Solicitation: # AG-INTS-S-14-0004

United States 

Department of 

Agriculture

FARM SERVICE AGENCY

Commodity Operations

The U.S. Department of Agriculture (USDA), Farm Service Agency (FSA), Deputy Administrator for 

Commodity Operations (DACO) requests proposals from responsible sources to provide marine cargo 

discharge/delivery survey services in the country of the Mauritania. 

The services will include surveys of containerized, and/or breakbulk, and/or bulk commodities for food 

assistance programs. It is the intention of the Government to award a fixed-price requirements contract with 

optional economic price adjustment to one firm to survey commodities for food assistance programs for the 

country listed above.

This is a combined synopsis/solicitation for commercial services prepared in accordance with the format in 

Subpart 12.6, as supplemented with additional information included in this notice. This announcement 

constitutes the only solicitation; proposals are being requested and a written solicitation will not be issued.

May 2, 2014
2

Solicitation # AG-INTS-S-14-0004

Contents

I. Solicitation Form 3

II. General Description 5

III. Contract Clauses 5

A. FAR 52.212-4 Contract Terms and Conditions—Commercial Items (Sep 2013) 5

A.1 Addenda to FAR 52.212-4..................................................................................................................................... 5

A.2. Additional Clauses................................................................................................................................................ 6

B. FAR 52.212-5 Contract Terms and Conditions Required to Implement Statutes or Executive Orders—

Commercial Items (Jan 2014) 9

IV. Contract Documents and Attachments 13

A. Statement of Work 13

B. Scope of Work 14

C. Required Services ................................................................................................................................................ 14

D. Deliverables 15

E. Applicable Documents 18

F. Exhibits 18

F.1. Attachment KC-337EPA RATE SCHEDULE................................................................................................. 19

F.2. Attachment KC-334 DISCHARGE/DELIVERY SURVEY SUMMARY ...................................................... 21

V. Solicitation Provisions 23

A. FAR 52.212-1 Instructions to Offerors—Commercial Items (Apr 2014) 23

A.1. Addenda to FAR 52.212-1................................................................................................................................. 23

A.2. Additional Provisions ........................................................................................................................................ 24

B. FAR 52.212-2 Evaluation-Commercial Items. (Jan 1999) 24
3

I. Solicitation Form

1. Solicitation Number: AG-INTS-S-14-0004

2. Solicitation Issue Date: May 2, 2014

3. Issued and Administered By:

USDA-Farm Service Agency-Deputy Administrator for Commodity Operations

International Procurement Division

Beacon Facility- Mail Stop 8738

P.O. Box 419205

Kansas City, MO 64141-6205

4. Solicitation Type: Request for Proposals (RFP)

5. Offer Due Date/Local Time: Wednesday, May 28, 2014 at 10:00 A.M. Central Time

6. Award Information Available By: Wednesday, June 4, 2014 at 4:00 P.M. Central Time

7. Public Release of Award By: Wednesday, June 4, 2014 at 4:00 P.M. Central Time

8. Solicitation Information Contact: 

Name: Patsy Carleton

Telephone: 816-926-2574

E-mail: patsy.carleton@kcc.usda.gov 

9. This Acquisition is:

/ X / Unrestricted

/ / Restricted

10. Schedule of Services: It is anticipated that food aid cargoes requiring marine cargo discharge/delivery 

survey services will be shipped to the following country:

 Mauritania

Due to potential program changes, there is no guarantee that a survey will be required during the period of 

the contract. However, the following shipment is currently scheduled to discharge in Nouakchott, 

Mauritania:

Receiver Commodity

Pack 

Size NMT Vessel/Voyage Carrier

ETA/Sail 

Date

ETA 

Disport

Discharge 

Port

World Food 

Programme Milled Rice 50K 1000 Northern Dexterity CMA-CGM 16-May 20-Jun Nouakchott

World Food 

Programme Milled Rice 50K 1250 CMA CGM Jamaica CMA-CGM 23-May 27-Jun Nouakchott

World Food 

Programme Lentils 50K 500 Northern General CMA-CGM 30-May 5-Jul Nouakchott

11. Place of Performance: See Section IV.B. for Scope of Work. 
4

12. Submit survey reports and invoices to:

USDA-FSA-DACO

Contract Reconciliation Division - Export Debt Branch 

Beacon Facility - Mail Stop 8758 

P.O. Box 419205

Kansas City, MO 64141-6205

For express mail:

USDA-FSA-DACO

Contract Reconciliation Division - Export Debt Branch 

Beacon Facility - Mail Stop 8758

9240 Troost Ave

Kansas City, MO 64131-3055

For questions concerning invoices contact Martha Locke at 816-926-2992 or Dennis Atkins at 816-926-1532.

13. Contract Type:

/ / Indefinite Delivery/Definite Quantity

/ / Indefinite Delivery/Indefinite Quantity

/X / Requirements/Indefinite Quantity

/X / Fixed-Price with Economic Price Adjustment

14. Accounting and Appropriation Data:

Funding for the service contracts awarded under this solicitation will be provided through the applicable 

funding source used for the procurement of the food aid that is to be surveyed.

15. Solicitation incorporates FAR provisions 52.212-1, 52.212-2, 52.212-3 and clauses 52.212-4 and 52.212-5. 

These provisions and clauses are included within this document either in their entirely or by reference 

only.

16. USDA Contracting Officer

/s/ Patsy Carleton, Contracting Officer
5

II. General Description

The Farm Service Agency procures staple foods for use in various international food aid programs 

administered by the U.S. Agency for International Development (USAID) and USDA’s Foreign Agricultural 

Service (FAS). The food is purchased in bulk and packaged form and transported overseas by ocean carriers to 

discharge ports or foreign inland destinations for delivery to Non-Governmental Organizations (NGO), Private 

Voluntary Organizations (PVO), or foreign governments. Given the inherent nature of transporting bulk and 

packaged food long distances by sea and overland in foreign nations, there is a potential for loss or damage. 

To address this risk, the Government is seeking to hire marine cargo survey companies to attend at discharge 

locations and, if applicable, customs and final delivery locations in order to witness and examine cargoes, 

document the count and condition of these food aid shipments and activities related to disposition, and provide 

a written report. The survey reports issued by the Contractors will be used by the Government to fix 

responsibility for loss and damage to the food aid. The Statement of Work under Section IV.A. provides the 

Government’s requirements.

Under certain circumstances, DACO may require that ancillary services be performed. Examples of such 

services include sampling of damaged commodities and providing analysis of suspected unfit cargoes.

Pursuant to FAR 15.306(a)(3), the government intends to evaluate proposals and make award without 

discussions. However, the Government reserves the right to hold discussions, if necessary. 

Provisions and clauses in effect through FAC 2005-73 are incorporated into this RFP, as applicable.

III. Contract Clauses

A. FAR 52.212-4 Contract Terms and Conditions—Commercial Items (Sep 2013) 

A.1 Addenda to FAR 52.212-4

1. Addendum to Paragraph (a) Inspection/Acceptance. The Contracting Officer or the Contracting 

Officer's duly authorized representative will inspect and accept the supplies and/or services to be 

provided under this contract. Inspection and acceptance will be performed at: United States 

Department of Agriculture, Deputy Administrator for Commodity Operations, 6501 Beacon 

Drive, Kansas City, Missouri, 64133-4676. 

2. Addendum to Paragraph (b) Assignment.

If requesting assignment of claims under the contract, the contractor may use USDA forms 

CCC-251 (Notice of Assignment) and CCC-252 (Instrument of Assignment), which may be 

obtained at: http://www.fsa.usda.gov/FSA/webapp?area=home&subject=coop&topic=pas or 

the contractor may use its own forms provided the forms are essentially consistent with 

CCC-251 and CCC-252 in content.

3. Addendum to Paragraph (e) Definitions.

(1) “COTR” means Contracting Officer Technical Representative duly authorized by the 

Contracting Officer. 

(2) "Major damage" means damage that in the estimation of the surveyor exceeds USD 

$20,000. 

(3) "Materials" applies to other direct costs, including travel expenses.

(4) "NGO" means non-governmental organization which receives the food aid to be 

surveyed.

(5) "TBL" means through bill of lading.

(6) "Third party lab" means a laboratory meeting international ISO testing standards that is 

not affiliated/associated with either the ocean carrier or receiver involved in the shipment.
6

4. Addendum to add Paragraph (v) – Submission of deliverables

All survey reports and related survey documentation shall be submitted concurrently with the 

associated invoice to the address in Section I Solicitation Form. Deliverables and invoice may be 

submitted electronically to the COTR.

