OFFEROR REPRESENTATIONS AND CERTIFICATIONS\--OTHER THAN COMMERCIAL ITEMS
(1852.213-70) (JULY 2004)

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

*\"Emerging small business\"* means a small business concern whose size
is no greater than 50 percent of the numerical size standard for the
NAICS code designated.

*\"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.

*\"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.

*\"Veteran-owned small business concern\"* means a small business
concern\--

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

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

*\"Women-owned small business concern\"* means a small business
concern\--

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

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

\(b\) Taxpayer Identification Number (TIN) (26 U.S.C. 6109, 31 U.S.C.
7701).

\(1\) All offerors must submit the information required in paragraphs
(b)(3) through (b)(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 relationships 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**](http://www.arnet.gov/far/current/html/Subpart_4_9.html#1039048),
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.

\(4\) *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 \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_.

\(c\) 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, for general
statistical purposes, that it \[ \] is, \[ \] is not a small
disadvantaged business concern as defined in 13 CFR 124.1002.

\(5\) *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.

\(6\) *Small Business Size for the Small Business Competitiveness
Demonstration Program and for the Targeted Industry Categories under the
Small Business Competitiveness Demonstration Program.* \[Complete only
if the offeror has represented itself to be a small business concern
under the size standards for this solicitation.\]

\(i\) \[Complete only for solicitations indicated as being set-aside for
emerging small

businesses in one of the four designated industry groups (DIGs).\] The
offeror represents as part of its offer that it \[ \] is, \[ \] is not
an emerging small business.

\(ii\) \[Complete only for solicitations indicated as being for one of
the targeted industry

categories (TICs) or four designated industry groups (DIGs).\] Offeror
represents as follows:

\(A\) Offeror\'s number of employees for the past 12 months (check the
Employees

column if size standard stated in the solicitation is expressed in terms
of number of employees); or

\(B\) Offeror\'s average annual gross revenue for the last 3 fiscal
years (check the Average Annual Gross Number of Revenues column if size
standard stated in the solicitation is expressed in terms of annual
receipts).

(Check one of the following):

  ------------------------------- ---------------------------------------
                                  AVERAGE ANNUAL GROSS

  NUMBER OF EMPLOYEES             REVENUES

  \_\_\_ 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

  \_\_\_ 751-1000                 \_\_\_ \$10,000,001\--\$17 million

  \_\_\_ Over 1000                \_\_\_ Over \$17 million
  ------------------------------- ---------------------------------------

\(7\) *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

\(ii\) It \[ \] is, \[ \] is not a joint venture that complies with the
requirements of 13 CFR Part 126, and the representation in paragraph
(c)(7)(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.

\(8\) (Complete if dollar value of the resultant contract is expected to
exceed \$25,000 and the offeror has represented itself as disadvantaged
in paragraph (c)(4) of this provision.) *\[The offeror shall check the
category in which its ownership falls\]:*

\_\_\_\_ Black American.

\_\_\_\_ Hispanic American.

\_\_\_\_ Native American (American Indians, Eskimos, Aleuts, or Native
Hawaiians).

\_\_\_\_ Asian-Pacific American (persons with origins from Burma,
Thailand, Malaysia, Indonesia, Singapore, Brunei, Japan, China, Taiwan,
Laos, Cambodia (Kampuchea), Vietnam, Korea, The Philippines, U.S. Trust
Territory of the Pacific Islands (Republic of Palau), Republic of the
Marshall Islands, Federated States of Micronesia, the Commonwealth of
the Northern Mariana Islands, Guam, Samoa, Macao, Hong Kong, Fiji,
Tonga, Kiribati, Tuvalu, or Nauru).

\_\_\_\_ Subcontinent Asian (Asian-Indian) American (persons with
origins from India, Pakistan, Bangladesh, Sri Lanka, Bhutan, the
Maldives Islands, or Nepal).

\_\_\_\_ Individual/concern, other than one of the preceding.

\(d\) *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.

\(e\) *Buy American Act Certificate.* (Applies only if the clause at
Federal Acquisition Regulation (FAR)
[**52.225-1**](http://www.arnet.gov/far/current/html/52_223_226.html#1046659),
Buy American Act\--Supplies, is included in this solicitation.)

\(1\) The offeror certifies that each end product, except those listed
in paragraph (e)(2) of this provision, is a domestic end product 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. The terms "component," "domestic end product," "end product,"
foreign end product," and "United States" are defined in the clause of
this solicitation entitled "Buy American Act---Supplies."

\(2\) 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**](http://www.arnet.gov/far/current/html/Subpart_25_1.html#1061854).

(f)(1) *Buy American Act\-- Free Trade Agreements\--Israeli Trade Act
Certificate.* (Applies only if the clause at [**FAR
52.225-3**](http://www.arnet.gov/far/current/html/52_223_226.html#1046689),
Buy American Act\--Free Trade Agreements\--Israeli Trade Act, is
included in this solicitation.)

