**REPRESENTATIONS, CERTIFICATIONS, AND OTHER STATEMENTS OF QUOTERS FOR
COMMERCIAL ITEM ACQUISITIONS (APPLIES TO ORAL PURCHASES BETWEEN \$3,000
AND \$100,000)**

*The government intends to place an oral purchase order for the required
goods or services with a governmentwide purchase card or third party
draft as the method of payment. If the government issues an oral
purchase order, there will be no follow-up with a written offer to buy
the goods or services. Your authorized signature herein represents your
willingness to accept this method of an offer to buy and payment for
goods or services.*

1.  **Authorized Signature**

The representations and certifications must be executed by an individual
authorized to bind the company. The quoter makes the following
representations and certifications as part of its quote (check or
complete all appropriate boxes or blanks on the following pages).

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

(Name of Company) Date

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

(Typed Name of Authorized (Signature of Authorized

Individual) Individual)

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

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

As prescribed in
[[4.607]{.underline}](http://www.acquisition.gov/comp/far/current/html/Subpart 4_6.html#wp1090166)(a),
insert the following provision:

[Data Universal Numbering System (DUNS) Number (Apr 2008)]{.smallcaps}

\(a\) The offeror shall enter, in the block with its name and address on
the cover page of its offer, the annotation "DUNS" or "DUNS+4" followed
by the DUNS number or "DUNS+4" 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, Inc. The DUNS+4 is the DUNS
number plus a 4-character suffix that may be assigned at the discretion
of the offeror to establish additional CCR records for identifying
alternative Electronic Funds Transfer (EFT) accounts (see
[[Subpart 32.11]{.underline}](http://www.acquisition.gov/comp/far/current/html/Subpart 32_11.html#wp1043964))
for the same concern.

\(b\) If the offeror does not have a DUNS number, it should contact Dun
and Bradstreet directly to obtain one.

\(1\) An offeror may obtain a DUNS number---

\(i\) Via the Internet at
[[http://fedgov.dnb.com/webform]{.underline}](../%20http://fedgov.dnb.com/webform)
or if the offeror does not have internet access, it may call Dun and
Bradstreet at 1-866-705-5711 if located within the United States; or

\(ii\) If located outside the United States, by contacting the local Dun
and Bradstreet office. The offeror should indicate that it is an offeror
for a U.S. Government contract when contacting the local Dun and
Bradstreet office.

\(2\) The offeror should be prepared to provide the following
information:

\(i\) Company legal business name.

\(ii\) Tradestyle, doing business, or other name by which your entity is
commonly recognized.

\(iii\) Company physical street address, city, state and ZIP Code.

\(iv\) Company mailing address, city, state and ZIP Code (if separate
from physical).

\(v\) Company telephone number.

\(vi\) Date the company was started.

\(vii\) Number of employees at your location.

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

\(ix\) Line of business (industry).

\(x\) Company Headquarters name and address (reporting relationship
within your entity).

(End of provision)

**NOTE: AS OFFERS ARE SUBMITTED ORALLY PROVIDE DUNS NUMBER HERE:**

**\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_**

**52.212-3  Offeror Representations and Certifications---Commercial
Items.**

As prescribed in
[[12.301]{.underline}](http://www.acquisition.gov/comp/far/current/html/Subpart 12_3.html#wp1084399)(b)(2),
insert the following provision:

[Offeror Representations and Certifications---Commercial Items
(June 2008)]{.smallcaps}

An offeror shall complete only paragraph (b) of this provision if the
offeror has completed the annual representations and certifications
electronically at
[[http://orca.bpn.gov]{.underline}](http://orca.bpn.gov/). If an offeror
has not completed the annual representations and certifications
electronically at the ORCA website, the offeror shall complete only
paragraphs (c) through (m) of this provision.

\(a\) *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.

"Manufactured end product" means any end product in Federal Supply
Classes (FSC) 1000-9999, except---

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

\(2\) Federal Supply Group (FSG) 87, Agricultural Supplies;

\(3\) FSG 88, Live Animals;

\(4\) FSG 89, Food and Related Consumables;

\(5\) FSC 9410, Crude Grades of Plant Materials;

\(6\) FSC 9430, Miscellaneous Crude Animal Products, Inedible;

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

\(8\) FSC 9610, Ores;

\(9\) FSC 9620, Minerals, Natural and Synthetic; and

\(10\) FSC 9630, Additive Metal Materials.