(End of addenda)

A.2. Additional Clauses

AGAR 452.211-74 Period of Performance. (Feb 1988)

The base period of performance of this contract is from

 Date of Award through Sept 30, 2014.

Option period 1, if exercised, is from Oct 1, 2014 through Sept 30, 2015.

(End of Clause)

AGAR452.211-75 Effective Period of the Contract. (Feb 1988)

The effective period of this contract is from contract award through the through date of clause 

452.211-74.

(End of Clause)

FAR 52.216-4 Economic Price Adjustment - Labor and Material (Jan 1997)

(a) The Contractor shall notify the Contracting Officer of any Economic Price Adjustment (EPA) 

needed, that is, if, at any time during contract performance, the travel costs shown in the Rate Schedule

(Form KC-337EPA REVERSE, page 2) submitted with the proposal either increase or decrease. The 

Contractor shall furnish this notice, in writing, not later than the date of final payment under this 

contract. The notice shall include the Contractor’s proposal for an adjustment in the travel costs to be 

negotiated under paragraph (b) of this clause, and shall include supporting data explaining the cause, 

effective date, and amount of the increase or decrease and the amount of the Contractor’s adjustment 

proposal.

(b) Promptly after the Contracting Officer receives the notice and data under paragraph (a) of this 

clause, the Contracting Officer and the Contractor shall negotiate a price adjustment and its effective 

date. The Contracting Officer shall modify this contract to include the price adjustment and to revise 

the unit prices of material as shown in the Schedule to reflect the increases or decreases resulting from 

the adjustment. The Contractor shall continue performance pending agreement on, or determination of, 

any adjustment and its effective date.

(c) Any EPA under this clause is subject to the following limitations:

(1) Only changes in the Contractor’s expenses relative to the travel itemized on the Rate 

Schedule (Reverse) Additional Expenses will be considered for an EPA. Reimbursement of 

travel expenses not included on the Rate Schedule shall not be considered, unless preapproval is obtained from the Contracting Officer, and will only be made in unusual and 

compelling circumstances. Travel costs are separate and distinct from the fixed rate portion 

of the Rate Schedule (page 1) and include expenses such as airfare or other transportation 

costs relative to the conduct of the contract. 

(2) The contractor shall only be reimbursed for actual costs incurred by and paid to the 

Contractor’s employees that are required to accomplish the task of performing 

discharge/delivery survey services for the Government under this contract. The Government 

reserves the right to verify independently that the travel costs are fair and reasonable. 

Charges associated to changes in the travel itinerary are not reimbursable unless the charges 

are directly attributable to changes in the performance of the contract to meet the 

Government’s needs.

(3) No upward adjustment shall apply to services that are required before the effective date of the 

adjustment, unless the Contractor’s failure to deliver or perform according to the delivery 
7

schedule results from causes beyond the Contractor’s control and without its fault or 

negligence, within the meaning of the Default clause.

(4) The aggregate of the increases in any contract unit price made under this clause shall not 

exceed 10 percent of the original unit price. There is no percentage limitation on the amount 

of decreases that may be made under this clause.

(d) The Contractor shall furnish documentary proof of all travel expenditures along with the invoice 

as described in Section III. A.1 Addenda to FAR 52.212-4. 

(End of Clause)

FAR 52.216-18 Ordering (Oct 1995 )

(a) Any supplies and services to be furnished under this contract shall be ordered by issuance of 

delivery orders or task orders by the individuals or activities designated in the Schedule. Such orders 

may be issued from date of contract award through contract expiration date.

(b) All delivery orders or task orders are subject to the terms and conditions of this contract. In the 

event of conflict between a delivery order or task order and this contract, the contract shall control.

(c) If mailed, a delivery order or task order is considered “issued” when the Government deposits the 

order in the mail. Orders may be issued orally, by facsimile, or by electronic commerce methods only 

if authorized in the Schedule.

(End of Clause) 

FAR 52.216-19 Order Limitations. (Oct 1995)

(a) Minimum order. When the Government requires supplies or services covered by this contract in 

an amount of less than one ocean container [for containerized cargoes], 75 metric tons [for breakbulk], 

or 500 metric tons [for bulk cargoes], the Government is not obligated to purchase, nor is the 

Contractor obligated to furnish, those supplies or services under the contract.

(b) Maximum order. The Contractor is not obligated to honor—

(1) Any order for a single item in excess of 450 ocean containers [for containerized cargoes], 

40,000 metric tons [for breakbulk], or 65,000 metric tons [for bulk cargoes];

(2) Any order for a combination of items in excess of 450 ocean containers [for containerized 

cargoes], 40,000 metric tons [for breakbulk], or 65,000 metric tons [for bulk cargoes]; or

(3) A series of orders from the same ordering office within two days that together call for 

quantities exceeding the limitation in paragraph (b)(1) or (2) of this section. 

(c) If this is a requirements contract (i.e., includes the Requirements clause at subsection 52.216-21 

of the Federal Acquisition Regulation (FAR)), the Government is not required to order a part of any 

one requirement from the Contractor if that requirement exceeds the maximum-order limitations in 

paragraph (b) of this section.

(d) Notwithstanding paragraphs (b) and (c) of this section, the Contractor shall honor any order 

exceeding the maximum order limitations in paragraph (b), unless that order (or orders) is returned to 

the ordering office within three (3) days after issuance, with written notice stating the Contractor’s 

intent not to perform the service called for and the reasons. Up on receiving this notice, the 

Government may acquire the supplies or services from another source.

(End of clause) 

FAR 52.216-21 Requirements. (Oct 1995)

(a) This is a requirements contract for the supplies or services specified, and effective for the period 

stated, in the Schedule. The quantities of supplies or services specified in the Schedule are estimates 

only and are not purchased by this contract. Except as this contract may otherwise provide, if the 

Government’s requirements do not result in orders in the quantities described as “estimated’’ or 

“maximum” in the Schedule, that fact shall not constitute the basis for an equitable price adjustment.

(b) Delivery or performance shall be made only as authorized by orders issued in accordance with the 

Ordering clause. Subject to any limitations in the Order Limitations clause or elsewhere in this 

contract, the Contractor shall furnish to the Government all supplies or services specified in the 
8

Schedule and called for by orders issued in accordance with the Ordering clause. The Government 

may issue orders requiring delivery to multiple destinations or performance at multiple locations.

(c) Except as this contract otherwise provides, the Government shall order from the Contractor all the 

supplies or services specified in the Schedule that are required to be purchased by the Government 

activity or activities specified in the Schedule.

(d) The Government is not required to purchase from the Contractor requirements in excess of any 

limit on total orders under this contract.

(e) If the Government urgently requires delivery of any quantity of an item before the earliest date that 

delivery may be specified under this contract, and if the Contractor will not accept an order providing 

for the accelerated delivery, the Government may acquire the urgently required goods or services from 

another source.

(f) Any order issued during the effective period of this contract and not completed within that period 

shall be completed by the Contractor within the time specified in the order. The contract shall govern 

the Contractor’s and Government’s rights and obligations with respect to that order to the same extent 

as if the order were completed during the contract’s effective period; provided, that the Contractor 

shall not be required to make any deliveries under this contract after sixty (60) days after the through 

date in clause 452.211-74.

(End of Clause)

AGAR 452.216-73 Minimum and Maximum Contract Amounts (Feb 1988)

During the period specified in FAR clause 52.216-18, ORDERING, the Government shall place orders 

totaling a minimum of not applicable, but not in excess of 5,000,000 metric tons.

(End of clause)

FAR 52.217-8 Option to Extend Services. (Nov 1999)

The Government may require continued performance of any services within the limits and at the rates 

specified in the contract. These rates may be adjusted only as a result of revisions to prevailing labor 

rates provided by the Secretary of Labor. The option provision may be exercised more than once, but 

the total extension of performance hereunder shall not exceed 6 months. The Contracting Officer may 

exercise the option by written notice to the Contractor within sixty (60) days prior to contract 

expiration date.

(End of clause)

FAR 52.217-9 Option to Extend the Term of the Contract (Mar 2000)

(a) The Government may extend the term of this contract by written notice to the Contractor within 

thirty (30) days of contract expiration; provided that the Government gives the Contractor a preliminary 

written notice of its intent to extend at least sixty (60) days before the contract expires. The preliminary 

notice does not commit the Government to an extension.

