**SUPPLIER REPRESENTATIONS/CERTIFICATION**

**FOR THE ACQUISITION OF GOODS AND SERVICES**

Date: \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

From:
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Company

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Street Address/P.O. Box

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

City/State/Zip Code

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Contact

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

E-Mail Address

Phone: \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Fax: \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Response to BBWI Request for Proposal due on \_\_\_\_\_\_\_\_\_\_\_\_:

1.  [Price]{.underline}

2.  [Delivery/Completion]{.underline}

    \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

3.  [Cash Terms]{.underline}

    (\_) Prompt Payment Discount: \_\_\_\_% for Payment within \_\_\_\_
    Days

    (\_) No Prompt Payment Discount: Net 30 Days

4.  [Proposal Expiration:]{.underline} (See Proposal Instructions)

    (\_) 90 Days (\_) Other: \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

    (Date)

5.  [Business Type Certification]{.underline}:

    (\_) Corporation (\_) Partnership

    (\_) Individual (\_) Sole Proprietorship

    State: \_\_\_\_\_\_\_\_\_\_\_

    (\_) Non-resident foreign individual, foreign partnership, foreign
    corporation, or foreign non-profit entity

    If Offeror certifies its business type to be \"Individual\",
    \"Offeror\" further certifies that Offeror \[(\_) is (\_) is not\] a
    participant in an INEEL Retirement Plan.

6.  As currently defined by the Small Business Administration, Offeror
    certifies it:

    (\_) is a Small Business: *Select applicable business
    classification(s)*

    (\_) Native-American Business

    (\_) Woman-owned Business

    (\_) Disadvantaged \[(\_) 8(a) (\_) non-8(a)\] Business\*

    (\_) HUB Zone Business\*

    (\_) Veteran Owned \[(\_) Service Disabled\]

    (\_) None of the Above

    (\_) is a Large Business

    (\_) is a Sheltered workshop

    (\_) is a Non-profit Business

    (\_) is an Educational Institution

    \* *Offeror may be requested to provide a copy of the Small Business
    Certification letter.*

    North American Industrial Classification System (NAICS) No.:
    \_\_\_\_\_\_\_\_\_\_\_\_\_

    Size Standard: \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

    Description: \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

7.  Any facility to be utilized in the performance of the proposed
    subcontract \[(\_) has (\_) has not\], been listed on the
    Environmental Protection Agency (EPA) List of Violating Facilities.
    Offeror will promptly notify Contractor, prior to award, of the
    receipt of any communication from the Director, Office of Federal
    Activities, EPA, indicating that any facility it proposes to use for
    the performance of the subcontract is under consideration to be on
    the EPA List of Violating Facilities. Offerors will include
    substantially this certification, including this sentence, in every
    nonexempt lower-tier subcontract.

8.  DUNS Number: (Required on all proposals \>= \$100K)
    \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

    Federal Tax ID or SS#:
    \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

    Principal Place of Performance:
    \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

9.  The Offeror \[(\_) is (\_) is not\] a parent, division, subsidiary
    or affiliated or associated company of Bechtel. If the Offeror is,
    complete the following:

    [Parent Company]{.underline} [Address]{.underline}

    \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
    \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

    \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
    \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

10. The Offeror or its principals certify it \[(\_) does not (\_) does\]
    appear on the GSA List of Parties Excluded From Federal Procurement
    or Nonprocurement Programs and \[(\_) is not (\_) is\] proposed for
    debarment by the Federal Government.

11. Buy American Act (for Goods): (See Proposal Instructions)

The following line item(s) is/are [Domestic]{.underline}:

\[(\_) All (­\_) None (\_)
Other:\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
\] (*insert **[Nondomestic]{.underline}** line item no(s) only*.)

12. [Certification of Nonsegregated Facilities]{.underline} (≥\$10,000)

    1.  Segregated facilities, as used in this provision, means 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 or
        directive or are in fact segregated on the basis of race, color,
        religion, or national origin because of habit, local custom, or
        otherwise.

    2.  By submission of this offer, the Offeror certifies that it does
        not and will not maintain or provide for its employees any
        segregated facilities at any of its establishments, and that it
        will not permit its employees to perform their services at any
        location under its control where segregated facilities are
        maintained. The Offeror agrees that a breach of this
        certification is a violation of the Equal Opportunity clause in
        the Contract.

    3.  The Offeror further agrees that (except where it has obtained
        identical certifications from proposed lower-tier subcontractors
        for specific time periods) it will:

        1.  Obtain identical certifications from proposed lower-tier
            subcontractors before the award of subcontractors under
            which the subcontractors will be subject to the Equal
            Opportunity clause:

        2.  Retain the certification on file; and

        3.  Forward the following notice to the proposed lower-tier
            subcontractors (except if the proposed subcontractors have
            submitted identical certifications for specific time
            periods):

            NOTICE TO PROSPECTIVE SUBCONTRACTORS OF REQUIREMENT FOR
            CERTIFICATIONS OF NONSEGREGATED FACILITIES.