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

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

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

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

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

\(4\) Consist of providing goods or services to an internationally
recognized peacekeeping force or humanitarian organization;

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

\(6\) Have been voluntarily suspended.

"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)]{.underline}](http://uscode.house.gov/uscode-cgi/fastweb.exe?getdoc+uscview+t37t40+200+2++(38)  AND ((38) ADJ USC)%3ACITE         ),
with a disability that is service-connected, as defined in
[[38 U.S.C. 101(16)]{.underline}](http://uscode.house.gov/uscode-cgi/fastweb.exe?getdoc+uscview+t37t40+200+2++(38)  AND ((38) ADJ USC)%3ACITE         ).

"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)]{.underline}](http://uscode.house.gov/uscode-cgi/fastweb.exe?getdoc+uscview+t37t40+200+2++(38)  AND ((38) ADJ USC)%3ACITE         ))
or, in the case of any publicly owned business, not less than 51 percent
of the stock of which is owned by one or more veterans; and

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

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

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

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

\(1\) Whose management and daily business operations are controlled by
one or more women.

\(b\)

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

\(2\) The offeror has completed the annual representations and
certifications electronically via the ORCA website at
[[http://orca.bpn.gov]{.underline}](http://orca.bpn.gov/). After
reviewing the ORCA database information, the offeror verifies by
submission of this offer that the representations and certifications
currently posted electronically at FAR 52.212-3, Offeror Representations
and Certifications---Commercial Items, have been entered or updated in
the last 12 months, are current, accurate, complete, and applicable to
this solicitation (including the business size standard applicable to
the NAICS code referenced for this solicitation), as of the date of this
offer and are incorporated in this offer by reference (see FAR
[[4.1201]{.underline}](http://www.acquisition.gov/comp/far/current/html/Subpart 4_12.html#wp1073667)),
except for paragraphs \_\_\_\_\_\_\_\_\_\_\_\_\_\_.

\[*Offeror to identify the applicable paragraphs at (c) through (m) of
this provision that the offeror has completed for the purposes of this
solicitation only, if any.*

*These amended representation(s) and/or certification(s) are also
incorporated in this offer and are current, accurate, and complete as of
the date of this offer.*

*Any changes provided by the offeror are applicable to this solicitation
only, and do not result in an update to the representations and
certifications posted on ORCA.*\]

\(c\) 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.

**Note:** Complete paragraphs (c)(6) and (c)(7) only if this
solicitation is expected to exceed the simplified acquisition threshold.

\(6\) *Women-owned business concern (other than small business
concern*). \[*Complete only if the offeror is a women-owned business
concern and did not represent itself as a small business concern in
paragraph (c)(1) of this provision*.\] The offeror represents that it \[
\] is a women-owned business concern.

\(7\) *Tie bid priority for labor surplus area concerns*. If this is an
invitation for bid, small business offerors may identify the labor
surplus areas in which costs to be incurred on account of manufacturing
or production (by offeror or first-tier subcontractors) amount to more
than 50 percent of the contract
price:\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

\(8\) Small Business Size for the Small Business Competitiveness
Demonstration Program and for the Targeted Industry Categories under the
Small Business Competitiveness Demonstration Program. \[*Complete only
if the offeror has represented itself to be a small business concern
under the size standards for this solicitation*.\]

\(i\) \[*Complete only for solicitations indicated in an addendum as
being set-aside for emerging small businesses in one of the designated
industry groups (DIGs).*\] The offeror represents as part of its offer
that it \[ \] is, \[ \] is not an emerging small business.

\(ii\) \[*Complete only for solicitations indicated in an addendum as
being for one of the targeted industry categories (TICs) or designated
industry groups (DIGs).*\] 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*):

  ---------------------------- ------------------------------------------
  **Number of Employees**      **Average Annual Gross 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--1,000         \_\_\_\_\_ \$10,000,001--\$17 million

  \_\_\_\_\_ Over 1,000        \_\_\_\_\_Over \$17 million
  ---------------------------- ------------------------------------------