(b) If the Government exercises this option, the extended contract shall be considered to include this 

option clause.

(c)The total duration of this contract, including the exercise of any options under this clause, shall not 

exceed two (2) years.

(End of clause)

FAR 52.232-18 Availability of Funds (Apr 1984)

Funds are not presently available for this contract. The Government’s obligation under this contract is 

contingent upon the availability of appropriated funds from which payment for contract purposes can 

be made. No legal liability on the part of the Government for any payment may arise until funds are 

made available to the Contracting Officer for this contract and until the Contractor receives notice of 

such availability, to be confirmed in writing by the Contracting Officer.

(End of Clause)
9

FAR 52.232-19 Availability of Funds for the Next Fiscal Year (Apr 1984)

Funds are not presently available for performance under this contract beyond September 30, 2014. The 

Government’s obligation for performance of this contract beyond that date is contingent upon the 

availability of appropriated funds from which payment for contract purposes can be made. No legal 

liability on the part of the Government for any payment may arise for performance under this contract 

beyond September 30, 2014, until funds are made available to the Contracting Officer for performance 

and until the Contractor receives notice of availability, to be confirmed in writing by the Contracting 

Officer.

(End of clause)

AGAR 452.246-70 Inspection and Acceptance (Feb 1988)

(a) The Contracting Officer or the Contracting Officer's duly authorized representative will 

inspect and accept the supplies and/or services to be provided under this contract.

(b) Inspection and acceptance will be performed at: United States Department of Agriculture, 

Deputy Administrator for Commodity Operations, 6501 Beacon Drive, Kansas City, Missouri, 

64133-4676.

(End of clause)

FAR 52.247-5 Familiarization with Conditions (Apr 1984)

The offeror shall become familiar with all available information regarding difficulties that may be 

encountered and the conditions, including safety precautions, under which the work must be 

accomplished under the contract. The offeror shall not be relieved from assuming all responsibility for 

properly estimating the difficulties and the cost of performing the services required in this contract 

because the offeror failed to investigate the conditions or to become acquainted with all information 

concerning the services to be performed.

(End of clause)

FAR 52.252-2 Clauses Incorporated by Reference (Feb 1998)

This contract incorporates one or more clauses by reference, with the same force and effect as if they 

were given full text. Upon request, the Contracting Officer will make their full text available. Also, 

the full text of a clause may be accessed electronically at this/these address(es): 

https://www.acquisition.gov/far/

http://www.usda.gov/procurement/policy/agar.html

(End of clause)

B. FAR 52.212-5 Contract Terms and Conditions Required to Implement Statutes or Executive 

Orders—Commercial Items (Jan 2014)

(a) The Contractor shall comply with the following Federal Acquisition Regulation (FAR) clauses, which are 

incorporated in this contract by reference, to implement provisions of law or Executive orders applicable to 

acquisitions of commercial items:

(1) 52.222-50, Combating Trafficking in Persons (FEB 2009) (22 U.S.C. 7104(g)).

____ Alternate I (AUG 2007) of 52.222-50 (22 U.S.C. 7104(g)).

(2) 52.233-3, Protest After Award (AUG 1996) (31 U.S.C. 3553).

(3) 52.233-4, Applicable Law for Breach of Contract Claim (OCT 2004) (Pub. L. 108-77, 108-78).

(b) The Contractor shall comply with the FAR clauses in this paragraph (b) that the contracting officer has 

indicated as being incorporated in this contract by reference to implement provisions of law or Executive 

orders applicable to acquisitions of commercial items:

[Contracting Officer check as appropriate.]

_X_ (1) 52.203-6, Restrictions on Subcontractor Sales to the Government (Sept 2006), with Alternate I 

(Oct 1995) (41 U.S.C. 253g and 10 U.S.C. 2402).

___ (2) 52.203-13, Contractor Code of Business Ethics and Conduct (Apr 2010) (Pub. L. 110-252, 

Title VI, Chapter 1 (41 U.S.C. 251 note)).

___ (3) 52.203-15, Whistleblower Protections under the American Recovery and Reinvestment Act of 

2009 (Jun 2010) (Section 1553 of Pub L. 111-5) (Applies to contracts funded by the American 

Recovery and Reinvestment Act of 2009).
10

___ (4) 52.204-10, Reporting Executive compensation and First-Tier Subcontract Awards (Jul 2013) 

(Pub. L. 109-282) (31 U.S.C. 6101 note).

___ (5) 52.204-11, American Recovery and Reinvestment Act—Reporting Requirements (Jul 2010) 

(Pub. L. 111-5).

___ (6) 52.209-6, Protecting the Government’s Interest When Subcontracting with Contractors 

Debarred, Suspended, or Proposed for Debarment (Aug 2013) (31 U.S.C. 6101 note). 

___ (7) 52.209-9, Updates of Publicly Available Information Regarding Responsibility Matters (Jul 

2013) (41 U.S.C. 2313).

___ (8) 52.209-10, Prohibition on Contracting with Inverted Domestic Corporations (May 2012) 

(section 738 of Division C of Public Law 112-74, section 740 of Division C of Pub. L. 111-117, 

section 743 of Division D of Pub. L. 111-8, and section 745 of Division D of Pub. L. 110-161).

___ (9) 52.219-3, Notice of HUBZone Set-Aside or Sole-Source Award (Nov 2011) (15 U.S.C. 657a).

___ (10) 52.219-4, Notice of Price Evaluation Preference for HUBZone Small Business Concerns (Jan 

2011) (if the offeror elects to waive the preference, it shall so indicate in its offer)(15 U.S.C. 657a).

___ (11) [Reserved]

___ (12) (i) 52.219-6, Notice of Total Small Business Aside (Nov 2011) (15 U.S.C. 644).

___ (ii) Alternate I (Nov 2011).

___ (iii) Alternate II (Nov 2011).

___ (13) (i) 52.219-7, Notice of Partial Small Business Set-Aside (June 2003) (15 U.S.C. 644).

___ (ii) Alternate I (Oct 1995) of 52.219-7.

___ (iii) Alternate II (Mar 2004) of 52.219-7.

___ (14) 52.219-8, Utilization of Small Business Concerns (Jul 2013) (15 U.S.C. 637(d)(2) and (3)).

___ (15) (i) 52.219-9, Small Business Subcontracting Plan (Jul 2013) (15 U.S.C. 637 (d)(4)).

___ (ii) Alternate I (Oct 2001) of 52.219-9.

___ (iii) Alternate II (Oct 2001) of 52.219-9.

___ (iv) Alternate III (July 2010) of 52.219-9.

___ (16) 52.219-13, Notice of Set-Aside of Orders (Nov 2011) (15 U.S.C. 644(r)).

___ (17) 52.219-14, Limitations on Subcontracting (Nov 2011) (15 U.S.C. 637(a)(14)).

___ (18) 52.219-16, Liquidated Damages—Subcontracting Plan (Jan 1999) (15 U.S.C. 

637(d)(4)(F)(i)).

___ (19) (i) 52.219-23, Notice of Price Evaluation Adjustment for Small Disadvantaged Business 

Concerns (Oct 2008) (10 U.S.C. 2323) (if the offeror elects to waive the adjustment, it shall so indicate 

in its offer).

___ (ii) Alternate I (June 2003) of 52.219-23.

___ (20) 52.219-25, Small Disadvantaged Business Participation Program—Disadvantaged Status and 

Reporting (Jul 2013) (Pub. L. 103-355, section 7102, and 10 U.S.C. 2323).

___ (21) 52.219-26, Small Disadvantaged Business Participation Program—Incentive Subcontracting 

(Oct 2000) (Pub. L. 103-355, section 7102, and 10 U.S.C. 2323).

___ (22) 52.219-27, Notice of Service-Disabled Veteran-Owned Small Business Set-Aside (Nov 2011) 

(15 U.S.C. 657f).

___ (23) 52.219-28, Post Award Small Business Program Rerepresentation (Jul 2013) (15 U.S.C. 

632(a)(2)).

___ (24) 52.219-29, Notice of Set-Aside for Economically Disadvantaged Women-Owned Small 

Business (EDWOSB) Concerns (Jul 2013) (15 U.S.C. 637(m)).

___ (25) 52.219-30, Notice of Set-Aside for Women-Owned Small Business (WOSB) Concerns 

Eligible Under the WOSB Program (Jul 2013) (15 U.S.C. 637(m)).

___ (26) 52.222-3, Convict Labor (June 2003) (E.O. 11755).

___ (27) 52.222-19, Child Labor—Cooperation with Authorities and Remedies (Jan 2014) (E.O. 

13126).

