTRATION PROGRAM]{.underline} (MAY 1999)**

> **(Complete only if the Offeror has represented itself under the
> provision 52.219-1 as a small business concern under the size
> standards of this solicitation.)**
>
> **(NOTE: This representation must be completed if this solicitation
> covers one of the ten targeted industry categories under the Small
> Business Competitiveness Demonstration Program [and]{.underline} if
> the offeror has certified itself under the clause at FAR 52.219-1 to
> be a small business concern under the size standards of this
> solicitation).**
>
> Offeror\'s number of employees for the past twelve months **(check
> this column if size standard stated in solicitation is expressed in
> terms of number of employees)** [or]{.underline} Offeror\'s average
> annual gross revenue for the last three fiscal years **(check this
> column if size standard stated in solicitation is expressed in terms
> of annual receipts).** **(Check one of the following.)**
>
> **[No. of Employees]{.underline} [Average Annual Gross
> Revenues]{.underline}**
>
> \[ \] 50 or fewer \[ \] \$1 million or less
>
> \[ \] 51 - 100 \[ \] \$1,000,001 - \$2 million
>
> \[ \] 101 -250 \[ \] \$2,000,001 - \$3.5 million
>
> \[ \] 251 - 500 \[ \] \$3,500,001 - \$5 million
>
> \[ \] 501 - 750 \[ \] \$5,000,001 - \$10 million
>
> \[ \] 751 - 1,000 \[ \] \$10,000,001 - \$17 million
>
> \[ \] Over 1,000 \[ \] Over \$17 million

The ten targeted industries are as follows:

[Product Service Code]{.underline} [SIC Code]{.underline}
[Description]{.underline}

G004 8742 Counseling/Training/Social Rehabilitation Services

J099 7699 Maintenance, Repair and Rebuilding of Equipment (Office
Machines, Text Processing Systems & Visible Record Equipment)

K099 7699 Modification of Equipment (misc.)

Q210 8099, 8742 General Health Care Services

R406 8742 Policy Review/Development Services

R497 7299 Personal Services

6505 2833, 2834 Drugs and Biologics

> 2835, 2836

7045 3572, 3695 ADP Supplies

> 5065

7110 5021 Office Furniture

7510 5112 Office Supplies

11. **52.219-22 [SMALL DISADVANTAGED BUSINESS STATUS]{.underline}
    (OCTOBER 1999)**

> **(Note: This applies to competitive solicitations over \$100,000
> under the SIC Major Groups for which a price evaluation adjustment is
> applicable.)**

\(a\) **General**. This provision is used to assess an offeror\'s small
disadvantaged business status for the purpose of obtaining a benefit on
this solicitation. Status as a small business and status as a small
disadvantaged business for general statistical purposes is covered by
the provision at FAR 52.219-1, Small Business Program Representation.

\(b\) **Representations**.

\(1\) **General**. The offeror represents, as part of its offer, that it
is a small business under the size standard applicable to this
acquisition; and either\--

**\[ \]** (i) It has received certification by the Small Business
Administration as a small disadvantaged business concern consistent with
13 CFR 124, Subpart B; and

\(A\) No material change in disadvantaged ownership and control has
occurred since its certification;

\(B\) Where the concern is owned by one or more disadvantaged
individuals, the net worth of each individual upon whom the
certification is based does not exceed \$750,000 after taking into
account the applicable exclusions set forth at 13 CFR 124.104(c)(2); and

\(C\) It is identified, on the date of its representation, as a
certified small disadvantaged business concern in the database
maintained by the Small Business Administration (PRO-Net); or

**\[ \]** (ii) It has submitted a completed application to the Small
Business Administration or a Private Certifier to be certified as a
small disadvantaged business concern in accordance with 13 CFR 124,
Subpart B, and a decision on that application is pending, and that no
material change in disadvantaged ownership and control has occurred
since its application was submitted.