\(9\) \[*Complete only if the solicitation contains the clause at
FAR *[[52.219-23]{.underline}](http://www.acquisition.gov/comp/far/current/html/52_217_221.html#wp1136333)*,
Notice of Price Evaluation Adjustment for Small Disadvantaged Business
Concerns, or
FAR *[[52.219-25]{.underline}](http://www.acquisition.gov/comp/far/current/html/52_217_221.html#wp1136374)*,
Small Disadvantaged Business Participation Program---Disadvantaged
Status and Reporting, and the offeror desires a benefit based on its
disadvantaged status*.\]

\(i\) *General.* The offeror represents that either---

\(A\) It \[ \] is, \[ \] is not certified by the Small Business
Administration as a small disadvantaged business concern and identified,
on the date of this representation, as a certified small disadvantaged
business concern in the database maintained by the Small Business
Administration (PRO-Net), and that no material change in disadvantaged
ownership and control has occurred since its certification, and, where
the concern is owned by one or more individuals claiming disadvantaged
status, 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); or

\(B\) It \[ \] has, \[ \] has not 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.

\(ii\) \[ \] *Joint Ventures under the Price Evaluation Adjustment for
Small Disadvantaged Business Concerns.* The offeror represents, as part
of its offer, that it is a joint venture that complies with the
requirements in 13 CFR 124.1002(f) and that the representation in
paragraph (c)(9)(i) of this provision is accurate for the small
disadvantaged business concern that is participating in the joint
venture. \[*The offeror shall enter the name of the small disadvantaged
business concern that is participating in the joint venture:
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_*.\]

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

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

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

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

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

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

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

\(2\) *Affirmative Action Compliance*. The offeror represents that---

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

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

\(e\) *Certification Regarding Payments to Influence Federal
Transactions (*[31 ]{.underline}U.S.C. 1352*)*. (Applies only if the
contract is expected to exceed \$100,000.) By submission of its offer,
the offeror certifies to the best of its knowledge and belief that no
Federal appropriated funds have been paid or will be paid to any person
for influencing or attempting to influence an officer or employee of any
agency, a Member of Congress, an officer or employee of Congress or an
employee of a Member of Congress on his or her behalf in connection with
the award of any resultant contract. If any registrants under the
Lobbying Disclosure Act of 1995 have made a lobbying contact on behalf
of the offeror with respect to this contract, the offeror shall complete
and submit, with its offer, OMB Standard Form LLL, Disclosure of
Lobbying Activities, to provide the name of the registrants. The offeror
need not report regularly employed officers or employees of the offeror
to whom payments of reasonable compensation were made.

\(f\) *Buy American Act Certificate*. (Applies only if the clause at
Federal Acquisition Regulation (FAR)
[[52.225-1]{.underline}](http://www.acquisition.gov/comp/far/current/html/52_223_226.html#wp1168995),
Buy American Act---Supplies, is included in this solicitation.)

\(1\) The offeror certifies that each end product, except those listed
in paragraph (f)(2) of this provision, is a domestic end product and
that 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]{.underline}](http://www.acquisition.gov/comp/far/current/html/FARTOCP25.html#wp225048).

(g)(1) *Buy American Act---Free Trade Agreements---Israeli Trade Act
Certificate*. (Applies only if the clause at
FAR [[52.225-3]{.underline}](http://www.acquisition.gov/comp/far/current/html/52_223_226.html#wp1169038),
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 (g)(1)(ii) or (g)(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 "Bahrainian or Moroccan end product," "component,"
"domestic end product," "end product," "foreign end product," "Free
Trade Agreement country," "Free Trade Agreement country end product,"
"Israeli end product," and "United States" are defined in the clause of
this solicitation entitled "Buy American Act-Free Trade
Agreements-Israeli Trade Act."

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

Free Trade Agreement Country End Products (Other than Bahrainian or
Moroccan End Products) 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 (g)(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]{.underline}](http://www.acquisition.gov/comp/far/current/html/FARTOCP25.html#wp225048).

\(2\) *Buy American Act---Free Trade Agreements---Israeli Trade Act
Certificate, Alternate I*. If Alternate I to the clause at
FAR [[52.225-3]{.underline}](http://www.acquisition.gov/comp/far/current/html/52_223_226.html#wp1169038)
is included in this solicitation, substitute the following
paragraph (g)(1)(ii) for paragraph (g)(1)(ii) of the basic provision:

> (g)(1)(ii) The offeror certifies that the following supplies are
> Canadian end products as defined in the clause of this solicitation
> entitled "Buy American 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
Certificate, Alternate II*. If Alternate II to the clause at
FAR [[52.225-3]{.underline}](http://www.acquisition.gov/comp/far/current/html/52_223_226.html#wp1169038)
is included in this solicitation, substitute the following
paragraph (g)(1)(ii) for paragraph (g)(1)(ii) of the basic provision:

> (g)(1)(ii) The offeror certifies that the following supplies are
> Canadian end products 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]{.underline}](http://www.acquisition.gov/comp/far/current/html/52_223_226.html#wp1169151),
Trade Agreements, is included in this solicitation.)

