Program No. 0437-S Term November 1, 2012 To October 31, 2013

Title: Electronic Intelligent Fillable/Printable Forms

BASIS OF

ITEM NO. DESCRIPTION AWARD UNIT RATE COST

I. DESIGN AND CONVERSION (a) Per Hour......................................................

... 580 125.00 72,500.00

CONTRACTOR TOTALS $72,500.00

DISCOUNT 0.00% $0.00

DISCOUNTED TOTALS $72,500.00

AWARDED 

LAUER AND ASSOC.

CROFTON, MD

Page 1 of 1
Program 437-S Page 1 of 17

Specifications by MRN

U.S. GOVERNMENT PRINTING OFFICE

Washington, DC

GENERAL TERMS, CONDITIONS, AND SPECIFICATIONS

For the Procurement of

Electronic Intelligent Fillable/Printable Forms

as requisitioned from the U.S. Government Printing Office (GPO) by the

Social Security Administration (SSA)

Single Award

TERM OF CONTRACT: The term of this contract is for the period beginning November 1, 2012 and ending October 

31, 2013, plus up to four (4) optional 12-month extension periods that may be added in accordance with the “OPTION 

TO EXTEND THE TERM OF THE CONTRACT” clause in SECTION 1 of this contract.

BID OPENING: Bids shall be publicly opened at 11:00 a.m., prevailing Washington, DC time, on October 11, 2012.

BID SUBMISSION: Submit bid in pre-addressed envelope furnished with solicitation, or send to: U.S. Government 

Printing Office, Bid Section, 36 H Street NW, Room C-161, STOP: PPSB, Washington, DC 20404-0001. Facsimile 

bids in response to this solicitation are permitted. Facsimile bids may be submitted directly to the GPO Bid Section, 

FAX No. (202) 512-1782. The Program Number and bid opening date must be specified with the bid. Refer to 

Facsimile Bids in Solicitation Provisions of GPO Contract Terms, GPO Publication 310.2 as revised June 2002.

NOTICE TO BIDDERS: Bidders are instructed to adhere to all requirements of the solicitation. Special attention is 

directed to the following provisions:

 Service Contract Act of 1965, as specified herein.

 Employees Rights on Government Contracts (Exhibit A).

THIS IS A NEW CONTRACT. THERE IS NO ABSTRACT AVAILABLE.

For information of a technical nature, call Brian Coleman at (202) 512-0310. (No collect calls.)
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SECTION 1. - GENERAL TERMS AND CONDITIONS

GPO CONTRACT TERMS: Any contract which results from this Invitation for Bid will be subject to the applicable 

provisions, clauses, and supplemental specifications of GPO Contract Terms (GPO Publication 310.2, effective 

December 1, 1987 (Rev. 6-01)).

GPO Contract Terms (GPO Publication 310.2) – http://www.gpo.gov/pdfs/vendors/sfas/terms.pdf.

DISPUTES: GPO Publication 310.2, GPO Contract Terms, Contract Clause 5. Disputes, is hereby replaced with the 

June 2008 clause found at www.gpo.gov/pdfs/vendors/contractdisputes.pdf. This June 2008 clause also cancels and 

supersedes any other disputes language currently included in existing contractual actions.

SUBCONTRACTING: Subcontracting is NOT allowed.

OPTION TO EXTEND THE TERM OF THE CONTRACT: The Government has the option to extend the term of 

this contract for a period of 12 months by written notice to the contractor not later than 30 days before the contract 

expires. If the Government exercises this option, the extended contract shall be considered to include this clause, 

except, the total duration of the contract may not exceed five (5) years as a result of, and including, any extension(s) 

added under this clause. Further extension may be negotiated under the “EXTENSION OF CONTRACT TERM” 

clause. See also “ECONOMIC PRICE ADJUSTMENT for authorized pricing adjustment(s).

EXTENSION OF CONTRACT TERM: At the request of the Government, the term of any contract resulting from 

this solicitation may be extended for such period of time as may be mutually agreeable to the GPO and the contractor.

ECONOMIC PRICE ADJUSTMENT: The pricing under this contract shall be adjusted in accordance with this 

clause, provided that in no event will any pricing adjustment be made that would exceed the maximum permissible 

under any law in effect at the time of the adjustment. There will be no adjustment for orders placed during the first 

period specified below. Pricing will thereafter be eligible for adjustment during the second and any succeeding 

performance period(s). For each performance period after the first, a percentage figure will be calculated as described 

below and that figure will be the economic price adjustment for that entire next period. Pricing adjustments under this 

clause are not applicable to reimbursable postage or transportation costs, or to paper, if paper prices are subject to 

adjustment by separate clause elsewhere in this contract.

For the purpose of this clause, performance under this contract will be divided into successive periods. The first period 

will extend from November 1, 2012 to October 31, 2013, and the second and any succeeding period(s) will extend for 

12 months from the end of the last preceding period, except that the length of the final period may vary. The first day 

of the second and any succeeding period(s) will be the effective date of the economic price adjustment for that period.

Pricing adjustments in accordance with this clause will be based on changes in the seasonally adjusted “Consumer Price 

Index For All Urban Consumers - Commodities Less Food” (Index) published monthly in the CPI Detailed Report by 

the U.S. Department of Labor, Bureau of Labor Statistics.

The economic price adjustment will be the percentage difference between Index averages as specified in this paragraph. 

An index called the variable index will be calculated by averaging the monthly Indexes from the 12-month interval 

ending 3 months prior to the beginning of the period being considered for adjustment. This average is then compared 

to the average of the monthly Indexes for the 12-month interval ending July 31, 2012, called the base index. The 

percentage change (plus or minus) of the variable index from the base index will be the economic price adjustment for 

the period being considered for adjustment.

The Government will notify the contractor by contract modification specifying the percentage increase or decrease to be 

applied to invoices for orders placed during the period indicated. The contractor shall apply the percentage increase or 

decrease against the total price of the invoice less reimbursable postage or transportation costs and separately adjusted 

paper prices. Payment discounts shall be applied after the invoice price is adjusted.
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SECURITY REQUIREMENTS: Protection of Confidential Information (as applicable):

(a) The contractor shall restrict access to all confidential information obtained from the Social Security Administration 

in the performance of this contract to those employees and officials who need it to perform the contract. Employees 

and officials who need access to confidential information for performance of the contract will be determined at the 

postaward conference between the Contracting Officer and the responsible contractor representative.