___ (28) 52.222-21, Prohibition of Segregated Facilities (Feb 1999).

___ (29) 52.222-26, Equal Opportunity (Mar 2007) (E.O. 11246).

___ (30) 52.222-35, Equal Opportunity for Veterans (Sep 2010) (38 U.S.C. 4212).

___ (31) 52.222-36, Affirmative Action for Workers with Disabilities (Oct 2010) (29 U.S.C. 793).

___ (32) 52.222-37, Employment Reports on Veterans (Sep 2010) (38 U.S.C. 4212).

___ (33) 52.222-40, Notification of Employee Rights Under the National Labor Relations Act (Dec 

2010) (E.O. 13496).
11

___ (34) 52.222-54, Employment Eligibility Verification (Aug 2013). (Executive Order 12989). (Not 

applicable to the acquisition of commercially available off-the-shelf items or certain other types of 

commercial items as prescribed in 22.1803.)

___ (35) (i) 52.223-9, Estimate of Percentage of Recovered Material Content for EPA-Designated 

Items (May 2008) (42 U.S.C. 6962(c)(3)(A)(ii)). (Not applicable to the acquisition of commercially 

available off-the-shelf items.)

___ (ii) Alternate I (May 2008) of 52.223-9 (42 U.S.C. 6962(i)(2)(C)). (Not applicable to the 

acquisition of commercially available off-the-shelf items.)

___ (36) 52.223-15, Energy Efficiency in Energy-Consuming Products (Dec 2007) (42 U.S.C. 8259b).

___ (37) (i) 52.223-16, IEEE 1680 Standard for the Environmental Assessment of Personal Computer 

Products (Dec 2007) (E.O. 13423).

___ (ii) Alternate I (Dec 2007) of 52.223-16.

___ (38) 52.223-18, Encouraging Contractor Policies to Ban Text Messaging while Driving (Aug 

2011).

___ (39) 52.225-1, Buy American Act--Supplies (Feb 2009) (41 U.S.C. 10a-10d).

___ (40) (i) 52.225-3, Buy American Act--Free Trade Agreements--Israeli Trade Act (Nov 2012) (41 

U.S.C. chapter 83, 19 U.S.C. 3301 note, 19 U.S.C. 2112 note, 19 U.S.C. 3805 note, 19 U.S.C. 4001 

note, Pub. L. 103-182, Pub. L. 108-77, 108-78, 108-286, 108-302, 109-53, 109-169, 109-283, 110-138, 

112-41, 112-42, and 112-43).

___ (ii) Alternate I (Mar 2012) of 52.225-3.

___ (iii) Alternate II (Mar 2012) of 52.225-3.

___ (iv) Alternate III (Nov 2012) of 52.225-3.

___ (41) 52.225-5, Trade Agreements (Nov 2013) (19 U.S.C. 2501, et seq., 19 U.S.C. 3301 note).

_X_ (42) 52.225-13, Restrictions on Certain Foreign Purchases (Jun 2008) (E.O.’s, proclamations, and 

statutes administered by the Office of Foreign Assets Control of the Department of the Treasury).

___ (43) 52.225-26, Contractors Performing Private Security Functions Outside the United States (Jul 

2013) (Section 862, as amended, of the National Defense Authorization Act for Fiscal Year 2008; 10 

U.S.C. 2303 Note).

___ (44) 52.226-4, Notice of Disaster or Emergency Area Set-Aside (Nov 2007) (42 U.S.C. 5150).

___ (45) 52.226-5, Restrictions on Subcontracting Outside Disaster or Emergency Area (Nov 2007) 

(42 U.S.C. 5150).

___ (46) 52.232-29, Terms for Financing of Purchases of Commercial Items (Feb 2002) (41 U.S.C. 

255(f), 10 U.S.C. 2307(f)).

___ (47) 52.232-30, Installment Payments for Commercial Items (Oct 1995) (41 U.S.C. 255(f), 10 

U.S.C. 2307(f)).

_X_ (48) 52.232-33, Payment by Electronic Funds Transfer— System for Award Management (Jul 

2013) (31 U.S.C. 3332).

___ (49) 52.232-34, Payment by Electronic Funds Transfer—Other Than System for Award 

Management (Jul 2013) (31 U.S.C. 3332).

___ (50) 52.232-36, Payment by Third Party (Jul 2013) (31 U.S.C. 3332).

___ (51) 52.239-1, Privacy or Security Safeguards (Aug 1996) (5 U.S.C. 552a).

___ (52) (i) 52.247-64, Preference for Privately Owned U.S.-Flag Commercial Vessels (Feb 2006) (46 

U.S.C. Appx 1241(b) and 10 U.S.C. 2631).

___ (ii) Alternate I (Apr 2003) of 52.247-64.

(c) The Contractor shall comply with the FAR clauses in this paragraph (c), applicable to commercial services, 

that the Contracting Officer has indicated as being incorporated in this contract by reference to implement 

provisions of law or executive orders applicable to acquisitions of commercial items:

[Contracting Officer check as appropriate.]

___ (1) 52.222-41, Service Contract Act of 1965 (Nov 2007) (41 U.S.C. 351, et seq.).

___ (2) 52.222-42, Statement of Equivalent Rates for Federal Hires (May 1989) (29 U.S.C. 206 and 41 

U.S.C. 351, et seq.).

___ (3) 52.222-43, Fair Labor Standards Act and Service Contract Act -- Price Adjustment (Multiple 

Year and Option Contracts) (Sep 2009) (29 U.S.C.206 and 41 U.S.C. 351, et seq.).

___ (4) 52.222-44, Fair Labor Standards Act and Service Contract Act -- Price Adjustment (Sep 2009) 

(29 U.S.C. 206 and 41 U.S.C. 351, et seq.).
12

___ (5) 52.222-51, Exemption from Application of the Service Contract Act to Contracts for 

Maintenance, Calibration, or Repair of Certain Equipment--Requirements (Nov 2007) (41 U.S.C. 351, 

et seq.).

___ (6) 52.222-53, Exemption from Application of the Service Contract Act to Contracts for Certain 

Services--Requirements (Feb 2009) (41 U.S.C. 351, et seq.).

___ (7) 52.222-17, Nondisplacement of Qualified Workers (Jan 2013) (E.O. 13495).

___ (8) 52.226-6, Promoting Excess Food Donation to Nonprofit Organizations. (Mar 2009) (Pub. L. 

110-247).

___ (9) 52.237-11, Accepting and Dispensing of $1 Coin (Sep 2008) (31 U.S.C. 5112(p)(1)).

(d) Comptroller General Examination of Record The Contractor shall comply with the provisions of this

paragraph (d) if this contract was awarded using other than sealed bid, is in excess of the simplified acquisition 

threshold, and does not contain the clause at 52.215-2, Audit and Records -- Negotiation.

(1) The Comptroller General of the United States, or an authorized representative of the Comptroller 

General, shall have access to and right to examine any of the Contractor’s directly pertinent records 

involving transactions related to this contract.

(2) The Contractor shall make available at its offices at all reasonable times the records, materials, and 

other evidence for examination, audit, or reproduction, until 3 years after final payment under this 

contract or for any shorter period specified in FAR Subpart 4.7, Contractor Records Retention, of the 

other clauses of this contract. If this contract is completely or partially terminated, the records relating 

to the work terminated shall be made available for 3 years after any resulting final termination 

settlement. Records relating to appeals under the disputes clause or to litigation or the settlement of 

claims arising under or relating to this contract shall be made available until such appeals, litigation, or 

claims are finally resolved.

(3) As used in this clause, records include books, documents, accounting procedures and practices, and 

other data, regardless of type and regardless of form. This does not require the Contractor to create or 

maintain any record that the Contractor does not maintain in the ordinary course of business or 

pursuant to a provision of law.

(e) 

(1) Notwithstanding the requirements of the clauses in paragraphs (a), (b), (c) and (d) of this clause, 

the Contractor is not required to flow down any FAR clause, other than those in this paragraph (e)(1) 

in a subcontract for commercial items. Unless otherwise indicated below, the extent of the flow down 

shall be as required by the clause—

(i) 52.203-13, Contractor Code of Business Ethics and Conduct (Apr 2010) (Pub. L. 110-252, 

Title VI, Chapter 1 (41 U.S.C. 251 note)).