\(i\) The offeror certifies that each end product, except those listed
in paragraph (g)(4)(ii) of this provision, is a U.S.-made or designated
country end product, as defined in the clause of this solicitation
entitled "Trade Agreements."

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

Other End Products:

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]{.underline}](http://www.acquisition.gov/comp/far/current/html/FARTOCP25.html#wp225048).
For line items covered by the WTO GPA, the Government will evaluate
offers of U.S.-made or designated country end products without regard to
the restrictions of the Buy American Act. The Government will consider
for award only offers of U.S.-made or designated country end products
unless the Contracting Officer determines that there are no offers for
such products or that the offers for such products are insufficient to
fulfill the requirements of the solicitation.

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

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

\(2\) \[ \] Have, \[ \] have not, within a three-year period preceding
this offer, been convicted of or had a civil judgment rendered against
them for: commission of fraud or a criminal offense in connection with
obtaining, attempting to obtain, or performing a Federal, state or local
government contract or subcontract; violation of Federal or state
antitrust statutes relating to the submission of offers; or commission
of embezzlement, theft, forgery, bribery, falsification or destruction
of records, making false statements, tax evasion, violating Federal
criminal tax laws, or receiving stolen property;

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

\(4\) \[ \] Have, \[ \] have not, within a three-year period preceding
this offer, been notified of any delinquent Federal taxes in an amount
that exceeds \$3,000 for which the liability remains unsatisfied.

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

\(A\) *The tax liability is finally determined*. The liability is
finally determined if it has been assessed. A liability is not finally
determined if there is a pending administrative or judicial challenge.
In the case of a judicial challenge to the liability, the liability is
not finally determined until all judicial appeal rights have been
exhausted.

\(B\) *The taxpayer is delinquent in making payment*. A taxpayer is
delinquent if the taxpayer has failed to pay the tax liability when full
payment was due and required. A taxpayer is not delinquent in cases
where enforced collection action is precluded.

\(ii\) *Examples*.

\(A\) The taxpayer has received a statutory notice of deficiency, under
I.R.C. §6212, which entitles the taxpayer to seek Tax Court review of a
proposed tax deficiency. This is not a delinquent tax because it is not
a final tax liability. Should the taxpayer seek Tax Court review, this
will not be a final tax liability until the taxpayer has exercised all
judicial appeal rights.

\(B\) The IRS has filed a notice of Federal tax lien with respect to an
assessed tax liability, and the taxpayer has been issued a notice under
I.R.C. §6320 entitling the taxpayer to request a hearing with the IRS
Office of Appeals contesting the lien filing, and to further appeal to
the Tax Court if the IRS determines to sustain the lien filing. In the
course of the hearing, the taxpayer is entitled to contest the
underlying tax liability because the taxpayer has had no prior
opportunity to contest the liability. This is not a delinquent tax
because it is not a final tax liability. Should the taxpayer seek tax
court review, this will not be a final tax liability until the taxpayer
has exercised all judicial appeal rights.

\(C\) The taxpayer has entered into an installment agreement pursuant to
I.R.C. §6159. The taxpayer is making timely payments and is in full
compliance with the agreement terms. The taxpayer is not delinquent
because the taxpayer is not currently required to make full payment.

\(D\) The taxpayer has filed for bankruptcy protection. The taxpayer is
not delinquent because enforced collection action is stayed under 11
U.S.C. §362 (the Bankruptcy Code).

\(i\) Certification Regarding Knowledge of Child Labor for *Listed End
Products (Executive Order 13126)*. \[*The Contracting Officer must list
in paragraph (i)(1) any end products being acquired under this
solicitation that are included in the List of Products Requiring
Contractor Certification as to Forced or Indentured Child Labor, unless
excluded at*
[[22.1503]{.underline}](http://www.acquisition.gov/comp/far/current/html/Subpart 22_15.html#wp1088086)*(b)*.\]

\(1\) *Listed end products*.