(b) The contractor shall process all confidential information obtained from SSA in the performance of this contract 

under the immediate supervision and control of authorized personnel, and in a manner that will protect the 

confidentiality of the records in such a way that unauthorized persons cannot retrieve any such records.

(c) The contractor shall inform all personnel with access to the confidential information obtained from SSA in the 

performance of this contract of the confidential nature of the information and the safeguards required to protect this 

information from improper disclosure.

(d) For knowingly disclosing information in violation of the Privacy Act, the contractor and the contractor employees 

may be subject to the criminal penalties as set forth in 5 U.S.C Section 552a (i) (1), which is made applicable to 

contractors by 5 U.S.C. 552a (m) (1) to the same extent as employees of the SSA. For knowingly disclosing 

confidential information as described in section 1106 of the Social Security Act (42 U.S.C. 1306), the contractor 

and contractor’s employees may also be subject to the criminal penalties as set forth in that provision.

(e) The contractor shall assure that each contractor employee with access to confidential information knows the 

prescribed rules of conduct, and that each contractor employee is aware that he/she may be subject to criminal 

penalties for violations of the Privacy Act and/or the Social Security Act. 

When the contractor employees are made aware of this information; they will be required to sign the SSA-301, 

“Contractor Personnel Security Certification” (see Exhibit B).

A copy of this signed certification must be forwarded to: SSA, Printing Management Branch, Attn: Charvonne 

Hamilton, Room 1360, Annex Building, 6401 Security Boulevard, Baltimore, MD 21235-6401. A copy must also 

be forwarded to: U.S. Government Printing Office, Attn.: AST 4, STOP: CSAPS, Room C838, 732 North Capitol 

Street, NW, Washington, DC 20401.

(f) All confidential information obtained from SSA for use in the performance of this contract shall, at all times, be 

stored in an area that is physically safe from unauthorized access.

(g) Performance of this contract may involve access to tax return information as defined in 26 U.S.C. Section 6103(b) 

of the Internal Revenue Code (IRC). All such information shall be handled as confidential and may not be 

disclosed without the written permission of SSA. 

For willingly disclosing confidential tax return information in violation of the IRC, the contractor and contractor 

employees may be subject to the criminal penalties set forth in 26 U.S.C. Section 7213.

(h) The Government reserves the right to conduct on-site visits to review the contractor’s documentation and in-house 

procedures for protection of confidential information.

(i) If a subcontractor is used for the presorting and/or mailing of the notices of this contract, the subcontractor must 

conform to all security requirements of the contract.
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SECURITY WARNING: In conjunction with the “SECURITY PROCEDURES” specified in SECTION 2, the 

contractor is responsible for the following, as applicable:

All employees working on this contract must –

 Be familiar with current information on security, privacy and confidentiality as they relate to the requirements 

of this contract.

 Obtain pre-screening authorization before using sensitive or critical applications pending a final suitability 

determination as applicable to the specifications.

 Lock or logoff their workstation/terminal prior to leaving it unattended.

 Act in an ethical, informed, and trustworthy manner.

 Protect sensitive electronic records.

 Be alert to threats and vulnerabilities to their systems.

Contractor’s managers working on this contract must –

 Monitor use of mainframes, PCs, LANs, and networked facilities to ensure compliance with national and local 

policies, as well as the Privacy Act statement.

 Ensure that employee screening for sensitive positions within their department has occurred prior to any 

individual being authorized access to sensitive or critical applications.

 Implement, maintain, and enforce the security standards and procedures as they appear in this contract and as 

outlined by the contractor.

 Contact the security officer within 24 hours whenever a systems security violation is discovered or suspected.

PUBLIC TRUST SECURITY REQUIREMENTS: This contract has been designated Public Trust Position Level 1. 

Due to the sensitive nature of the information contained in the products produced under this contract, contractor 

employees performing under this contract will be subject to a thorough civil and criminal background check as detailed 

in the “Security Requirements” (see Exhibit C). 

“Performing under this contract” is defined as working on-site at an SSA facility (including visiting the SSA site for 

any reason) or having access to Government programmatic or sensitive information.

Upon award, the contractor must provide SSA with an applicant listing of all individuals for whom the contractor is 

requesting a suitability determination (i.e., background investigation). This listing should include the following:

 the contractor’s name

 the contract number

 the contractor’s point of contact (CPOC) name

 the CPOC’s contact information including email address

 each applicant’s full name

 each applicant’s Social Security Number (SSN)

 each applicant’s date of birth

 each applicant’s place of birth (must show city and state if born in the United States (U.S.) OR city and country 

if born outside of the U.S.)

The contractor should submit the applicant listing upon contract award. The background investigation process will not 

start until the applicant listing is submitted.

Contractor must submit the applicant listing via fax to: CPSPM Suitability Team (410) 966-0640 or via U.S. Mail to: 

SSA, CPSPM Suitability Team, Room 1260, Dunleavy Building, 6401 Security Boulevard, Baltimore, MD 21235.
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Once SSA receives and reviews the applicant listing, SSA will initiate the Electronic Questionnaire for Investigations 

Process (eQIP). SSA will email notification to the CPOC that each applicant has been invited into the eQIP website to 

electronically complete their background investigation form. The CPOC will provide the website to the applicants to 

complete their eQIP form. The applicant will have up to seven (7) calendar days to complete the eQIP form. The 7-day 

timeframe begins once SSA notifies the CPOC of the eQIP invitation(s). The applicant must print the signature pages 

of the form (pages 5 and 6 of SF 85) (see Exhibit D), sign the signature pages, and then provide the signed originals to 

the CPOC.

The following is a list of forms each contractor employee is responsible to for completing:

 Original signed and dated eQIP signature pages (pages 5 and 6 of SF 85) as specified in the above paragraph.

 Two (2) “Fingerprint Cards” (FD-258, Exhibit E) (NOTE: The contractor will absorb the costs for obtaining 

fingerprints).

 One (1) “Declaration for Federal Employment” (Optional Form 306, Exhibit F).