\(2\) **\[ \]** **For Joint Ventures**. The offeror represents, as part
of its offer, that it is a joint venture that complies with the
requirements at 13 CFR 124.1002(f) and that the representation in
paragraph (b)(1) of this provision is accurate for the small
disadvantaged business concern that is participating in the joint
venture. *\[The offeror shall enter the name of the small disadvantaged
business concern that is participating in the joint venture:
\_\_\_\_\_\_\_\_\_\_\_\_.\]*

\(c\) **Penalties and Remedies**. Anyone who misrepresents any aspects
of the disadvantaged status of a concern for the purposes of securing a
contract or subcontract shall:

\(1\) Be punished by imposition of a fine, imprisonment, or both;

\(2\) Be subject to administrative remedies, including suspension and
debarment; and

\(3\) Be ineligible for participation in programs conducted under the
authority of the Small Business Act.

> **Alternate I (OCTOBER 1998)**
>
> **(Note: Applies when price evaluation adjustment for small
> disadvantaged business concerns is authorized on a regional basis.
> Designated regions by Major SIC Category can be found at
> [[http://www.arnet.gov/References/sdbadjustments.htm]{.underline}](http://www.arnet.gov/References/sdbadjustments.htm)
> .** **Currently, this includes SIC Major Industry Groups 15, 16, 17
> which are all construction related groups.)**
>
> As prescribed in 19.306(b), add the following paragraph (b)(3) to the
> basic provision:

\(3\) Address. The offeror represents that its address\_\_\_\_\_\_is,
\_\_\_\_\_\_is not in a region for which a small disadvantaged business
procurement mechanism is authorized and its address has not changed
since its certification as a small disadvantaged business concern or
submission of its application for certification. The list of authorized
small disadvantaged business procurement mechanisms and regions is
posted at
[[http://www.arnet.gov/References/sdbadjustments.htm]{.underline}](http://www.arnet.gov/References/sdbadjustments.htm)
The offeror shall use the list in effect on the date of this
solicitation. "Address," as used in this provision, means the address of
the offeror as listed on the Small Business Administration's register of
small disadvantaged business concerns or the address on the completed
application that the concern has submitted to the Small Business
Administration or a Private Certifier in accordance with 13 CFR part
124, subpart B. For joint ventures, "address" refers to the address of
the small disadvantaged business concern that is participating in the
joint venture.

12. **52.222-18 [CERTIFICATION REGARDING KNOWLEDGE OF CHILD LABOR FOR
    LISTED END PRODUCTS]{.underline} (MAY 2001)**

> *(Applies to all contracts for supplies over \$2,500. See FAR 22.1503
> for more information)*

a.  *Definition*.

*Forced or indentured child labor means all work or service\--*

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

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

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b.  *Listed end products.* The following end product(s) being acquired
    under this solicitation is (are) included in the List of Products
    Requiring Contractor Certification as to Forced or Indentured Child
    Labor, identified by their country of origin. There is a reasonable
    basis to believe that listed end products from the listed countries
    of origin may have been mined, produced, or manufactured by forced
    or indentured child labor.

Listed End Product

Listed Countries of Origin

c.  *Certification*. The Government will not make award to an offeror
    unless the offeror, by checking the appropriate block, certifies to
    either paragraph (c)(1) or paragraph (c)(2) of this provision.

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

**\[ \]** (2) The offeror may supply an end product listed in paragraph
(b) 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
indentured child labor was used to mine, produce, or manufacture such
end product. On the basis of those efforts, the offeror certifies that
it is not aware of any such use of child labor.

13. **52.222-21 [CERTIFICATION OF NONSEGREGATED FACILITIES]{.underline}
    (FEBRUARY 1999)**

\(a\) *Segregated facilities*, as used in this clause, means any waiting
rooms, work areas, rest rooms and wash rooms, restaurants and other
eating areas, time clocks, locker rooms and other storage or dressing
areas, parking lots, drinking fountains, recreation or entertainment
areas, transportation, and housing facilities provided for employees,
that are segregated by explicit directive or are in fact segregated on
the basis of race, color, religion, sex, or national origin because of
written or oral policies or employee custom. The term does not include
separate or single-user rest rooms or necessary dressing or sleeping
areas provided to assure privacy between the sexes.