  ------------------------------ ----------------------------------------
  **Listed End Product**         **Listed Countries of Origin**

  ------------------------------ ----------------------------------------

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

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

\[  \] (ii) The offeror may supply an end product listed in
paragraph (i)(1) of this provision that was mined, produced, or
manufactured in the corresponding country as listed for that product.
The offeror certifies that it has made a good faith effort to determine
whether forced or indentured child labor was used to mine, produce, or
manufacture any such end product furnished under this contract. On the
basis of those efforts, the offeror certifies that it is not aware of
any such use of child labor.

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

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

\(2\) \[ \] Outside the United States.

\(k\) *Certificates regarding exemptions from the application of the
Service Contract Act.* (Certification by the offeror as to its
compliance with respect to the contract also constitutes its
certification as to compliance by its subcontractor if it subcontracts
out the exempt services.) \[*The contracting officer is to check a box
to indicate if paragraph (k)(1) or (k)(2) applies.*\]

\[  \] (1) Maintenance, calibration, or repair of certain equipment as
described in FAR
[[22.1003-4]{.underline}](http://www.acquisition.gov/comp/far/current/html/Subpart 22_10.html#wp1105165)(c)(1).
The offeror \[ \] does \[ \] does not certify that---

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

\(ii\) The services will be furnished at prices which are, or are based
on, established catalog or market prices (see FAR
[[22.1003-4]{.underline}](http://www.acquisition.gov/comp/far/current/html/Subpart 22_10.html#wp1105165)(c)(2)(ii))
for the maintenance, calibration, or repair of such equipment; and

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

\[  \] (2) Certain services as described in
FAR [[22.1003-4]{.underline}](http://www.acquisition.gov/comp/far/current/html/Subpart 22_10.html#wp1105165)(d)(1).
The offeror \[ \] does \[ \] does not certify that---

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

\(ii\) The contract services will be furnished at prices that are, or
are based on, established catalog or market prices (see FAR
[[22.1003-4]{.underline}](http://www.acquisition.gov/comp/far/current/html/Subpart 22_10.html#wp1105165)(d)(2)(iii));

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

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

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

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

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

\(l\) *Taxpayer Identification Number (TIN) (*[[26 U.S.C.
6109]{.underline}](http://uscode.house.gov/)*, [[31 U.S.C.
7701]{.underline}](http://uscode.house.gov/))*. (Not applicable if the
offeror is required to provide this information to a central contractor
registration database to be eligible for award.)

\(1\) All offerors must submit the information required in paragraphs
(l)(3) through (l)(5) of this provision to comply with debt collection
requirements of [[31 U.S.C. 7701(c) and
3325(d)]{.underline}](http://uscode.house.gov/), reporting requirements
of [[26 U.S.C. 6041, 6041A, and
6050M]{.underline}](http://uscode.house.gov/), and implementing
regulations issued by the Internal Revenue Service (IRS).

\(2\) The TIN may be used by the Government to collect and report on any
delinquent amounts arising out of the offeror's relationship with the
Government ([[31 U.S.C.
7701(c)(3)]{.underline}](http://uscode.house.gov/)). If the resulting
contract is subject to the payment reporting requirements described in
FAR
[[4.904]{.underline}](http://www.acquisition.gov/comp/far/current/html/Subpart 4_9.html#wp1091081),
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 \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_.

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

(End of provision) ADDITIONAL/APPLICABLE AS INDICATED

**[FAR 52.223-1 Biobased Product Certification (Dec
2007)](http://www.acquisition.gov/comp/far/current/html/52_223_226.html#wp1168785)
*-(Applies to orders in which an
[USDA-designated](http://www.biobased.oce.usda.gov/fb4p/DesignationItemList.aspx?SMSESSION=NO)
product has been identified)***

As required by the Farm Security and Rural Investment Act of 2002 and
the Energy Policy Act of 2005 ([[7 U.S.C.
8102(c)(3)]{.underline}](../%20http://uscode.house.gov/)), the offeror
certifies, by signing this offer, that biobased products (within
categories of products listed by the United States Department of
Agriculture in 7 CFR part 2902, subpart B) to be used or delivered in
the performance of the contract, other than biobased products that are
not purchased by the offeror as a direct result of this contract, will
comply with the applicable specifications or other contractual
requirements.