(ii) 52.219-8, Utilization of Small Business Concerns (Jul 2013) (15 U.S.C. 637(d)(2) and (3)), 

in all subcontracts that offer further subcontracting opportunities. If the subcontract (except 

subcontracts to small business concerns) exceeds $650,000 ($1.5 million for construction of 

any public facility), the subcontractor must include 52.219-8 in lower tier subcontracts that 

offer subcontracting opportunities.

(iii) 52.222-17, Nondisplacement of Qualified Workers (Jan 2013) (E.O. 13495). Flow down 

required in accordance with paragraph (1) of FAR clause 52.222-17.

(iv) 52.222-26, Equal Opportunity (Mar 2007) (E.O. 11246).

(v) 52.222-35, Equal Opportunity for Veterans (Sep 2010) (38 U.S.C. 4212).

(vi) 52.222-36, Affirmative Action for Workers with Disabilities (Oct 2010) (29 U.S.C. 793).

(vii) 52.222-40, Notification of Employee Rights Under the National Labor Relations Act 

(Dec 2010) (E.O. 13496). Flow down required in accordance with paragraph (f) of FAR clause 

52.222-40.

(viii) 52.222-41, Service Contract Act of 1965, (Nov 2007), (41 U.S.C. 351, et seq.)

(ix) 52.222-50, Combating Trafficking in Persons (Feb 2009) (22 U.S.C. 7104(g)).

___ Alternate I (Aug 2007) of 52.222-50 (22 U.S.C. 7104(g)).

(x) 52.222-51, Exemption from Application of the Service Contract Act to Contracts for 

Maintenance, Calibration, or Repair of Certain Equipment--Requirements (Nov 2007) (41 

U.S.C. 351, et seq.)

(xi) 52.222-53, Exemption from Application of the Service Contract Act to Contracts for 

Certain Services--Requirements (Feb 2009) (41 U.S.C. 351, et seq.)

(xii) 52.222-54, Employment Eligibility Verification (Aug 2013).
13

(xiii) 52.225-26, Contractors Performing Private Security Functions Outside the United States 

(Jul 2013) (Section 862, as amended, of the National Defense Authorization Act for Fiscal 

Year 2008; 10 U.S.C. 2302 Note).

(xiv) 52.226-6, Promoting Excess Food Donation to Nonprofit Organizations. (Mar 2009) 

(Pub. L. 110-247). Flow down required in accordance with paragraph (e) of FAR clause 

52.226-6.

(xv) 52.247-64, Preference for Privately-Owned U.S. Flag Commercial Vessels (Feb 2006) 

(46 U.S.C. Appx 1241(b) and 10 U.S.C. 2631). Flow down required in accordance with 

paragraph (d) of FAR clause 52.247-64.

(2) While not required, the contractor may include in its subcontracts for commercial items a minimal 

number of additional clauses necessary to satisfy its contractual obligations.

(End of Clause)

IV. Contract Documents and Attachments

A. Statement of Work

1. Background 

To address risks inherent with shipping U.S. food aid to overseas destinations, the Government 

is seeking to hire a marine cargo survey company to attend, witness, and examine food cargoes, 

document the count and condition of these food aid shipments and activities related to 

disposition, and provide a written report. In general, we are seeking an experienced survey firm 

with a proven performance record conducting like work.

2. Government Contact Information

Upon contract award the Contractor will be advised of the individual serving as the COTR for 

the contract and the individual serving as COTR for report and invoice submission, including 

applicable phone numbers and E-mail addresses.

3. Availability and Notification

The Contractor shall be available on 48 hour notice of the shipments. Attendance may be 

required simultaneously at numerous locations.

4. Task Orders

a. The Government intends to issue task orders electronically pursuant to 4.b. below; however, 

it reserves the right to issue task orders orally, by email, or by facsimile, if necessary.

b. Once the cargo has lifted, the COTR shall provide the Contractor a task order which will 

include information detailing the cargo to be surveyed with identifying information, the 

vessel on which it is shipped, the destination(s) with estimated arrival date, attendance 

location(s), and contact information. The instructions on the task order will identify the 

shipment terms (ie: port-to-port or through bill of lading) to define the prices used.

c. The task order will be issued to the survey contract holder on the basis of where the survey 

work ends. Shipments for which title transfers at the discharge port will be awarded on the 

discharge port country survey contract, if one exists. Those shipments considered by USDA 

to be on a through bill of lading requiring attendance at both the discharge port and inland 

location(s) will be awarded on the survey country contract of the inland location.

5. Conveyances

Bulk cargoes will be typically shipped in bulk and tanker vessels; packaged cargoes in bulk or 

breakbulk vessels, lash barges, or in containers. Cargoes will be shipped port-to-port or on 

through bills of lading where the cargoes are transported to inland locations. 

6. Products

The products subject to marine cargo discharge/delivery survey service include dry staple foods 

such as rice, peas, beans, and lentils; dry blended foods such as wheat-soy blend and corn-soy 
14

blend; and vegetable oil. This food aid is packaged in polypropylene or paper bags ranging in 

size from 20 pounds to 50 kilograms, cardboard cartons containing consumer-pack quantities, 

liquid 20 liter pails, 6/4 liter containers, and 208 liter drums. Bulk grain and oil cargoes may be 

shipped such as wheat, corn, soybeans, soybean meal and vegetable oil.

7. Communications

The Contractor shall provide timely replies to inquiries, within seven (7) working days.

B. Scope of Work

1. The surveyor is required to attend at the discharge and delivery of all food aid cargoes covered by 

the contract. These locations include: 

o the discharge port 

o the delivery location(s), as applicable

o for containerized shipments, at any customs locations outside of port areas where the 

containers are to be opened.

2. The Government intends to award an indefinite delivery requirements contract to one 

company for all food aid cargoes destined for Mauritania. There is approximately 2,750

metric tons of commodities tentatively scheduled for discharge in Nouakchott, Mauritania

beginning the end of June 2014, as detailed under Section I.10 Schedule of Services. Any 

future shipments for Mauritania scheduled during the effective period of this contract (see 

Section A.2) will be included in this contract. Generally speaking, commodities will typically 

be containerized, and the discharge port most likely will be Nouakchott. Attendance may be 

required at various inland locations within Mauritania. Please include any geographic 

limitations in your proposal. 

C. Required Services

The Contractor shall provide all management, supervision, and personnel to provide the following 

under the contract:

1. A single point of contact, including phone number and e-mail, for all matters under the 

contract(s).

2. A cargo survey by qualified, experienced surveyors at vessel discharge and, if any, the 

port customs station, as well as at the ultimate destination(s) for through bills-of-lading 

shipments.

3. For bulk shipments, at our instruction, a draft survey may be required in place of, or in 

addition to, a discharge survey.

4. For bulk shipments which require bagging, additional survey reporting will be required 

which specifies losses and damages resulting from the bagging operation, as well as 

survey reporting at the ultimate destination(s) for through bill-of-lading shipments.

5. For any containerized cargoes, a survey at discharge and at customs locations between 

discharge port and at final destination where containers are opened. Also, survey 

reporting will be required at the ultimate destination(s) for through bill-of-lading 

shipments.

6. Documentation and evidence of:

a. The quantity of cargo discharged/delivered.

b. Condition of container seals at discharge/customs/delivery. If broken or additional 

seals applied, must state where new seals were applied and report both the original 

seal numbers and new seal numbers.

c. Quantity of cargo removed by customs.

d. The condition of cargo discharged/delivered, including a complete description of the 

type and severity of the damage, and give probable cause of damage.

e. If containerized, the number and condition of containers discharged/delivered.

7. In the event of major loss, the Contracting Officer or COTR is notified immediately.
15

8. Evidence that written notice of loss was presented to carrier/carrier's representative 

within three days of discharge/delivery.

9. Observe, and provide documentation and evidence for the disposition of any damaged 

(including reconstituted) cargo.

10. The names, titles, and organizational affiliations of those present at discharge/customs 

inspection/delivery/destruction.

11. In the event of damaged cargo, obtain photographs and a representative sample and, 

subject to separate authorization by the Contracting Officer or COTR, provide timely 

documentation of the analysis of suspected unfit cargo by an independent third party lab, 

if local health official is not available.

12. Certifications signed by third parties (vessel personnel, NGO and PVO representatives, 

and custom representatives) establishing attendance by the Contractor at each location 

attended.

13. Submission of the preliminary form KC-334 upon completion of discharge/delivery and 

submission of the final form KC-334 with the survey report.