            A Certification of Nonsegregated Facilities must be
            submitted before the award of a subcontract under which the
            subcontractor will be subject to the Equal Opportunity
            clause. The certification may be submitted either for each
            subcontract or for all subcontracts during a period (i.e.,
            quarterly, semiannually, or annually).

13. [Certification and Disclosure Regarding Payments to Influence
    Certain Federal Transactions]{.underline} (≥\$100,000)

    1.  The definitions and prohibitions contained in the clause, at FAR
        52.203-12, Limitation on Payments to Influence Certain Federal
        Transactions, included in this solicitation, are hereby
        incorporated by reference in the following paragraph of this
        certification.

    2.  Offeror, by signing the offer, hereby certifies that, as of
        December 23, 1989, to the best of his or her knowledge and
        belief:

        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 any Federal contract, the making of any Federal
            grant, the making of any Federal loan, the entering into of
            any cooperative agreement, and the extension, continuation,
            renewal, amendment or modification of any Federal contract,
            grant, loan, or cooperative agreement;

        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 on his or her behalf in connection with
            this solicitation, the Offeror shall complete and submit,
            with its offer, OMB Standard Form LLL, Disclosure 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.

    3.  Submission of this certification and disclosure is a
        prerequisite for making or entering into a subcontract 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.

14\. [Certification of Filing Toxic Chemical Release Inventory Reporting
Form]{.underline} (≥\$100,000 for competitive, noncommercial actions)

The following certification shall be completed by the offeror, who
certifies for all of its covered facilities that will be used in the
performance of this proposed contract. Under EPCRA section 313 and PPA
section 6607, each facility within Standard Industrial Classification
Code designation of major groups 20-39 as in effect on July 1, 1985 (and
currently codified at 48 CFR 19.102) meeting the reporting requirements
files a Form R. If none of the offeror\'s facilities that will be used
in the performance of this proposed contract currently are subject to
the Form R reporting requirements because they are not with Standard
Industrial Classification (SIC) code designations of major groups 20-39
(as in effect on July 1, 1985), the offeror should check box (e). This
would complete the offeror\'s certification requirements. Further, if
all of the offeror\'s facilities that will be used in the performance of
this proposed contract meet at least one of the criteria in paragraph
(b) below, the offeror should check the appropriate box under (b) to
certify to that effect. This also would complete the offeror\'s
certification requirements. For offerors with more than one facility,
however, there may be situations where some of its facilities are
subject to the Form R filing and reporting requirements and others are
exempt. In these cases, the offeror cannot certify that it is exempt
under paragraph (b) below unless all of its covered facilities meet at
least one of the criteria in paragraph (b) of the certification.

\(a\) The Offeror, by signing this offer, expressly certifies and agrees
that:

If awarded a Contract resulting from this offer, its covered facilities
that will be used in the performance of this proposed contract will file
(and continue to file for the life of the contract), unless otherwise
exempt as stated below in paragraph (b)(1)-(3), a Toxic Chemical Release
Inventory Form (Form R) as described in sections 313(a) and (g) of
EPCRA, 42 U.S.C. 11023(a) and (g) and section 6607 of PPA, 42 U.S.C.
13106, for each toxic chemical manufactured, processed, or otherwise
used by the offeror at a facility as described in section 313 of EPCRA,
42 U.S.C. 11023, and section 6607 of PPA, 42 U.S.C. 13106. The offeror
further agrees and certifies that during the period of performance of
this proposed contract, its covered facilities that will be used in the
performance of this proposed contract will file a Form R annually on or
before July 1 (for the prior calendar year) with the United States
Environmental Protection Agency and each appropriate State, pursuant to
section 313(a) and (g) of EPCRA; or

> \(b\) To the best of its knowledge and belief, none of its covered
> facilities that will be used in the performance of this proposed
> contract are currently subject to the filing and reporting
> requirements set forth in paragraph (a) above because such facilities
> (the offeror must check all of the appropriate boxes):
>
> (\_) (1) Do not manufacture, process or otherwise use any toxic
> chemicals listed under section 313(c) of EPCRA, 42 U.S.C. 11023(c); or
>
> (\_) (2) Do 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); or
>
> (\_) (3) Do not exceed the reporting thresholds, including the
> alternative threshold established in 40 CFR 372.27, of toxic chemicals
> established under EPCRA, 42 U.S.C. 11023(f).

\(c\) If awarded a Contract resulting from this offer, and circumstances
change during the life of the Contract such that, for example, any of
its facilities that will be used in the performance of this proposed
contract become subject to E.O. 12969 because none of the exemptions in
paragraph (b) above any longer apply (or it no longer is subject to E.O.
12969 reporting and filing requirements) it will provide written notice
to BBWI, and if required, its facility(ies) to be used in the
performance of this proposed contract will file and continue to file for
the life of the contract a Form R as described in paragraph (a).