\(b\) The Contractor agrees that it does not and will not maintain or
provide for its employees any segregated facilities at any of its
establishments, and that it does not and will not permit its employees
to perform their services at any location under its control where
segregated facilities are maintained. The Contractor agrees that a
breach of this clause is a violation of the Equal Opportunity clause in
this contract.

\(c\) The Contractor shall include this clause in every subcontract and
purchase order that is subject to the Equal Opportunity clause of this
contract.

14. **52.222-22 [PREVIOUS CONTRACTS AND COMPLIANCE REPORTS]{.underline}
    (FEBRUARY 1999)**

> The offeror represents that \--

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

\(b\) It **\[ \]** has, **\[ \]** has not, filed all required compliance
reports; and

\(c\) Representations indicating submission of required compliance
reports, signed by proposed subcontractors, will be obtained before
subcontract awards.

15. **52.222-25 [AFFIRMATIVE ACTION COMPLIANCE]{.underline} (APRIL
    1984)**

> The offeror represents that (a) it **\[ \]** has developed and has on
> file, **\[ \]** has not developed and does not have on file, at each
> establishment, affirmative action programs required by the rules and
> regulations of the Secretary of Labor (41 CFR 60-1 and 60-2), or (b)
> it **\[ \]** has not previously had contracts subject to the written
> affirmative action programs requirement of the rules and regulations
> of the Secretary of Labor.

16. **52.222-48 [EXEMPTION FROM APPLICATION OF SERVICE CONTRACT ACT
    PROVISIONS FOR CONTRACTS FOR MAINTENANCE, CALIBRATION, AND/OR REPAIR
    OF CERTAIN INFORMATION TECHNOLOGY, SCIENTIFIC AND MEDICAL AND/OR
    OFFICE AND BUSINESS EQUIPMENT\--CONTRACTOR
    CERTIFICATION]{.underline} (AUGUST 1996)**

> **(NOTE: This clause is applicable to all solicitations and resultant
> contracts calling for maintenance, calibration, and/or repair of
> information technology, scientific and medical, and office and
> business equipment if the contracting officer determines that the
> resultant contract may be exempt from Service Contract Act
> coverage).**
>
> \(a\) The following certification shall be checked:

**CERTIFICATION**

> The offeror certifies **\[ \]**, does not certify **\[ \]** that: (1)
> The items of equipment to be serviced under this contract are
> commercial items which are used regularly for other than Government
> purposes, and are sold or traded by the Contractor in substantial
> quantities to the general public in the course of normal business
> operations; (2) The contract services are furnished at prices which
> are, or are based on, established catalog or market prices for the
> maintenance, calibration, and/or repair of certain information
> technology, scientific and medical, and/or office and business
> equipment. An \"established catalog price\" is a price (including
> discount price) recorded in a catalog, price list schedule, or other
> verifiable and established record that is regularly maintained by the
> manufacturer or the Contractor and is either published or otherwise
> available for inspection by customers. An \"established market price\"
> is a current price, established in the usual course of ordinary and
> usual trade between buyers and sellers free to bargain, which can be
> substantiated by data from sources independent of the manufacturer or
> Contractor; and (3) The Contractor utilizes the same compensation
> (wage and fringe benefits) plan for all service employees performing
> work under the contract as the Contractor uses for equivalent
> employees servicing the same equipment of commercial customers.

\(b\) If a negative certification is made and a Service Contract Act
wage determination is not attached to the solicitation, the Contractor
shall notify the Contracting Officer as soon as possible.

\(c\) Failure to execute the certification in paragraph (a) of this
clause or to contact the Contracting Officer as required in paragraph
(b) of this clause may render the bid or offer nonresponsive.

17. **52.223-4 [RECOVERED MATERIAL CERTIFICATION]{.underline} (OCTOBER
    1997)**

> **(This certification is applicable in solicitations that are for, or
> specify the use, of recovered materials.)**
>
> As required by the Resource Conservation and Recovery Act of 1976 (42
> U.S.C. 6962(c)(3)(A)(i)), the offeror certifies, by signing this
> offer, that the percentage of recovered materials to be used in the
> performance of the contract will be at least the amount required by
> the applicable contract specifications.