D. Deliverables

1. The Contractor shall interact with DACO, the applicable vessel agent, and NGO/PVO in order 

to coordinate on-time attendance and the service to be provided.

2. The Contractor shall attend and observe at the locations stipulated in this RFP.

3. The Contractor shall provide a separate, written survey report and supporting documentation, 

in English or with translation, for each originating vessel's cargo and destination with 

sufficient detail and documentation so as to fix responsibility for losses occurring while cargo 

is under the care, custody, and control of the steamship company transporting the cargo. The 

report may be electronic or hard copy. A copy of the report should be sent to the receiver.

4. The completed report shall be submitted within 60 days of completion of discharge/delivery. 

If submission of the report cannot be made within 60 days, a request for extension must be 

made to the contracting officer by e-mail prior to the 60 day deadline, with justification for the 

delay and an estimated date of submission. If reconstitution is not expected to be completed 

within approximately two weeks, the report should still be submitted, with reconstitution 

documentation to follow upon completion of the process.

5. The Contractor shall provide timely replies to inquiries, within seven (7) working days.

6. Additional information related to deliverables to be provided under the contract:

PERFORMANCE 

STANDARD

ACCEPTABLE 

QUALITY LEVEL

MONITORING 

METHOD

1. For containerized shipments, the 

following factors must be elements 

of a written report:

- the quantity of cargo discharged/

delivered

- the condition of cargo 

discharged/delivered, including a 

complete description of the type 

and severity of the damage, and 

give probable cause of damage.

- check vessel holds before and 

after discharge

- list container numbers and seal 

numbers at time of discharge/

customs/delivery

- personally observe discharge/

delivery and comment on 

container conditions and note 

Report is sufficient to 

support the USDA claims 

recovery process.

USDA review of all 

Contractor’s reports.
16

PERFORMANCE 

STANDARD

ACCEPTABLE 

QUALITY LEVEL

MONITORING 

METHOD

container defects, if any

- signed, legible, accurate original 

stroke tallies 

- attendance and reporting on 

accessing containers at customs 

locations

- report of infestation, if any

- photographs of any broken seals 

on the containers

2. For breakbulk shipments, the 

following factors must be elements 

of a written report:

- the quantity of cargo discharged/

delivered

- the condition of cargo 

discharged/delivered, including a 

complete description of the type 

and severity of the damage, and 

give probable cause of damage.

- check vessel holds before and 

after discharge

- personally observe discharge/ 

delivery

- signed, legible, accurate original 

stroke tallies 

- for TBL shipments, attendance 

and reporting on loading of land 

conveyance.

- report of infestation, if any

Report is sufficient to 

support the USDA claims 

recovery process.

USDA review of all 

Contractor’s reports.

3. For bulk shipments, the 

following factors must be elements 

of a written report:

- the quantity of cargo discharged/

delivered

- the condition of cargo 

discharged/delivered, including 

a complete description of the 

type and severity of the damage, 

and give probable cause of 

damage.

- check vessel holds before and 

after discharge

- conduct draft surveys to 

establish quantity on free-out 

shipments, at lightering 

operations and at ports where 

scales not available

- personally observe and describe 

in detail the discharge/delivery 

process

- scale information including 

Report is sufficient to 

support the USDA claims 

recovery process.

USDA review of all 

Contractor’s reports.
17

PERFORMANCE 

STANDARD

ACCEPTABLE 

QUALITY LEVEL

MONITORING 

METHOD

scale location, scale type, date of 

last calibration, and other factors 

affecting scale weight accuracy

- for TBL shipments, attendance 

and reporting on loading of land 

conveyance

- for liquid cargoes and tallow, 

condition of pumping equipment 

and shore tanks/tank trucks

- provide the actual (or estimated, 

if actual not available) weight 

loss of any shortage, or damaged 

cargo and the type and severity 

of damage

- if bulk cargo is being bagged, 

observe bagging operation and 

report the quantity bagged; 

document the total bag count 

and weight and the method of 

such determination; forward 

original stroke tallies with the 

survey report to document the 

quantity of cargo bagged and 

stacked.

4.A. In the event of major loss, the 

Contracting Officer or COTR is 

notified immediately.

100 percent compliance USDA review of all 

Contractor’s reports.

4.B. Evidence that written notice of 

loss was presented to carrier/

carrier's representative within three 

days of discharge/delivery.

100 percent compliance 

when there are losses 

suffered, if no mitigating 

circumstances. 

Determination of 

mitigation is at the 

discretion of the 

Government.

USDA review of all 

Contractor’s reports.

4.C. Observe, and provide 

documentation and evidence for the 

disposition of any damaged cargo. 

- Document reconstitution efforts 

and results

- Obtain health officer's certificate 

for cargoes suspected to be unfit

- Provide disposal or destruction 

documentation

- The names of those present at 

discharge/customs inspection/

delivery/destruction, including 

names, titles, and organizational 

affiliations.

100 percent compliance 

for observation, if no 

mitigating circumstances. 

Determination of 

mitigation is at the 

discretion of the 

Government.

USDA review of all 

Contractor’s reports.

4.D. In the event of damaged and/or 

out of condition cargo, take 

photographs and samples and, 

100 percent compliance 

when local health official 

is not immediately 

USDA review of all 

Contractor’s reports.
18

PERFORMANCE 

STANDARD

ACCEPTABLE 

QUALITY LEVEL

MONITORING 

METHOD

subject to separate authorization by 

the Contracting Officer, provide 

timely analysis of suspected unfit 

cargo by an independent third party 

lab, if local health official is not 

available.

available, contractor must 

take representative 

samples at the time 

damage is discovered, or 

commodity is suspected 

to be unfit.

Submit samples for testing 

within one week of 

authorization:

- 100 percent compliance 

when major damage 

(damage that in the 

estimation of the 

surveyor exceeds USD 

$20,000) is present

- 75 percent compliance 

when value of the loss 

is minor

5. Certifications signed by third 

parties (vessel personnel, NGO/ 

PVO representatives, customs 

representatives) establishing 

attendance by the Contractor at 

each location attended.

100 percent compliance, 

if no mitigating 

circumstances. 

Determination of 

mitigation is at the 

discretion of the 

Government.

USDA review of all 

Contractor’s reports.

E. Applicable Documents

The following legal/regulatory documents may be relevant to this acquisition:

 United States Carriage of Goods by Sea Act (COGSA);

 The Harter Act;

 22 CFR 211—Transfer of Food Commodities for Food Use in Disaster Relief, 

Economic Development and Other Assistance;

 7 CFR 1499—Foreign Donation Programs, Liability For Loss, Damage, Or Improper 

Distribution Of Commodities--Claims And Procedures;

F. Exhibits

The forms included as Exhibits on the following pages shall be used by the contractor in performance 

of its work under this contract.
19

F.1. Attachment KC-337EPA RATE SCHEDULE

See reverse side for Privacy Act, Public Burden and Nondiscrimination Statements.

KC-337EPA U.S. DEPARTMENT OF AGRICULTURE

(01-01-2014) Farm Service Agency

Rate Schedule

Country/Region: Base Year / Option Year 1 / 2 / 3 / 4 (Circle, as appropriate)

DISCHARGE SURVEYS

Metric Tons (MT)

(Rates are per net MT except for Min. Fee)

Type of Cargo Up to 999 MT Min. Fee* 1,000 - 5,000 MT 5,001 - 10,000 MT 10,001 MT and above

Bulk-No bagging

Bulk-Including Bagging

Breakbulk

DRAFT SURVEYS

(Cost is separate from your base rates)

Rate for each draft survey: 

CUSTOMS LOCATIONS 

(Cost shall be expressed per workday)

Rate per workday: 

THROUGH BILL OF LADING SURVEYS

(Rates must include cost to perform surveys at both the discharge and delivery locations.) 

Metric Tons (MT)

(Rates are per net MT except for Min. Fee)

Type of Cargo Up to 999 MT Min. Fee* 1,000 - 5,000 MT 5,001 - 10,000 MT 10,001 MT and above

Bulk-No bagging

Bulk-Including Bagging

Breakbulk

CONTAINERIZED SHIPMENT SURVEYS

(Rates for shipments delivered inland must cover surveys conducted at both the discharge and delivery locations.)

 Number of Containers

 (Rates are per container except for Min. Fee)

Min. Fee* Min. 10 Max. 25 Min. 26 Max. 50 51 and above

No Devanning 1

Devan at Port 2

Devan at Inland Delivery Location 3

Devan at Port + Breakbulk Inland Delivery Location 4

* Minimum fee applies only to shipments of less than 1,000 MT or shipments of less than 10 containers.