 One (1) “Fair Credit Reporting Act Authorization Form” (Exhibit G).

 For a non-U.S. citizens, one (1) legible photocopy of the work authorization permit and social security card. 

The CPOC must ensure all paper forms are fully completed and signed prior to submission to SSA. 

All forms and fingerprinting cards must be submitted at least 15 workdays prior to the date work is to begin on the 

contract. For new contract employees hired during the contract term, forms must be submitted at least 15 workdays 

prior to working under the contract. 

The fingerprint cards and all paper forms must be legible or typed in black ink and all signatures must be in black ink. 

There must be no “breaks” in residences or employment. SSA requires complete addresses, including zip codes and 

phone numbers. It is the responsibility of the contractor to ensure fingerprint cards are processed through their local 

police departments or other authorized finger printers. The forms received at SSA must be signed and dated within the 

past 30 calendar days. SSA will return forms not fully completed back to the contractor. Forms may be obtained by 

calling SSA Personnel Security Suitability Program Officer (SPO) Leslie Herman at (410) 965-4426.

The CPOC shall submit one (1) cover sheet to SSA containing the names of all of the individuals for whom the 

contractor is submitting completed paperwork. This cover sheet should include the contract number, each applicant’s 

full name, each applicant’s SSN, each applicant’s date of birth, and each applicant’s place of birth. Submit this cover 

sheet along with the completed paper forms and two FD-258 fingerprint charts for each applicant to: SSA, CPSPM 

Suitability Team, Room 1260 Dunleavy Building, 6401 Security Boulevard, Baltimore, MD 21235.

The CPOC must also furnish a copy of the cover sheet only to: SSA, Attn: Charvonne Hamilton, Room 1360, Annex 

Building, 6401 Security Boulevard, Baltimore, MD 21235. (Telephone: (410) 965- 4159)

SSA will send a pre-screening notification within 15 workdays of receipt of properly completed forms and 

fingerprinting cards. Once a contractor employee is approved to work via the pre-screen notification, they are permitted 

to perform work under the contract. A final suitability determination can take up to 45 workdays.

In addition, the contractor shall be required to provide a resume with references for each employee required to work on 

this contract. NOTE: The required resumes should be submitted with the contractor’s bid.

DATA RIGHTS: All data furnished and/or produced in the performance of this contract shall be the sole property of 

the Government. The contractor agrees not to assert rights or to establish any claim to such designs in whole or in part 

in any manner or form, or to authorize others to do so, without prior written consent of the Contracting Officer.

ASSIGNMENT OF JACKETS, PURCHASE AND PRINT ORDERS: A GPO jacket number will be assigned and 

a purchase order issued to the contractor to cover work performed. The purchase order will be supplemented by an 

individual “print order” for each job placed with the contractor. The print order, when issued, will indicate the quantity 

to be produced and any other information pertinent to the particular order.
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POSTAWARD CONFERENCE: Unless waived by the Contracting Officer, the total requirements of the job as 

indicated in these specifications will be reviewed by Government representatives with the contractor’s representatives at 

the Social Security Administration, Baltimore, MD, immediately after award.

ORDERING: Items to be furnished under the contract shall be ordered by the issuance of print orders by the 

Government. Orders may be issued under the contract from November 1, 2012 through October 31, 2013, plus for 

such additional period(s) as the contract is extended. All print orders issued hereunder are subject to the terms and 

conditions of the contract. The contract shall control in the event of conflict with any print order. A print order shall be 

“issued” for purposes of the contract, when it is either deposited in the U.S. Postal Service mail or otherwise furnished 

to the contractor in conformance with the schedule.

REQUIREMENTS: This is a requirements contract for the items and for the period specified herein. 

Shipment/delivery of items or performance of work shall be made only as authorized by orders issued in accordance 

with the clause entitled “ORDERING.” The quantities of items specified herein are estimates only, and are not 

purchased hereby. Except as may be otherwise provided in this contract, if the Government’s requirements for the items 

set forth herein do not result in orders in the amounts or quantities described as “estimated,” it shall not constitute the 

basis for an equitable price adjustment under this contract.

Except as otherwise provided in this contract, the Government shall order from the contractor all the items set forth 

which are required to be purchased by the Government activity identified on page 1.

The Government shall not be required to purchase from the contractor, requirements in excess of the limit on total 

orders under this contract, if any.

Orders issued during the effective period of this contract and not completed within that time shall be completed by the 

contractor within the time specified in the order, and the rights and obligations of the contractor and the Government 

respecting those orders shall be governed by the terms of this contract to the same extent as if completed during the 

effective period of this contract.

If shipment/delivery of any quantity of an item covered by the contract is required by reason of urgency prior to the 

earliest date that shipment/delivery may be specified under this contract, and if the contractor will not accept an order 

providing for the accelerated shipment/delivery, the Government may procure this requirement from another source.

The Government may issue orders which provide for shipment/delivery to or performance at multiple destinations.

Subject to any limitations elsewhere in this contract, the contractor shall furnish to the Government all items set forth 

herein which are called for by print orders issued in accordance with the “ORDERING” clause of this contract.

SERVICE CONTRACT ACT OF 1965, applies as Amended.

(a) Definitions. “Act” as used in this clause, means the Service Contract Act of 1965, as amended (41 U.S.C. 351, 

et seq.).

“Contractor,” as used in this clause or in any subcontract, shall be deemed to refer to the subcontractor, except 

in the term “Government Prime Contractor.”

“Service employee” means any person engaged in the performance of this contract other than any person 

employed in a bona fide executive, administrative, or professional capacity, as these terms are defined in Part 

541 of Title 29, Code of Federal Regulations, as revised. It includes all such persons regardless of any 

contractual relationship that may be alleged to exist between a contractor or subcontractor and such persons.

(b) Applicability. This contract is subject to the following provisions and to all other applicable provisions of the 

Act and regulations of the Secretary of Labor (29 CFR Part 4). This clause does not apply to contracts or 

subcontracts administratively exempted by the Secretary of Labor or exempted by 41 U.S.C. 356, interpreted in 

subpart C of 29 CFR part 4.
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(c) Compensation. (1) Each service employee employed in the performance of this contract by the contractor or 

any subcontractor shall be paid not less than the minimum monetary wages and shall be furnished fringe 

benefits in accordance with the wages and fringe benefits determined by the Secretary of Labor, or authorized 

representative, as specified in any wage determination attached to this contract.