> \(d\) If awarded a Contract resulting from this offer, it shall
> include a certification substantially the same as this certification
> in every competitive solicitation for a first tier subcontract
> expected to be greater than \$100,000 where the subcontract is not for
> \"commercial items\" as that term is defined in Part 2 of the FAR.
>
> \(e\) (­\_) It does not own or operate any facilities that will be used
> in the performance of this proposed contract having Standard
> Industrial Classification Code designations of major groups 20 through
> 39 or their corresponding North American Industry Classification
> System (NAICS) sectors 31 through 33, (and currently contained in FAR
> section 19.102) consistent with EPCRA section 313(b)(1). If, however,
> the offeror is awarded the contract, and the status of any of its
> facilities used in the performance of the contract changes during the
> life of the contract, it will provide written notice to BBWI, and if
> required, complete this certification. Further, the offeror will
> include a certification substantially the same as this certification
> in all competitive solicitations for first-tier subcontracts for
> non-commercial items expected to exceed \$100,000.
>
> \(f\) This certification concerns a matter within the jurisdiction of
> an agency of the United States and that making a false, fictitious, or
> fraudulent certification may result in criminal prosecution under
> Title 18, United States Code, Section 1001, and/or administrative
> action under the Program Fraud Civil Remedies Act, Title 31, United
> States Code, Sections 3801-3812. Accordingly, the offeror expressly
> certifies the truthfulness and accuracy of the contents of this
> certification.

15\. [Cost Accounting Standards Certification]{.underline} (≥\$500,000
and NOT set-aside for small businesses)

> ( ) Offeror certifies that modified CAS coverage is applicable, i.e.,
> compliance with CAS 401 CAS 402, CAS 405, and CAS 406 only, based on
> the exemption(s) claimed as follows:

( ) Received less than \$25 million in CAS-covered awards in the
immediately preceding cost accounting period.

> ( ) Sum of awards in preceding cost accounting period equaled more
> than \$25 million in net CAS-covered awards, wherein no single
> contract award exceeded \$1 million.

Offeror thus claims exemption from the Cost Accounting Standards clause
under the provisions

> of 48 CFR 9903.201-2(b), and certifies that it is eligible for use of
> the Disclosure and Consistency of Cost Accounting Practices.

( ) Offeror certifies that full CAS coverage is applicable, i.e., it net
CAS-covered contract award(s) of \$25 million or more; or received a net
CAS-covered contract award(s) of \$25 million or more wherein no single
award was less than \$1 million.

The applicable certification regarding submission of a disclosure
statement(s) (concurrent or previous) follows:

A. CERTIFICATE OF CONCURRENT SUBMISSION OF DISCLOSURE STATEMENT(S)

Offeror certifies that it has submitted, as part of its proposal under
this solicitation, copies of the disclosure statement(s) as follows: (1)
original and one copy to the cognizant Contracting Officer
\[Administrative Contracting Office, (ACO)\], see DOD Directory of
Contract Administration Components (DOD 4105.59H); and (2) one copy to
the cognizant contract auditor.

Date of Disclosure Statement(s)
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Name(s) and Address(es) of Cognizant ACO(s) Where Filed:

B. CERTIFICATE OF PREVIOUSLY SUBMITTED DISCLOSURE STATEMENT(S)

Offeror hereby certifies that the disclosure statement(s) were filed as
follows:

Date of Disclosure Statement(s)
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Name(s) and Address(es) of Cognizant ACO(s) Where Filed:

Offeror further certifies that practices used in estimating costs in
pricing this proposal are

> consistent with the cost accounting practices disclosed in the
> disclosure statement(s).

Offeror shall indicate below whether award of the contemplated
subcontract would, in accordance with the Cost Accounting Standards
clause (incorporated by reference to BBWI's applicable General
Provisions), require a change in its established cost accounting
practices affecting existing contracts and subcontracts.

( ) Yes ( ) No

NOTE: If the Offeror has checked \"Yes\" above, and is awarded the
contemplated subcontract, it will be required to comply with the
Administration of Cost Accounting Standards clause.

16\. [Equal Opportunity Compliance Certification]{.underline}
(≥\$10,000,000 other than Construction)

\(a\) A full compliance review of the Offeror\'s employment practices
has ( ), has not ( ), been conducted by an agency of the Federal
Government.

\(b\) If a full compliance review has been conducted by an agency of the
Federal Government, the most recent compliance review was conducted on
\_\_\_\_\_\_\_\_\_\_\_\_\_\_ by \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_.

(Date) (Federal Agency)

\(c\) The proposed lower tier subcontractors that will be awarded
subcontracts of \$1,000,000 or more are:
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Offeror and its known lower tier subcontractors that will be awarded
subcontracts of \$10,000,000 or more will be subject to full preaward
equal opportunity reviews before the award of the subcontract for the
purpose of determining whether the offeror and its lower tier
subcontractors are able to comply with the provisions of the Equal
Opportunity clause.

The undersigned acknowledges the receipt of the following addendum(a):
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Offeror\'s Signature:
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Offeror\'s Printed Name:
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Title:
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Date:
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_