COMPANY NAME:

AUTHORIZED COMPANY OFFICIAL NAME:

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_SIGNATURE
AND DATE:

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

The following 52.212-3 with Alternate I applies to CI solicitations
expected to exceed \$25,000. Alternate III applies to all NASA
Solicitations.

**52.212-3 OFFEROR REPRESENTATIONS AND CERTIFICATIONS --COMMERCIAL ITEMS
(FEB 2001) (DEVIATION) \-- ALTERNATE I (OCT 2000) -- ALTERNATE III
(OCTOBER 2000**)

\(a\) *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
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\--

\(1\) 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 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.

\"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.

\(b\) *Taxpayer Identification Number (TIN) (26 U.S.C. 6109, 31 U.S.C.
7701*). (Not applicable if the offeror is required to provide this
information to a central contractor registration database to be eligible
for award.)

\(1\) 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 relationship with the
Government (31 U.S.C. 7701(c)(3)). If the resulting contract is subject
to the payment reporting requirements described in FAR 4.904, the TIN
provided hereunder may be matched with IRS records to verify the
accuracy of the offeror's TIN.

\(3\) *Taxpayer Identification Number (TIN)*.

\[ \] TIN: \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_.

\[ \] TIN has been applied for.

\[ \] TIN is not required because:

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

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

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

\(4\) 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 is to be performed inside the United States, its
territories or possessions, Puerto Rico, the Trust Territory of the
Pacific Islands, or the District of Columbia. 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 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 in an addendum 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*):

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

\_\_\_751-1000 \_\_\_ \$10,000,001\--\$17 million

\_\_\_Over 1000 \_\_\_ Over \$17 million

\(9\) \[*Complete only if the solicitation contains the clause at FAR
52.219-23, Notice of Price Evaluation Adjustment for Small Disadvantaged
Business Concerns, or FAR 52.219-25, Small Disadvantaged Business
Participation Program\--Disadvantaged Status and Reporting, and the
offeror desires a benefit based on its disadvantaged status.\]*

\(i\) 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)(7)(i) of this provision is accurate for the small
disadvantaged business concern that is participating in the joint
venture. \[*The offeror shall enter the name of the small disadvantaged
business concern that is participating in the joint
venture:\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_.\]*

\(10\) (Complete if the offeror has represented itself as disadvantaged
in paragraph (c)(2) or (c)(9) 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 Americans (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, 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.

\(11\) 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 place of
ownership, or HUBZone employee percentage has occurred since it was
certified by the Small Business Administration in accordance with 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)(11)(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 either to the Equal Opportunity clause of this
solicitation; and

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

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

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

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

\(e\) *Certification Regarding Payments to Influence Federal
Transactions (31 U.S.C. 1352)*. (Applies only if the contract is
expected to exceed \$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.

\(f\) *Buy American Act\--Balance of Payments Program Certificate.*
(Applies only if the clause at Federal Acquisition Regulation (FAR)
52.225-1, Buy American Act\--Balance of Payments Program\--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 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 no qualify as domestic end products.

\(2\) Foreign End Products:

#  LINE ITEM NO. COUNTRY OF ORIGIN

> \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
>
> \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
>
> \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
>
> \[List as necessary\]

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

## (g)(1) Buy American Act\--North American Free Trade Agreement----Israeli Trade Act\--Balance of Payments Program Certificate. (Applies only if the clause at FAR 52.225-3, Buy American Act\--North American Free Trade Agreement\--Israeli Trade Act----Balance of Payments Program, is included in this solicitation.) 

\(i\) The offeror certifies that each end product, except those listed
in paragraph (g)(1)(ii) or (g)(1)(ii) 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.

\(ii\) 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

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

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

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

> \[List as necessary\]

\(iii\) 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\--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 quality 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.

\(2\) Buy American Act\--North American Free Trade Agreements\--Israeli
Trade Act\--Balance of Payments program Certificate, Alternate I (Feb
2000). If Alternate I to the clause at FAR 52.225-3 is included in this
solicitation, substitute the following paragraph (g)(1)(ii) for
paragraph (g)(1)(ii) of the basic provision:

(g)(l)(ii) 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. COUNTRY OF ORIGIN

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

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

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

> \[List as necessary\]

\(3\) Buy American Act\--North American Free Trade Agreements \--Israeli
Trade Act\--Balance of Payments program Certificate, Alternate II (Feb
2000). If Alternate II to the clause at FAR 52.225-3 is included in this
solicitation, substitute the following paragraph (g)(1)(ii) for
paragraph (g)(1)(ii) of the basic provision:

(g)(l)(ii) 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 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, 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, designated
country, Caribbean Basin country, or NAFTA 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
NAFTA 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. 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 the
solicitation.

\(h\) *Certification Regarding Debarment, Suspension or Ineligibility
for Award (Executive Order 12549* The offeror certifies, to the best of
its knowledge and belief, that---

\(1\) The offeror and/or any of its principals are, are not presently
debarred, suspended, proposed for debarment, or declared ineligible for
the award of contracts by any Federal agency; and

\(2\) 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 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 or receiving stolen
property; and are, are not presently indicted for, or otherwise
criminally or civilly charged by a Government entity with, commission of
any of these offenses.

(End of provision)