(2)(i) If a wage determination is attached to this contract, the contractor shall classify any class of service 

employee which is not listed therein and which is to be employed under the contract (i.e., the work to 

be performed is not performed by any classifications listed in the wage determination) so as to provide a

reasonable relationship (i.e., appropriate level of skill comparison) between such unlisted classifications 

and the classifications listed in the wage determination. Such conformed class of employees shall be 

paid the monetary wages and furnished the fringe benefits as are determined pursuant to the procedures 

in this paragraph (c).

(ii) This conforming procedure shall be initiated by the contractor prior to the performance of contract work 

by the unlisted class of employee. The contractor shall submit Standard Form (SF) 1444, Request For 

Authorization of Additional Classification and Rate, to the Contracting Officer no later than 30 days 

after the unlisted class of employee performs any contract work. The Contracting Officer shall review 

the proposed classification and rate and promptly submit the completed SF 1444 (which must include 

information regarding the agreement or disagreement of the employees’ authorized representatives or 

the employees themselves together with the agency recommendation), and all pertinent information to 

the Wage and Hour Division, Employment Standards Administration, U.S. Department of Labor. The 

Wage and Hour Division will approve, modify, or disapprove the action or render a final determination 

in the event of disagreement within 30 days of receipt or will notify the Contracting Officer within 30 

days of receipt that additional time is necessary.

(iii) The final determination of the conformance action by the Wage and Hour Division shall be transmitted 

to the Contracting Officer who shall promptly notify the contractor of the action taken. Each affected 

employee shall be furnished by the contractor with a written copy of such determination or it shall be 

posted as part of the wage determination.

(iv)(A) The process of establishing wage and fringe benefit rates that bear a reasonable relationship to 

those listed in a wage determination cannot be reduced to any single formula. The approach used 

may vary from wage determination to wage determination depending on the circumstances. 

Standard wage and salary administration practices which rank various job classifications by pay 

grade pursuant to point schemes or other job factors may, for example, be relied upon. Guidance 

may also be obtained from the way different jobs are rated under Federal pay systems (Federal 

Wage Board Pay System and the General Schedule) or from other wage determinations issued in 

the same locality. Basic to the establishment of any conformable wage rate(s) is the concept that a 

pay relationship should be maintained between job classifications based on the skill required and 

the duties performed.

(B) In the case of a contract modification, an exercise of an option, or extension of an existing contract, 

or in any other case where a contractor succeeds a contract under which the classification in 

question was previously conformed pursuant to paragraph (c) of this clause, a new conformed wage 

rate and fringe benefits may be assigned to the conformed classification 

by indexing (i.e., adjusting) the previous conformed rate and fringe benefits by an amount equal to 

the average (mean) percentage increase (or decrease, where appropriate) between the wages and 

fringe benefits specified for all classifications to be used on the contract which are listed in the 

current wage determination, and those specified for the corresponding classifications in the 

previously applicable wage determination. Where conforming actions are accomplished in 

accordance with this paragraph prior to the performance of contract work by the unlisted class of 

employees, the contractor shall advise the Contracting Officer of the action taken but the other 

procedures in subdivision (c)(2)(ii) of this clause need not be followed.
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(C) No employee engaged in performing work on this contract shall in any event be paid less than the 

currently applicable minimum wage specified under section 6(a)(1) of the Fair Labor Standards Act 

of 1938, as amended.

(v) The wage rate and fringe benefits finally determined under this subparagraph (c)(2) of this clause shall 

be paid to all employees performing in the classification from the first day on which contract work is 

performed by them in the classification. Failure to pay the unlisted employees the compensation agreed 

upon by the interested parties and/or finally determined by the Wage and Hour Division retroactive to 

the date such class of employees commenced contract work shall be a violation of the Act and this 

contract.

(vi) Upon discovery of failure to comply with subparagraph (c)(2) of this clause, the Wage and Hour 

Division shall make a final determination of conformed classification, wage rate, and/or fringe benefits 

which shall be retroactive to the date such class or classes of employees commenced contract work.

(3)Adjustment of Compensation. If the term of this contract is more than 1 year, the minimum monetary 

wages and fringe benefits required to be paid or furnished there under to service employees under this 

contract shall be subject to adjustment after 1 year and not less than once every 2 years, under wage 

determinations issued by the Wage and Hour Division.

(d) Obligation to Furnish Fringe Benefits. The contractor or subcontractor may discharge the obligation to furnish 

fringe benefits specified in the attachment or determined under subparagraph (c)(2) by furnishing equivalent 

combinations of bona fide fringe benefits, or by making equivalent or differential cash payments, only in 

accordance with subpart D of 29 CFR Part 4.

(e) Minimum Wage. In the absence of a minimum wage attachment for this contract, neither the contractor nor any 

subcontractor under this contract shall pay any person performing work under this contract (regardless of 

whether the person is a service employee) less than the minimum wage specified by section 6(a)(1) of the Fair 

Labor Standards Act of 1938. Nothing in this clause shall relieve the contractor or any subcontractor of any 

other obligation under law or contract for payment of a higher wage to any employee.