Rate schedule must be stated in U.S. currency ($0.00)

I certify that this firm has the expertise necessary to perform the survey services required by Commodity Credit Corporation in this country/region. I further 

certify that this rate schedule is my bid to perform survey services in this country/region for a period of one year from the date the contract is awarded to this 

firm and that such rate schedule is all-inclusive and will not change during the period under which the contract is effective.

Signature: ________________________________________________ Title: ____________________________________________

Firm Name: ________________________________________________ E-Mail: ____________________________________________

 

1 Containers are not devanned OR surveyor not a witness to devanning. Container and seal check only. Attendance at port.

2 Containers are devanned at port (within 25 km radius). Attendance at port.

3 Containers are transported inland where devanning occurs. Attendance at port and inland delivery location.

4 Containers are devanned at port, cargo loaded onto conveyance to inland destination for breakbulk survey. Attendance at port and inland delivery location.
20

KC—337EPA (REVERSE)

ECONOMIC PRICE ADJUSTMENT for TRAVEL COSTS (Only complete the fields below if travel costs are not already covered in the 

fixed rates in the table above. For example, there is no contractor staff on location and travel costs cannot be calculated with 

sufficient certainty to include in the fixed price(s) above. Travel costs include transportation costs, accommodations, or other 

incidental charges. Rates reported below should be those NOT incorporated into the fixed rates identified above.)

Additional Expenses - Please be specific.

1. Travel Costs (Receipts will be required with invoice for actual cost reimbursement). Please be specific. 

Transportation Type_____________________________________ Estimated Cost per Person: __________________(USD)

Transportation Type _____________________________________ Estimated Cost per Person: __________________(USD)

Transportation Type _____________________________________ Estimated Cost per Person: __________________(USD)

When applicable (Example: All task orders under this contract, only surveys on Through Bills of Lading, etc): 

________________________________________________________________________________________________________

2. Per Diem/Daily Fees (per Person).

Lodging/Meals: ______________________________________________________________________________________________________

Number of free days allowed before these charges are applied: ____________________________________________________

When applicable: 

________________________________________________________________________________________________________

3. Other Fees (per Person).

Description: ______________________________________________________________________________________________________

Number of free days allowed before these charges are applied: ____________________________________________________

See FAR 52.216-4 Economic Price Adjustment - Labor and Material clause for more information on 

Economic Price Adjustments.

PRIVACY ACT AND PUBLIC BURDEN STATEMENTS

The following statements are made in accordance with the Privacy Act of 1974 (5 USC 552a) and the Paperwork Reduction Act of 1995, as amended. The 

authority for requesting the following information is 7 CFR 1400, Subchapter C. The information will be used to evaluate bids to purchase commodities and 

provide services. Furnishing the requested information is voluntary; however, failure to furnish the requested information will result in nonconsideration. This 

information may be provided to other agencies, IRS, Department of Justice, or other State and Federal law enforcement agencies, and in response to a court 

magistrate or administrative tribunal. The provisions of criminal and civil fraud statutes, including 18 USC 286, 287, 371, 641, 651, 1001; 15 USC 714m; and 

31 USC 3729, may be applicable to the information provided.

Federal Agencies may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a currently valid OMB 

control number. Public reporting burden for this collection of information is estimated to average 30 minutes per response, including the time for reviewing 

instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send 

comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to Department of 

Agriculture, Clearance Officer, OIRM (OMB No. 0560-0177), Stop 7630, Washington, D.C. 20250-7630.

NONDISCRIMINATION STATEMENT

The U.S. Department of Agriculture (USDA) prohibits discrimination in all its programs and activities on the basis of race, color, national origin, gender, religion, 

age, disability, political beliefs, sexual orientation, and marital or family status. (Not all prohibited bases apply to all programs.) Persons with disabilities who 

require alternative means for communication of program information (Braille, large print, audiotape, etc.) should contact USDA’s TARGET Center at (202) 720-

2600 (voice and TDD).

To file a complaint of discrimination, write USDA, Director, Office of Civil Rights, Room 326-W, Whitten Building, 1400 Independence Avenue, SW, Washington, 

D.C. 20250-9410 or call (202) 720-5964 (voice or TDD). USDA is an equal opportunity provider and employer.
21

F.2. Attachment KC-334 DISCHARGE/DELIVERY SURVEY SUMMARY
22

KC-334 (REVERSE)

PRIVACY ACT AND PUBLIC BURDEN STATEMENTS

The following statements are made in accordance with the Privacy Act of 1974 (5 USC 552a) and the Paperwork 

Reduction Act of 1995, as amended. The authority for requesting the following information is 7 CFR 1400, 

Subchapter C. The information will be used to evaluate bids to purchase commodities and provide services. 

Furnishing the requested information is voluntary; however, failure to furnish the requested information will result in 

nonconsideration. This information may be provided to other agencies, IRS, Department of Justice, or other State 

and Federal law enforcement agencies, and in response to a court magistrate or administrative tribunal. The 

provisions of criminal and civil fraud statutes, including 18 USC 286, 287, 371, 641, 651, 1001; 15 USC 714m; and 

31 USC 3729, may be applicable to the information provided.

Federal Agencies may not conduct or sponsor, and a person is not required to respond to, a collection of information 

unless it displays a currently valid OMB control number. Public reporting burden for this collection of information is 

estimated to average 30 minutes per response, including the time for reviewing instructions, searching existing data 

sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. 

Send comments regarding this burden estimate or any other aspect of this collection of information, including 

suggestions for reducing this burden, to Department of Agriculture, Clearance Officer, OIRM (OMB No. 0560-0177), 

Stop 7630, Washington, D.C. 20250-7630.

NONDISCRIMINATION STATEMENT

The U.S. Department of Agriculture (USDA) prohibits discrimination in all its programs and activities on the basis of 

race, color, national origin, gender, religion, age, disability, political beliefs, sexual orientation, and marital or family 

status. (Not all prohibited bases apply to all programs.) Persons with disabilities who require alternative means for 

communication of program information (Braille, large print, audiotape, etc.) should contact USDA=s TARGET Center 

at (202) 720-2600 (voice and TDD).

To file a complaint of discrimination, write USDA, Director, Office of Civil Rights, Room 326-W, Whitten Building, 

1400 Independence Avenue, SW, Washington, D.C. 20250-9410 or call (202) 720-5964 (voice or TDD). USDA is 

an equal opportunity provider and employer.
23

V. Solicitation Provisions

A. FAR 52.212-1 Instructions to Offerors—Commercial Items (Apr 2014) 

A.1. Addenda to FAR 52.212-1

1. Addendum to paragraph (b) Submission of offers.

Submission of offers is revised to remove “Offers may be submitted on the SF 1449.” The SF 

1449 is not being used for this streamlined solicitation. Offerors should submit their signed and 

dated offers using company letterhead.

Paragraph (b) is further amended to update items (1) through (11), outlining required components 

of the offer. As a minimum, the following replacement items must be included in the offeror’s 

proposal package –

(1) The offer must be submitted on company letterhead and identify the 

company name, address, and telephone number, as well as the e-mail address 

of the person submitting the offer for contact purposes.

(2) It must identify both the solicitation number and the country.

(3) All technical factors outlined in Section V.B. FAR 52.212-2 EvaluationCommercial Items, below, shall be addressed in sufficient detail to evaluate 

compliance with the requirements in the solicitation.

(4) A completed Form KC-337EPA Rate Schedule, dated 01-01-2014 as found in Section 

IV.F. Exhibits of the solicitation, must be included. An offeror may bid on the base 

year and as many option years as desired by circling the appropriate number. 

Separate rate sheets may be submitted if the prices vary by option year, as long as the 

years the prices are effective are clearly marked. Completion of the Reverse side 

(page 20) is optional.

(5) Any solicitation amendments must be acknowledged. 

(6) A statement must be submitted, certifying that the offeror has the capability to 

utilize standard digital photography to document any issues which might be 

raised.

(7) The offeror must submit a statement specifying the extent of agreement with all terms,

conditions, and provisions included in the solicitation. Offers that fail to furnish 

required representations or information, or reject the terms and conditions of the 

solicitation may be excluded from consideration.

(8) A completed copy of the representations and certifications at FAR 52.212-3 must be 

submitted. These can be submitted electronically in www.acquisition.gov OR by 

completing the pages found at the end of this solicitation in Section V.C. 