18. **52.223-13 [CERTIFICATION OF TOXIC CHEMICAL RELEASE
    REPORTING]{.underline} (OCTOBER 2000)**

> **[NOTE]{.underline}: This certification is applicable for all
> solicitations for competitive contracts expected to exceed \$100,000
> (including all options) and competitive 8(a) contracts. It is not
> applicable to acquisitions of commercial items, or to contracts where
> the contractor\'s facilities are located outside the United States
> (the \"United States\" includes any state of the United States, the
> District of Columbia, the Commonwealth of Puerto Rico, Guam, American
> Samoa, the United States Virgin Islands, the Northern Mariana Islands,
> and any other territory or possession over which the United States has
> jurisdiction)**

\(a\) Submission of this certification is a prerequisite for making or
entering into this contract imposed by Executive Order 12969, August 8,
1995.

\(b\) By signing this offer, the offeror certifies that--

\(1\) As the owner or operator of facilities that will be used in the
performance of this contract that are subject to the filing and
reporting requirements described in section 313 of the Emergency
Planning and Community Right-to-Know Act of 1986 (EPCRA) (42 U.S.C.
11023) and section 6607 of the Pollution Prevention Act of 1990 (PPA)
(42 U.S.C. 13106), the offeror will file and continue to file for such
facilities for the life of the contract the Toxic Chemical Release
Inventory Form (Form R) as described in sections 313(a) and (g) of EPCRA
and section 6607 of PPA; or

\(2\) None of its owned or operated facilities to be used in the
performance of this contract is subject to the Form R filing and
reporting requirements because each such facility is exempt for at least
one of the following reasons: (Check each block that is applicable.)

**\[ \]** (i) The facility does not manufacture, process, or otherwise
use any toxic chemicals listed under section 313(c) of EPCRA, 42 U.S.C.
11023(c);

**\[ \]** (ii) The facility does not have 10 or more full-time employees
as specified in section 313(b)(1)(A) of EPCRA, 42 U.S.C. 11023(b)(1)(A);

**\[ \]** (iii) The facility does not meet the reporting thresholds of
toxic chemicals established under section 313(f) of EPCRA, 42 U.S.C.
11023(f) (including the alternate thresholds at 40 CFR 372.27, provided
an appropriate certification form has been filed with EPA);

**\[ \]** (iv) The facility does not fall within Standard Industrial
Classification Code (SIC) major groups 20 through 39 or their
corresponding North American Industry Classification System (NAICS)
sectors 31 through 33; or

**\[ \]** (v) The facility is not located within any State of the United
States, the District of Columbia, the Commonwealth of Puerto Rico, Guam,
American Samoa, the United States Virgin Islands, the Northern Mariana
Islands, or any other territory or possession over which the United
States has jurisdiction.

19. **52.225-2 [BUY AMERICAN ACT\--BALANCE OF PAYMENTS PROGRAM
    CERTIFICATE]{.underline} (FEBRUARY 2000)**

> **\[Note: This provision is applicable for all requirements EXCEPT
> for 1) foreign contracts or 2) when one of the following two
> provisions (52.225-4, Buy American Act\--North American Free Trade
> Agreement\--Israeli Trade Act\--Balance of Payments Program
> Certificate, or 52.225-6, Trade Agreements Certificate) apply.**

\(a\) The offeror certifies that each end product, except those listed
in paragraph (b) of this provision, is a domestic end product as defined
in the clause of this solicitation entitled "Buy American Act\--Balance
of Payments Program\--Supplies" and that 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.

\(b\) Foreign End Products:

Line Item No.:

Country of Origin:

(List as necessary)

\(c\) The Government will evaluate offers in accordance with the
policies and procedures of Part 25 of the Federal Acquisition
Regulation.