(f) Successor Contracts. If this contract succeeds a contract subject to the Act, under which substantially the same 

services were furnished in the same locality and service employees were paid wages and fringe benefits 

provided for in a collective bargaining agreement, in the absence of the minimum wage attachment for this 

contract setting forth such collectively bargained wage rates and fringe benefits, neither the contractor nor any 

subcontractor under this contract shall pay any service employee performing any of the contract work 

(regardless of whether or not such employee was employed under the predecessor contract), less than the wages 

and fringe benefits provided for in such collective bargaining agreement, to which such employee would be 

entitled if employed under the predecessor contract, including accrued wages and fringe benefits and any 

prospective increases in wages and fringe benefits provided for under such agreement. No contractor or 

subcontractor under this contract may be relieved of the foregoing obligation unless the limitations of 29 CFR 

4.1b(b) apply or unless the Secretary of Labor or the Secretary's authorized representative finds, after a hearing 

as provided in 29 CFR 4.10 that the wages and/or fringe benefits provided for in such agreement are 

substantially at variance with those which prevail for services of a character similar in the locality, or 

determines, as provided in 29 CFR 4.11, that the collective bargaining agreement applicable to service 

employees employed under the predecessor contract was not entered into as a result of arm's length 

negotiations. Where it is found in accordance with the review procedures provided in 29 CFR 4.10 and/or 4.11 

and parts 6 and 8 that some or all of the wages and/or fringe benefits contained in a predecessor contractor's 

collective bargaining agreement are substantially at variance with those which prevail for services of a 

character similar in the locality, and/or that the collective bargaining agreement applicable to service employees 

employed under the predecessor contract was not entered into as a result of arm's length negotiations, the 

Department will issue a new or revised determination setting forth the applicable wage rates 
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and fringe benefits. Such determination shall be made a part of the contract or subcontract, in accordance with 

the decision of the Administrator, the Administrative Law Judge, or the Board of Service Contract Appeals, as 

the case may be, irrespective of whether such issuance occurs prior to or after the award of a contract or 

subcontract (53 Comp. Gen. 401 (1973)). In the case of a wage determination issued solely as a result of a 

finding of substantial variance, such determination shall be effective as of the date of the final administrative 

decision.

(g) Notification to employees. The contractor and any subcontractor under this contract shall notify each service 

employee commencing work on this contract of the minimum monetary wage and any fringe benefits required 

to be paid pursuant to this contract, or shall post the wage determinations attached to this contract. The poster 

provided by the Department of Labor (Publication WH 1313) shall be posted in a prominent and accessible 

place at the worksite. Failure to comply with this requirement is a violation of section 2(a)(4) of the Act and of 

this contract.

(h) Safe and Sanitary Working Conditions. The contractor or subcontractor shall not permit any part of the 

services called for by this contract to be performed in buildings or surroundings or under working conditions 

provided by or under the control or supervision of the contractor or subcontractor which are unsanitary or 

hazardous, or dangerous to the health or safety of the service employees. The contractor or subcontractor shall 

comply with the safety and health standards applied under 29 CFR Part 1925. 

(i) Records. (1) The contractor and each subcontractor performing work subject to the Act shall make and 

maintain for 3 years from the completion of the work and make them available for inspection and transcription 

by authorized representatives of the Wage and Hour Division, Employment Standards Administration a record 

of the following:

(i) For each employee subject to the Act-

(A) Name and address and social security number,

(B) Correct work classification or classifications, rate or rates of monetary wages paid and fringe benefits 

provided, rate or rates of payments in lieu of fringe benefits, and total daily or weekly compensation;

(C) Daily and weekly hours worked by each employee; and,

(D) Any deductions, rebates, or refunds from the total daily or weekly compensation of each employee.

(ii) For those classes of service employees not included in any wage determination attached to this contract, 

wage rates or fringe benefits determined by the interested parties or by the Administrator or authorized 

representative under the terms of paragraph (c) of this clause. A copy of the report required by subdivision 

(c)(2)(ii) of this clause will fulfill this requirement.

(iii) Any list of the predecessor contractor’s employees which had been furnished to the contractor as 

prescribed by paragraph (n) of this clause.

(2) The contractor shall also make available a copy of this contract for inspection or transcription by 

authorized representatives of the Wage and Hour Division.

(3) Failure to make and maintain or to make available these records for inspection and transcription shall be a 

violation of the regulations and this contract, and in the case of failure to produce these records, the 

Contracting Officer, upon direction of the Department of Labor and notification to the contractor, shall 

take action to cause suspension of any further payment or advance of funds until the violation ceases.

(4) The contractor shall permit authorized representatives of the Wage and Hour Division to conduct 

interviews with employees at the worksite during normal working hours.
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(j) Pay Periods. The contractor shall unconditionally pay to each employee subject to the Act all wages due free 

and clear and without subsequent deduction (except as otherwise provided by law or regulations, 29 CFR part 

4), rebate, or kickback on any account. These payments shall be made no later than one pay period following 

the end of the regular pay period in which the wages were earned or accrued. A pay period under this Act may 

not be of any duration longer than semi-monthly.

(k) Withholding of Payment and Termination of Contract. The Contracting Officer shall withhold or cause to be 

withheld from the Government Prime Contractor under this or any other Government contract with the Prime 

Contractor such sums as an appropriate official of the Department of Labor, requests or such sums as an 

appropriate official of the Department of Labor, requests or such sums as the Contracting Officer decides may 

be necessary to pay underpaid employees employed by the contractor or subcontractor. In the event of failure 

to pay any employees subject to the Act all or part of the wages or fringe benefits due under the Act, the 

Contracting Officer may, after authorization or by direction of the Department of Labor and written notification 

to the contractor, take action to cause suspension of any further payment or advance of funds until such 

violations have ceased. Additionally, any failure to comply with the requirements of this clause may be 

grounds for termination of the right to proceed with the contract work. In such event, the Government may 

enter into other contracts or arrangements for completion of the work, charging the contractor in default with 

any additional cost.

(l) Subcontracts. The contractor agrees to insert this clause in all subcontracts subject to the Act.

(m) Collective Bargaining Agreements Applicable to Service Employees. If wages to be paid or fringe benefits to 

be furnished any service employees employed by the Government Prime Contractor or any subcontractor under 

the contract are provided for in a collective bargaining agreement which is or will be effective during any 

period in which the contract is being performed, the Government Prime Contractor shall report such fact to the 

Contracting Officer, together with full information as to the application and accrual of such wages and fringe 

benefits, including any prospective increases, to service employees engaged in work on the contract, and a copy 

of the collective bargaining agreement. Such report shall be made upon commencing performance of the 

contract, in the case of collective bargaining agreements effective at such time, and in the case of such 

agreements of provisions or amendments thereof effective at a later time during the period of contract 

performance, such agreements shall be reported promptly after negotiations thereof.