(End of provision)

[**52.223-4  Recovered Material Certification (MAY
2008)**](http://www.acquisition.gov/comp/far/current/html/52_223_226.html#wp1168826)
**. (*Applies to orders in which an [EPA
designated](http://www.epa.gov/epaoswer/non-hw/procure/products.htm)
product has been identified)***

[Recovered Material Certification (May 2008)]{.smallcaps}

As required by the Resource Conservation and Recovery Act of 1976
([[42 U.S.C. 6962(c)(3)(A)(i)]{.underline}](http://uscode.house.gov/uscode-cgi/fastweb.exe?getdoc+uscview+t41t42+250+1286++(42)  AND ((42) ADJ USC)%3ACITE         )),
the offeror certifies, by signing this offer, that the percentage of
recovered materials content for EPA-designated items to be delivered or
used in the performance of the contract will be at least the amount
required by the applicable contract specifications or other contractual
requirements.

(End of provision)

**[FAR 52.226-2 Historically Black College Or University And Minority
Institution Representation (May
2001)](http://www.acquisition.gov/comp/far/current/html/52_223_226.html#wp1169667)
(*Applies To Research, Studies, Supplies Or Services Of The Type
Normally Acquired From Higher Educational Institutions*)**

[Historically Black College or University and Minority Institution
Representation (May 2001)]{.smallcaps}

\(a\) *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]{.underline}](http://uscode.house.gov/uscode-cgi/fastweb.exe?getdoc+uscview+t17t20+2890+133++(20)  AND ((20) ADJ USC)%3ACITE         ),
including a Hispanic-serving institution of higher education, as defined
in Section 316(b)(1) of the Act
([[20 U.S.C. 1101a]{.underline}](http://uscode.house.gov/uscode-cgi/fastweb.exe?getdoc+uscview+t17t20+2890+133++(20)  AND ((20) ADJ USC)%3ACITE         ))).

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

> \[ \] is \[ \] is not a historically black college or university;
>
> \[ \] is \[ \] is not a minority institution.

(End of provision)

[**52.226-3 Disaster or Emergency Area Representation (NOV
2007)**](http://www.acquisition.gov/comp/far/current/html/52_223_226.html#wp1177343)
**(*Applies only if CO has indicated that this acquisition has been
set-aside for a local area as authorized by the Stafford Act preference
(P.L. 109-218), and include the clauses at
[52.226-4](http://www.acquisition.gov/comp/far/current/html/52_223_226.html#wp1173773)
and
[52.226-5](http://www.acquisition.gov/comp/far/current/html/52_223_226.html#wp1173393).)***

\(a\) *Set-aside area*. The area covered in this contract is:
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ \[*Contracting Officer to fill in with
definite geographic boundaries*.\]

\(b\) *Representations*. The offeror represents that it
\_\_\_\_\_\_does\_\_\_\_\_does not reside or primarily do business in
the set-aside area.

\(c\) An offeror is considered to be residing or primarily doing
business in the set-aside area if, during the last twelve months\--

\(1\) The offeror had its main operating office in the area; and

\(2\) That office generated at least half of the offeror\'s gross
revenues and employed at least half of the offeror\'s permanent
employees.

\(d\) If the offeror does not meet the criteria in paragraph (c) of this
provision, factors to be considered in determining whether an offeror
resides or primarily does business in the set-aside area include\--

\(1\) Physical location(s) of the offeror\'s permanent office(s) and
date any office in the set-aside area(s) was established;

\(2\) Current state licenses;

\(3\) Record of past work in the set-aside area(s) (e.g., how much and
for how long);

\(4\) Contractual history the offeror has had with subcontractors and/or
suppliers in the set-aside area;

\(5\) Percentage of the offeror\'s gross revenues attributable to work
performed in the set-aside area;

\(6\) Number of permanent employees the offeror employs in the set-aside
area;

\(7\) Membership in local and state organizations in the set-aside area;
and

\(8\) Other evidence that establishes the offeror resides or primarily
does business in the set-aside area. For example, sole proprietorships
may submit utility bills and bank statements.

\(e\) If the offeror represents it resides or primarily does business in
the set-aside area, the offeror shall furnish documentation to support
its representation if requested by the Contracting Officer. The
solicitation may require the offeror to submit with its offer
documentation to support the representation.

(End of provision)

Revised 06/17/08 through FAC 2005-26