20. **52.225-4 [BUY AMERICAN ACT NORTH AMERICAN FREE TRADE
    AGREEMENT\--ISRAELI TRADE ACT\--BALANCE OF PAYMENTS PROGRAM
    CERTIFICATE]{.underline} (FEBRUARY 2000)**

> **\[Note: This provision is applicable for requirements with a value
> exceeding \$25,000 but less than \$186,000 EXCEPT for 1) foreign
> acquisitions or 2) acquisitions that are exempt from NAFTA and the
> Israeli Trade Act. (See FAR 25.401).\]**

\(a\) The offeror certifies that each end product, except those listed
in paragraph (b) or (c) of this provision, is a domestic end product (as
defined in the clause of this solicitation entitled, "Buy American
Act\--North American Free Trade Agreement\--Israeli Trade Act\--Balance
of Payments Program") and that the offeror has considered components of
unknown origin to have been mined, produced, or manufactured outside the
United States.

\(b\) The offeror certifies that the following supplies are NAFTA
country end products or Israeli end products as defined in the clause of
this solicitation entitled, "Buy American Act\--North American Free
Trade Agreement\--Israeli Trade Act\--Balance of Payments Program":

**NAFTA Country or Israeli End Products**:

Line Item No.:

Country of Origin:

(List as necessary)

\(c\) The offeror shall list those supplies that are foreign end
products (other than those listed in paragraph (b) of this provision) as
defined in the clause of this solicitation entitled, "Buy American
Act\--North American Free Trade Agreement\--Israeli Trade Act\--Balance
of Payments Program." 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.

**Other Foreign End Products**

Line Item No.:

Country of Origin:

(List as necessary)

\(d\) The Government will evaluate offers in accordance with the
policies and procedures of Part 25 of the Federal Acquisition
Regulation.

> **ALTERNATE I (FEBRUARY 2000)** As prescribed in 25.1101(b)(2)(ii),
> substitute the following paragraph (b) for paragraph (b) of the basic
> provision:
>
> **\[Note: Applies when the acquisition value exceeds \$25,000 but is
> less than \$50,000.\]**

\(b\) The offeror certifies that the following supplies are Canadian end
products as defined in the clause of this solicitation entitled "Buy
American Act\--North American Free Trade Agreement\--Israeli Trade
Act\--Balance of Payments Program":

**Canadian End Products**:

Line Item No.:

(List as necessary)

> **ALTERNATE II (FEBRUARY 2000)** As prescribed in 25.1101(b)(2)(iii),
> substitute the following paragraph (b) for paragraph (b) of the basic
> provision:
>
> **\[Note: Applies when the acquisition value is \$50,000 or more, but
> is less than \$53,150.\]**

\(b\) The offeror certifies that the following supplies are Canadian end
products or Israeli end products as defined in the clause of this
solicitation entitled "Buy American Act\--North American Free Trade
Agreement\--Israeli Trade Act\--Balance of Payments Program":

**Canadian or Israeli End Products**

Line Item No.:

Country of Origin:

(List as necessary)

21. **52.225-6 [TRADE AGREEMENTS CERTIFICATE]{.underline} - (FEBRUARY
    2000)**

> **\[Note: This provision is applicable for acquisitions valued at
> \$186,000 or more, if the Trade Agreement Act applies. (See FAR 25.401
> and 25.403).\]**

\(a\) The offeror certifies that each end product, except those listed
in paragraph (b) of this provision, is a U.S.-made, designated country,
Caribbean Basin country, or NAFTA country end product, as defined in the
clause of this solicitation entitled "Trade Agreements."

\(b\) The offeror shall list as other end products those supplies that
are not U.S.-made, designated country, Caribbean Basin country, or NAFTA
country end products.

**Other End Products**

Line Item No.:

Country of Origin:

(List as necessary)

\(c\) The Government will evaluate offers in accordance with the
policies and procedures of Part 25 of the Federal Acquisition
Regulation. For line items subject to the Trade Agreements Act, the
Government will evaluate offers of U.S.-made, designated country,
Caribbean Basin country, or NAFTA country end products without regard to
the restrictions of the Buy American Act or the Balance of Payments
Program. The Government will consider for award only offers of
U.S.-made, designated country, Caribbean Basin country, or NAFTA 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 this solicitation.