(n) Seniority List. Not less than 10 days prior to completion of any contract being performed at a Federal facility 

where service employees may be retained in the performance of the succeeding contract and subject to a wage 

determination which contains vacation or other benefit provisions based upon length of service with a 

contractor (predecessor) or successor (29 CFR 4.173), the incumbent Prime Contractor shall furnish the 

Contracting Officer a certified list of names of all service employees on the contractor's or subcontractor's 

payroll during the last month of contract performance. Such list shall also contain anniversary dates of 

employment on the contract either with the current or predecessor contractors of each such service employee. 

The Contracting Officer shall turn over such list to the successor contractor at the commencement of the 

succeeding contract.

(o) Rulings and Interpretations. Rulings and interpretations of the Act are contained in Regulations, 29 CFR part 

4.

(p) Contractor’s Certification. (1) By entering into this contract, the contractor (and officials thereof) certifies that 

neither it (nor he or she) nor any person or firm who has a substantial interest in the contractor's firm is a 

person or firm ineligible to be awarded Government contracts by virtue of the sanctions imposed under section 

5 of the Act.

(2) No part of this contract shall be subcontracted to any person or firm ineligible for award of a Government 

contract under section 5 of the Act.

(3) The penalty for making false statement is prescribed in the U.S. Criminal Code, 18 U.S.C. 1001.
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(q) Variations, Tolerances, and Exemptions Involving Employment. Notwithstanding any of the provisions in 

paragraphs (b) through (o) of this clause, the following employees may be employed in accordance with the 

following variations, tolerances, and exemptions, which the Secretary of Labor, pursuant to section 4(b) of the 

Act prior to its amendment by Pub. L.92-473, found to be necessary and proper in the public interest or to 

avoid serious impairment of the conduct of Government business:

(1) Apprentices, student-learners, and workers whose earning capacity is impaired by age, physical or mental 

deficiency or injury may be employed at wages lower than the minimum wages otherwise required by 

section 2(a)(1) or 2(b)(1) of the Act, without diminishing any fringe benefits or cash payments in lieu 

thereof required under section 2(a)(2) of the Act, in accordance with the conditions and procedures 

prescribed for the employment of apprentices, student-learners, handicapped persons, and handicapped 

clients of sheltered workshops under section 14 of the Fair Labor Standards Act of 1938, in the regulations 

issued by the Administrator (29 CFR Parts 520, 521, 524, and 525).

(2) The Administrator will issue certificates under the Act for the employment of apprentices, student-learners, 

handicapped persons, or handicapped clients of sheltered workshops not subject to the Fair Labor 

Standards Act of 1938, or subject to different minimum rates of pay under the two Acts, authorizing 

appropriate rates of minimum wages (but without changing requirements concerning fringe benefits or 

supplementary cash payments in lieu thereof), applying procedures prescribed by the applicable 

regulations issued under the Fair Labor Standards Act of 1938 (29 CFR Parts 520, 521, 524, 525);

(3) The Administrator will also withdraw, annul, or cancel such certificates in accordance with the regulations 

in 29 CFR parts 525 and 528.

(r) Apprentices. Apprentices will be permitted to work at less than the predetermined rate for the work they 

perform when they are employed and individually registered in a bona fide apprenticeship program registered 

with a State apprenticeship agency which is recognized by the U.S. Department of Labor, or if no such 

recognized agency exists in a State, under a program registered with the Bureau of Apprenticeship and 

Training, Employment and Training Administration, U.S. Department of Labor. Any employee who is not 

registered as an apprentice in an approved program shall be paid the wage rate and fringe benefits contained in 

the applicable wage determination for the journeyman classifications of work actually performed. The wage 

rates paid apprentices shall not be less than the wage rate for their level of progress set forth in the registered 

program, expressed as the appropriate percentage of the journeyman's rate contained in the applicable wage 

determination. The allowable ratio of apprentices to journeymen employed on the contract work in any craft 

classification shall not be greater than the ratio permitted to the contractor as to his entire work force under the 

registered program.

(s) Tips. An employee engaged in an occupation in which the employee customarily and regularly receives more 

than $30 a month in tips may have the amount of these tips credited by the employer against the minimum 

wage required by section 2(a)(1) or section 2(b)(1) of the Act, in accordance with Regulations, 29 CFR Part 

531. However, the amount of credit shall not exceed $1.34 per hour beginning January 1, 1981. To use this 

provision-

(1) The employer must inform tipped employees about this tip credit allowance before the credit is utilized;

(2) The employees must be allowed to retain all tips (individually or through a pooling arrangement and 

regardless of whether the employer elects to take a credit for tips received);

(3) The employer must be able to show by records that the employee receives at least the applicable Service 

Contract Act minimum wage through the combination of direct wages and tip credit; and

(4) The use of such tip credit must have been permitted under any predecessor collective bargaining agreement 

applicable by virtue of section 4(c) of the Act.
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(t) Disputes Concerning Labor Standards. The U.S. Department of Labor has set forth in 29 CFR parts 4, 6, and 8 

procedures for resolving disputes concerning labor standards requirements. Such disputes shall be resolved in 

accordance with those procedures and not the Disputes clause of this contract. Disputes within the meaning of 

this clause include disputes between the contractor (or any of its subcontractors) and the contracting agency, 

the U.S. Department of Labor, or the employees or their representatives. 

NOTE: SPECIAL EMPHASIS TO THE AFFECT THAT EMPLOYEE COMPENSATION MUST BE AT TIME 

AND HALF. (REFERENCE: OVERTIME PAY/WAGE HOUR PUBLICATION 1313).

The contractor shall pay the determined wage rate and fringe benefits to all employees performing in the stated 

classification, which include annual leave and pay for holidays as described in the Service Contract Act of 1965. The 

Government is not responsible for these benefits.

PRIVACY ACT NOTIFICATION: This procurement action requires the contractor to do one or more of the 

following: design, develop, or operate a system of records on individuals to accomplish an agency function in 

accordance with the Privacy Act of 1974, Public Law 93-579, December 31, 1974 (5 U.S.C. 552a) and applicable 

agency regulations. Violation of the Act may involve the imposition of criminal penalties.