\(i\) The offeror certifies that each end product, except those listed
in paragraph (f)(1)(ii) or (f)(1)(iii) of this provision, is a domestic
end product and that the offeror has considered components of unknown
origin to have been mined, produced, or manufactured outside the United
States. The terms "component," "domestic end product," "end product,"
"foreign end product," and "United States" are defined in the clause of
this solicitation entitled "Buy American Act---Free Trade
Agreements---Israeli Trade Act".

\(ii\) The offeror certifies that the following supplies are FTA country
end products or Israeli end products as defined in the clause of this
solicitation entitled \"Free Trade Agreements\--Israeli Trade Act\":

FTA Country or Israeli End Products:

  ---------------------------------------- --------------------------------------------
  LINE ITEM NO.                            COUNTRY OF ORIGIN

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

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

  \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_   \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
  ---------------------------------------- --------------------------------------------

\[List as necessary\]

\(iii\) The offeror shall list those supplies that are foreign end
products (other than those listed in paragraph (f)(1)(ii) of this
provision) as defined in the clause of this solicitation entitled \"Buy
American Act\--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.

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**](http://www.arnet.gov/far/current/html/Subpart_25_1.html#1061854).

\(2\) *Buy American Act\--Free Trade Agreements\--Israeli Trade Act,
Alternate I (JAN 2004).* If Alternate I to the clause at [**FAR
52.225-3**](http://www.arnet.gov/far/current/html/52_223_226.html#1046689)
is included in this solicitation, substitute the following paragraph
(f)(1)(ii) for paragraph (f)(1)(ii) of the basic provision:

(f)(1)(ii) The offeror certifies that the following supplies are
Canadian end products as defined in the clause of this solicitation
entitled \"Buy American Act\--Free Trade Agreements\--Israeli Trade
Act\":

Canadian End Products:

Line Item No.

> \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
>
> \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

(List as necessary)

\(3\) *Buy American Act\--Free Trade Agreements\--Israeli Trade Act,
Alternate II (JAN 2004).* If Alternate II to the clause at **[FAR
52.225-3](http://www.arnet.gov/far/current/html/52_223_226.html#1046689)**
is included in this solicitation, substitute the following paragraph
(f)(1)(ii) for paragraph (f)(1)(ii) of the basic provision:

(f)(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 Act---Free Trade
Agreements\--Israeli Trade Act\":

Canadian or Israeli End Products:

  ---------------------------------------- --------------------------------------------
  LINE ITEM NO.                            COUNTRY OF ORIGIN

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

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

  \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_   \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
  ---------------------------------------- --------------------------------------------

\[List as necessary\]

\(4\) *Trade Agreements Certificate.* (Applies only if the clause at
[**FAR
52.225-5**](http://www.arnet.gov/far/current/html/52_223_226.html#1046758),
Trade Agreements, is included in this solicitation.)

\(i\) The offeror certifies that each end product, except those listed
in paragraph (f)(4)(ii) of this provision, is a U.S.-made, designated
country, Caribbean Basin country, or FTA 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, designated country, Caribbean Basin country, or
FTA country end products.

Other End Products:

  ---------------------------------------- --------------------------------------------
  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**](http://www.arnet.gov/far/current/html/Subpart_25_1.html#1061854).
For line items subject to the Trade Agreements Act, the Government will
evaluate offers of U.S.-made, designated country, Caribbean Basin
country, or FTA country end products without regard to the restrictions
of the Buy American Act. The Government will consider for award only
offers of U.S.-made, designated country, Caribbean Basin country, or FTA
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.

\(g\) *Certification Regarding Knowledge of Child Labor for Listed End
Products (Executive Order 13126).* \[The Contracting Officer must list
in paragraph (g)(1) any end products being acquired under this
solicitation that are included in the List of Products Requiring
Contractor Certification as to Forced or Indentured Child Labor, unless
excluded at [**FAR
22.1503(b)**](http://www.arnet.gov/far/current/html/Subpart_22_15.html#1046489).\]

\(1\) *Listed end products.*

+-----------------------------------+----------------------------------+
| Listed End Product                | # Listed Countries of Origin     |
+-----------------------------------+----------------------------------+
| \_\_\                             | \_\_\_\_\_                       |
| _\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ | \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ |
+-----------------------------------+----------------------------------+
| \_\_\                             | \_\_\_\_\_                       |
| _\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ | \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ |
+-----------------------------------+----------------------------------+
| \_\_\                             | \_\_\_\_\_                       |
| _\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ | \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ |
+-----------------------------------+----------------------------------+

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

\[ \] (i) The offeror will not supply any end product listed in
paragraph (g)(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
(g)(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 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.

(End of provision)