22. **52.226-2 [HISTORICALLY BLACK COLLEGE OR UNIVERSITY AND MINORITY
    INSTITUTION REPRESENTATION]{.underline} - (MAY 2001)**

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

> *Historically Black College or University* means an institution
> determined by the Secretary of Education to meet the requirements of
> 34 CFR 608.2. For the Department of Defense, the National Aeronautics
> and Space Administration, and the Coast Guard, the term also includes
> any nonprofit research institution that was an integral part of such a
> college or university before November 14, 1986.
>
> *Minority Institution* means an institution of higher education
> meeting the requirements of Section 1046(3) of the Higher Education
> Act of 1965 (20 U.S.C. 1067k, including a Hispanic-serving institution
> of higher education, as defined in Section 316(b)(1) of the Act (20
> U.S.C. 1101a.)).

\(b\) *Representation*. The offeror represents that it\--

**\[ \]** is **\[ \]** is not a Historically Black College or
University;

**\[ \]** is **\[ \]** is not a Minority Institution.

23. **52.227-6 [ROYALTY INFORMATION]{.underline} - (APRIL 1984)**

\(a\) **Cost or charges for royalties.** When the response to this
solicitation contains costs or charges for royalties totaling more than
\$250, the following information shall be included in the response
relating to each separate item of royalty or license fee:

\(1\) Name and address of licensor.

\(2\) Date of license agreement.

\(3\) Patent numbers, patent application serial numbers or other basis
on which the royalty is payable.

\(4\) Brief description, including any part or model numbers of each
contract item or component on which the royalty is payable.

\(5\) Percentage or dollar rate of royalty per unit.

\(6\) Unit price of contract item.

\(7\) Number of units.

\(8\) Total dollar amount of royalties.

\(b\) **Copies of current licenses**. In addition, if specifically
requested by the Contracting Officer before execution of the contract,
the offeror shall furnish a copy of the current license agreement and an
identification of applicable claims of specific patents.

> (**[NOTE: Alternate I, below, is applicable for communication services
> and facilities by a common carrier]{.underline}.)**
>
> **ALTERNATE I (APRIL 1984), 52.227-6 [ROYALTY INFORMATION]{.underline}
> (APRIL 1984)**
>
> Substitute the following for the introductory portion of paragraph (a)
> of the basic clause:
>
> When the response to this solicitation covers charges for special
> construction or special assembly that contain costs or charges for
> royalties totaling more than \$250, the following information shall be
> included in the response relating to each separate item of royalty or
> license fee:

24. **52.230-1** **[COST ACCOUNTING STANDARDS NOTICES AND
    CERTIFICATION]{.underline} (JUNE 2000)**

**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]{.underline}**

\(a\) Any contract in excess of \$500,000 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 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 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:
>
> **\[ \]** (1) Certificate of Concurrent Submission of Disclosure
> Statement.
>
> The offeror hereby certifies that, as 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 looseleaf 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.
>
> **\[ \]** (2) Certificate of Previously Submitted Disclosure
> Statement.
>
> The offeror hereby certifies that the required Disclosure Statement
> was filed as follows:
>
> 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.
>
> **\[ \]** (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 more than \$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.
>
> **\[ \]** (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.**
>
> **\[ \]** (5) Certificate of Disclosure Statement Due Date by
> Educational Institution.

(ALTERNATE I - APRIL 1996)

> 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***):
>
> **\[ \]** (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:

**II. [Cost Accounting Standards \-- Eligibility for Modified Contract
Coverage]{.underline}**

> 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.
>
> **\[ \]** 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.**

**III. [Additional Cost Accounting Standards Applicable to Existing
Contracts]{.underline}**

> 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.