PRIVACY ACT

(a) The contractor agrees:

(1) to comply with the Privacy Act of 1974 and the rules and regulations issued pursuant to the Act in the 

design, development, or operation of any system of records on individuals in order to accomplish an 

agency function when the contract specifically identifies (i) the system or systems of records and (ii) the 

work to be performed by the contractor in terms of any one or combination of the following: (A) design, 

(B) development, or (C) operation;

(2) to include the solicitation notification contained in this contract in every solicitation and resulting 

subcontract and in every subcontract awarded without a solicitation when the statement of work in the 

proposed subcontract requires the design, development, or operation of a system of records on individuals 

to accomplish an agency function; and

(3) to include this clause, including this paragraph (3), in all subcontracts awarded pursuant to this contract 

which require the design, development, or operation of such a system of records.

(b) In the event of violations of the Act, a civil action may be brought against the agency involved where the 

violation concerns the design, development, or operation of a system of records on individuals to accomplish 

an agency function, and criminal penalties may be imposed upon the officers or employees of the agency where 

the violation concerns the operation of a system of records on individuals to accomplish an agency function. 

For purposes of the Act when the contract is for the operation of a system of records on individuals to 

accomplish an agency function, the contractor and any employee of the contractor is considered to be an 

employee of the agency.

(c) The terms used in this clause have the following meanings:

(1) “Operation of a system of records” means performance of any of the activities associated with maintaining 

the system of records including the collection, use, and dissemination of records.

(2) “Record” means any item, collection or grouping of information about an individual that is maintained by 

an agency, including, but not limited to, his education, financial transactions, medical history, and criminal 

or employment history and that contains his name, or the identifying number, symbol, or other identifying 

particular assigned to the individual, such as a finger or voice print or a photograph.
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(3) “System of records” on individuals means a group of any records under the control of any agency from 

which information is retrieved by the name of the individual or by some identifying number, symbol, or 

other identifying particular assigned to the individual.

CRIMINAL SANCTIONS: It is incumbent upon the Contractor to inform its officers and employees of the penalties 

for improper disclosure imposed by the Privacy Act of 1974, 5 U.S.C. 552a. Specifically, 5 U.S.C. 552a (i)(1) which is 

made applicable to Contractors by 5 U.S.C. 552a (m)(1), provides that any officer or employee of an agency, who by 

virtue of his/her employment of official position, has possession of or access to agency records which contain 

individually identifiable information, the disclosure of which is prohibited by the Privacy Act or regulations established 

thereunder, and who knowing that disclosure of the specific material is prohibited, willfully discloses the material in 

any manner to any person or agency not entitled to receive it, shall be guilty of a misdemeanor and fined not more than 

$10,000.00.

NOTE: The evaluation criteria for determining an employee’s financial solvency will be supplied by SSA after award.

BILLING: Upon completion of each order, the contractor shall submit an itemized statement for billing to the 

ordering agency for examination and certification as to the correctness of the billing. Submit billing to: SSA, Printing 

Procurement Management Branch, Attn: Charvonne Hamilton, Room 1360, Annex Building, 6401 Security 

Boulevard, Baltimore, MD 21235-6401.

After agency verification, the billing invoice and a copy of the modification must be submitted to the U.S. Government 

Printing Office for payment. Submit to: U.S. Government Printing Office, Office of Financial Management, Attn: 

Comptroller, Stop: FMCE, Washington, DC 20401. (NOTE: GPO offers a Contractor Fax Billing System. Please 

visit the GPO website for more information.)
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SECTION 2. - SPECIFICATIONS

SCOPE: These specifications cover the production of electronic intelligent/fillable forms requiring such operations as 

designing, revising, and converting furnished forms.

TITLE: Electronic Intelligent Fillable/Printable Forms.

FREQUENCY OF ORDERS: It is impossible to predetermine the number or frequency of orders which will be 

placed during the term of the contract. However, it is anticipated that approximately 12 to 18 orders will be placed per 

year.

QUANTITY: One (1) electronic file per form per order. (See “FINAL DELIVERABLE.”)

NOTE: Only one form will be ordered on a print order.

NUMBER OF PAGES: Forms will range from approximately 1 to 4 fillable pages. (NOTE: Majority of forms will 

have an average of three (3) fillable pages.)

TRIM SIZES: The hard copy form size will range from 5-1/2 x 8” up to and including 8-1/2 x 11” (portrait or 

landscape). These forms must be electronically designed to always print on 8-1/2 x 11” size paper.

GOVERNMENT TO FURNISH: Materials will be furnished and/or made available immediately after award. 

Furnished materials will include the following –

 Workstation equipped with PC and Monitor

 Email and Internet Access

 Access to FileMaker 11.0, Microsoft Office 2010 Applications, Adobe Acrobat Professional 9

 Access to the SSA Printing Procurement eForms System (PPeS)

CONTRACTOR TO FURNISH: All materials and operations, other than those listed under “GOVERNMENT TO 

FURNISH,” necessary to produce the product(s) in accordance with these specifications.

The contractor will be responsible for performing all necessary proofreading to ensure that the forms are in conformity 

with the SSA PPeS, as follows –

 All forms must be in strict compliance with the specifications of SSA’s Printing Procurement eForms System. 

 The forms must be capable of producing near mirror image print versions of the forms provided for electronic 

design (having all elements in their proper position).

 It is imperative that the eForms be formatted to include all of the required intelligence and scripting in order to 

be seamlessly incorporated into SSA’s current workflow processes and to easily export/import data from all 

fillable fields to be saved in the PPeS back-end procurement database. 

 Forms must be converted into an electronic intelligent fillable form in strict compliance with the specifications 

of the SSA PPes Form Design Standards (Exhibit H).

 The contractor will be responsible for ensuring that the forms are Section 508 compliant. SSA will provide 

directions on what is required and will answer questions in unique situations.

 The files must be easily stored, accessible, and searchable in PPeS. 
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SECURITY PROCEDURES: All work must be performed on-site at the Social Security Administration, Baltimore, 

MD.

All forms will be created using SSA’s Printing Procurement eForms System. Contractor will work closely with SSA IT 

personnel who will test the forms created.

Unless otherwise specified, the hours of operation for the contractor to work are 8:00 a.m. to 4:30 p.m., Eastern Time, 

Monday through Friday, excluding Federal Holidays and unexpected closures (e.g., weather).

Contractor must keep deliverables secure within the designated workspace at all times. 

FINAL DELIVERABLE: For each order placed, the contractor must provide one (1) file for each form ordered

consisting of an electronic FileMaker (11.0 or later) intelligent/fillable form that looks like the printed version of the 

form. Each file must have the ability to be saved and printed to a PDF file.

Forms will be created and built in SSA’s Printing Procurement eForms System. 

SCHEDULE: Adherence to this schedule must be maintained. Contractor must not start production of any job prior to 

receipt of the individual print order (GPO Form 2511).

Print order will be faxed to the contractor. Furnished materials will be made available to the contractor at the SSA, 

Baltimore, MD.

No definite schedule for availability of material can be predetermined. However, it is anticipated that the first order 

will be placed in November.

Contractor must complete all work as specified on the print order and make the final deliverable available in accordance 

with the schedule specified on the individual print order. NOTE: Each print order may require a different schedule.

The ship/deliver date indicated on the print order is the date the final deliverable must be completed and made available 

to the ordering agency.

Upon completion of each order, the contractor is to notify the U.S. Government Printing Office of the date of shipment 

or delivery. Call (202) 512-0516 or 0520; callers outside the Washington, DC area may call toll free 1-800-424-9470 

or 9471.

STATUS REPORTS: On a weekly basis, the contractor shall deliver a status report to the SSA, as specified on the 

individual print order. The report shall be submitted via email by close of business each Friday.

The status report must include, but is not limited to, the following:

 Number of hours required to complete the work as specified on the print order.

 What work has been completed thus far.

 What remaining work is left to be completed.

 Number of hours worked thus far.

 Number of hours still remaining to complete the print order.

 Any pertinent information that may have an impact on the timely completion of the print order. 
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SECTION 3. - DETERMINATION OF AWARD

The Government will determine the lowest bid by applying the prices offered in the “SCHEDULE OF PRICES” to the 

following units of production which are the estimated requirements to produce one (1) year’s production under this 

contract. These units do not constitute, nor are they to be construed as, a guarantee of the volume of work which may 

be ordered for a like period of time.

The following item designations correspond to those listed in the “SCHEDULE OF PRICES.”

I. 580
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SECTION 4. - SCHEDULE OF PRICES

Bidder must make an entry in each of the spaces provided. Bids submitted with any obliteration, revision, or alteration 

of the order and manner of submitting bids may be declared non-responsive.

An entry of NC (No Charge) shall be entered if bidder intends to furnish individual items at no charge to the 

Government.

Bids submitted with NB (No Bid) or blank spaces for an item may be declared non-responsive.

The Contracting Officer reserves the right to reject any offer that contains prices for individual items of production 

(whether or not such items are included in the DETERMINATION OF AWARD) that are inconsistent or unrealistic in 

regard to other prices in the same offer or to GPO prices for the same operation if such action would be in the best 

interest of the Government.

All invoices submitted to the GPO shall be based on the most economical method of production. 

I. DESIGN AND CONVERSION: Prices offered shall include the cost of all required materials and operations 

necessary for the complete production and distribution of the product listed in accordance with these specifications.

Per Hour.......................................................................................................................................$___________

NOTE: The minimum charge for Line Item I. shall be one (1) hour. In case of dispute, the Contracting Officer 

reserves the right to be the final judge as to the operations and/or number of hours chargeable under Line Item I.

INSTRUCTIONS FOR BID SUBMISSION: Fill out “SECTION 4. - SCHEDULE OF PRICES,” initialing or 

signing each page in the space(s) provided. Submit two copies (original and one exact duplicate) of the “SCHEDULE 

OF PRICES” with two copies of the GPO Form 910 “BID” form. Do not enter bid prices on GPO Form 910; prices 

entered in the “SCHEDULE OF PRICES” will prevail.

Bidder _____________________________________________________________________________________

___________________________________________________________________________________________

(City - State)

By ________________________________________________________________________________________

(Signature and title of person authorized to sign this bid)

___________________________________________________________________________________

(Person to be contacted) (Telephone Number)
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437-S (10/13) EXHIBIT A Page 1 of 3
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437-S (10/13) EXHIBIT A Page 2 of 3
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437-S (10/13) EXHIBIT A Page 3 of 3
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CONTRACTOR PERSONNEL SECURITY CERTIFICATION
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CONTRACTOR PERSONNEL SECURITY CERTIFICATION
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CONTRACTOR PERSONNEL SECURITY CERTIFICATION
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437-S (10/13) EXHIBIT 

C Page 1 of 4

SECURITY REQUIREMENTS
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437-S (10/13) EXHIBIT 

C Page 2 of 4

SECURITY REQUIREMENTS
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C Page 3 of 4

SECURITY REQUIREMENTS
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C Page 4 of 4

SECURITY REQUIREMENTS
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437-S (10/13) EXHIBIT D Page 1 of 8

QUESTIONNAIRE FOR NON-SENSITIVE POSITIONS
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QUESTIONNAIRE FOR NON-SENSITIVE POSITIONS
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QUESTIONNAIRE FOR NON-SENSITIVE POSITIONS
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QUESTIONNAIRE FOR NON-SENSITIVE POSITIONS
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QUESTIONNAIRE FOR NON-SENSITIVE POSITIONS
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QUESTIONNAIRE FOR NON-SENSITIVE POSITIONS
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QUESTIONNAIRE FOR NON-SENSITIVE POSITIONS
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QUESTIONNAIRE FOR NON-SENSITIVE POSITIONS
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437-S (10/13) EXHIBIT 

E Page 1 of 1

FINGERPRINT CARD
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437-S (10/13) EXHIBIT 

F Page 1 of 3
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437-S (10/13) EXHIBIT 

F Page 2 of 3
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F Page 3 of 3
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437-S (10/13) EXHIBIT G Page 1 of 4

FAIR CREDIT REPORTING ACT

AUTHORIZATION FORM
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FAIR CREDIT REPORTING ACT

AUTHORIZATION FORM
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FAIR CREDIT REPORTING ACT

AUTHORIZATION FORM
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FAIR CREDIT REPORTING ACT

AUTHORIZATION FORM
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SSA PPeS FORM DESIGN STANDARDS
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SSA PPeS FORM DESIGN STANDARDS