**\[ \]** YES **\[ \]** NO

25. **[CERTIFICATION REGARDING ENVIRONMENTAL TOBACCO SMOKE]{.underline}
    (DECEMBER 1994)**

> **[(Note: This certification applies only to those contract which
> contain provisions for children\'s services. The offeror\'s signature
> on the face page of these Representations and Certifications
> constitutes certification by the submitting organization of its
> compliance with the Act.)]{.underline}**
>
> Public Law 103-227, also known as the Pro-Children Act of 1994 (Act),
> requires that smoking not be permitted in any portion of any indoor
> facility owned or leased or contracted for by an entity and used
> routinely or regularly for the provision of health, day care, early
> childhood development services, education or library services to
> children under the age of 18, if the services are funded by Federal
> programs either directly or through State or local governments, by
> Federal grant, contract, loan, or loan guarantee. The law also applies
> to children\'s services that are provided in indoor facilities that
> are constructed, operated, or maintained with such federal funds. The
> law does not apply to children\'s services provided in private
> residences; portions of facilities used for inpatient drug or alcohol
> treatment; service providers whose sole source of applicable federal
> funds is Medicare or Medicaid; or facilities where WIC coupons are
> redeemed. Failure to comply with the provisions of the law may result
> in the imposition of a civil monetary penalty of up to \$1,000 for
> each violation and/or the imposition of an administrative compliance
> order on the responsible entity.
>
> By signing this certification, the offeror/contractor (for
> acquisitions) or applicant/grantee (for grants) certifies that the
> submitting organization will comply with the requirements of the Act
> and will not allow smoking within any portion of any indoor facility
> used for the provision of services for children as defined by the Act.
>
> The submitting organization agrees that it will require that the
> language of this certification be included in any subawards which
> contain provisions for children\'s services and that all subrecipients
> shall certify accordingly.

26. **[CERTIFICATION OF INSTITUTIONAL POLICY ON CONFLICT OF FINANCIAL
    INTEREST]{.underline} (OCTOBER 1995)**

> **([Note:]{.underline} This certification is applicable to Research
> and Development (R&D) Contracts. However, this certification does not
> apply to SBIR-Phase I contractors.)**
>
> By submission of its offer, the offeror certifies that:

\(1\) A written and enforced administrative process to identify and
manage, reduce or eliminate conflicting financial interest with respect
to all research projects for which funding is sought from the NIH is
**\[ \]**, is not **\[ \]** currently in effect.

\(2\) Should a process not be in effect at the time of the submission of
its offer, the offeror certifies that it will, no later than 30 days
subsequent to submission of its offer or prior to award, whichever is
earlier, notify the Contracting Officer of the establishment of a
written and enforced financial conflict of interest policy.

27. **15.406-2 [CERTIFICATE OF CURRENT COST OR PRICING
    DATA]{.underline}**

> **(When cost or pricing data are required in accordance with FAR
> 15.406-2, the Contracting Officer will request that the offeror
> complete, execute, and submit to the Contracting Officer a
> certification in the format shown in the following Certificate of
> Current Cost or Pricing Data. The certification shall be submitted
> only at the time negotiations are concluded. Offerors should complete
> the certificate and return it when requested by the Contracting
> Officer.)**
>
> This is to certify that, to the best of my knowledge and belief, the
> cost or pricing data (as defined in section 15.401 of the Federal
> Acquisition Regulation (FAR) and required under FAR subsection
> 15.403-4) submitted, either actually or by specific identification in
> writing, to the Contracting Officer or to the Contracting Officer\'s
> representative in support of **\*** are accurate, complete, and
> current as of **\*\***.
>
> This certification includes the cost or pricing data supporting any
> advance agreements and forward pricing rate agreements between the
> offeror and the Government that are part of the proposal.
>
> Firm
>
> Signature
>
> Name
>
> Title
>
> Date of execution**\*\*\***

**\*** Identify the proposal, request for price adjustment, or other
submission involved, giving the appropriate identifying number (e.g.,
RFP No.)

**\*\*** Insert the day, month, and year when price negotiations were
concluded and price agreement was reached, or, if applicable, an earlier
date agreed upon between the parties that is as close as practicable to
the date of agreement on price.

**\*\*\*** Insert the day, month, and year of signing, which should be
as close as practicable to the date when the price negotiations were
concluded and the contract price was agreed to.

(End of Certificate)