PLEASE NOTE: for survey work performed outside the US, only paragraphs 

(e), (h), (m), and (o) are applicable and need to be addressed.

Prior to the deadline stated in Section I, offer packages may be submitted electronically to: 

patsy.carleton@kcc.usda.gov and must be in a format compatible with Microsoft Office or 

Adobe Acrobat.

2. Addendum to paragraph (j) – Data Universal Numbering System (DUNS) Number.

Foreign firms are exempted from the requirement to obtain and provide a DUNS number with 

their offer.

3. Addendum to paragraph (k) –System for Award Management. By submission of an offer, the 

offeror acknowledges the requirement that a prospective awardee shall be registered in the SAM 

database within fifteen (15) days after contract award, or at least three (3) days prior to 

submission of the first invoice, whichever occurs first. Payments to awardees can only be made 

to vendors registered in SAM. Offerors may obtain information on registration and annual 

confirmation requirements via the SAM database accessed through https://www.acquisition.gov.

(End of addenda)
24

A.2. Additional Provisions

AGAR 452.219-70 Size Standard and NAICS Code Information (Sep 2001)

The North American Industrial Classification System Code(s) and business size standard(s) 

describing the products and/or services to be acquired under this solicitation are listed below:

- Contract line item(s): See Schedule of Services

- NAICS Code 488390

- Size Standard $35.5 million 

(End of provision)

4K52.242-01 Contractor Past Performance

The Government will prepare a past performance evaluation at the time the work under the contract is 

completed. In addition, interim evaluations may be conducted as to provide current information for 

source selection purposes, for contracts or orders with a period of performance, including options, 

exceeding one year. Evaluation will rate performance areas such as quality of product or service, cost 

control, timeliness of performance, and business relations. The evaluation will be entered into the 

Contractor Performance Assessment Reporting System (CPARS). Contractor will have an opportunity 

to comment on the Governments evaluation. Details on access and use of CPARS will be provided to 

the Contractor at a future date.

The past performance evaluation may be used by the Government to support future award decisions.

 (End of provision)

52.252-1 -- Solicitation Provisions Incorporated by Reference. (Feb 1998)

This solicitation incorporates one or more solicitation provisions by reference, with the same force and 

effect as if they were given in full text. Upon request, the Contracting Officer will make their full text 

available. The offeror is cautioned that the listed provisions may include blocks that must be completed 

by the offeror and submitted with its quotation or offer. In lieu of submitting the full text of those 

provisions, the offeror may identify the provision by paragraph identifier and provide the appropriate 

information with its quotation or offer. Also, the full text of a solicitation provision may be accessed 

electronically at this/these address(es):

https://www.acquisition.gov/far/

http://www.usda.gov/procurement/policy/agar.html

(End of Provision)

B. FAR 52.212-2 Evaluation-Commercial Items. (Jan 1999)

(a) The Government intends to award a contract resulting from this solicitation to the

responsible offeror whose offer conforming to the solicitation will be most advantageous to 

the Government, price and other factors considered. The following technical factors shall be

used to evaluate offers:

1. Staffing. The Government will evaluate proposals on the basis of a firm’s 

sufficient staffing to be deployed to cover all anticipated locations in the 

particular country. For Mauritania, please include any geographical

limitations in your proposal. If the survey work is to be performed by an 

affiliated company or subcontractor, the name of that company should be 

provided. 

2. Experience. This technical factor will be evaluated on the basis of the 

experience level of the surveyors performing the work in the pertinent country. 

Information on the key parties, including years of experience and type of work 

experience should be included. Experience of any management staff 

coordinating the operations should also be included in the proposal.
25

3. Sample Survey Report. One (1) sample survey report shall be submitted. The 

sample should be relevant for the type work being solicited. The Government will 

review the report for content, clarity of reporting, and accuracy of figures. It is 

recognized that a report performed for a third party will not necessarily contain all 

the components listed in the Deliverables and Required Service sections listed 

above, but should reflect an understanding of the key factors.

4. Past Performance. The Government shall evaluate proposals on the basis of customer 

satisfaction on past (within the last three years) or current Government or commercial 

contracts similar to this Government requirement. Offerors are allowed to submit 

information on a maximum of five contracts.

Offerors shall provide the following information in its proposal:

1. Contract number

2. Date of contract

3. Customer name

4. Point of contact (name and current phone number)

In rating an offeror's past performance, information in the offeror's proposal will be 

considered along with information obtained from other sources, such as USDA. The 

Government reserves the right to contact any and all references to assess the offeror’s 

performance and relative capability related to customer satisfaction, timeliness of 

performance, and commitment to customer satisfaction. If there is no information on past 

contract performance of an offeror or past contract performance is not available, the 

offeror will not be evaluated favorably or unfavorably on this factor, and past performance 

will be rated as neutral.

(b) The Government is concerned with obtaining the best value rather than making an award to the 

lowest cost or price in awarding this contract. Therefore, each of the above factors (Staffing, 

Experience, Sample Report, and Past Performance) will be given equal weight in the evaluation 

process, and all, when combined, are significantly more important than price.

(c) Option Years. The Government will evaluate offers for award purposes by adding the total price 

for the option year to the total price for the basic requirement, then dividing to obtain an average rate. 

The Government may determine that an offer is unacceptable if the option prices are significantly 

unbalanced. Evaluation of options shall not obligate the Government to exercise the option.

(d) The Government may reject any or all proposals, if such action is in the Government’s best interest, 

and may waive information and minor irregularities in proposals received. 

(e) A written notice of award or acceptance of an offer, mailed or otherwise furnished to the successful 

offeror within the time for acceptance specified in the offer, shall result in a binding contract without 

further action by either party. Before the offer’s specified expiration time, the Government may accept 

an offer (or part of an offer), whether or not there are negotiations after its receipt, unless a written 

notice of withdrawal is received before award.

(End of provision)

C. FAR 52.212-3 Offeror Representations and Certifications—Commercial Items (Nov 2013)

An offeror shall complete only paragraphs (b) of this provision if the offeror has completed the annual 

representations and certificates electronically via http://www.acquisition.gov . If an offeror has not completed 

the annual representations and certifications electronically at the System for Award Management (SAM) 

website, the offeror shall complete only paragraphs (c) through (o) of this provision.

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

“Economically disadvantaged women-owned small business (EDWOSB) concern” means a small business 

concern that is at least 51 percent directly and unconditionally owned by, and the management and daily 

business operations of which are controlled by, one or more women who are citizens of the United States and 
26

who are economically disadvantaged in accordance with 13 CFR part 127. It automatically qualifies as a 

women-owned small business eligible under the WOSB Program.

“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.

“Inverted domestic corporation,” as used in this section, means a foreign incorporated entity which is treated as 

an inverted domestic corporation under 6 U.S.C. 395(b), i.e., a corporation that used to be incorporated in the 

United States, or used to be a partnership in the United States, but now is incorporated in a foreign country, or is 

a subsidiary whose parent corporation is incorporated in a foreign country, that meets the criteria specified in 6 

U.S.C. 395(b), applied in accordance with the rules and definitions of 6 U.S.C. 395(c). An inverted domestic 

corporation as herein defined does not meet the definition of an inverted domestic corporation as defined by the 

Internal Revenue Code at 26 U.S.C. 7874.

“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 (as that term is defined in Section 2 of the Sudan 

Accountability and Divestment Act of 2007) 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.

Sensitive technology—

(1) Means hardware, software, telecommunications equipment, or any other technology that is to be 

used specifically—

(i) To restrict the free flow of unbiased information in Iran; or

(ii) To disrupt, monitor, or otherwise restrict speech of the people of Iran; and
27

(2) Does not include information or informational materials the export of which the President does not 

have the authority to regulate or prohibit pursuant to section 203(b)(3) of the International Emergency 

Economic Powers Act (50 U.S.C. 1702(b)(3)).

“Service-disabled veteran-owned small business concern”—

(1) Means a small business concern—

(i) Not less than 51 percent of which is owned by one or more service-disabled veterans or, in the 

case of any publicly owned business, not less than 51 percent of the stock of which is owned by 

one or more service-disabled veterans; and

(ii) The management and daily business operations of which are controlled by one or more 

service-disabled veterans or, in the case of a service-disabled veteran with permanent and severe 

disability, the spouse or permanent caregiver of such veteran.

(2) Service-disabled veteran means a veteran, as defined in 38 U.S.C. 101(2), with a disability that is 

service-connected, as defined in 38 U.S.C. 101(16).

“Small business concern” means a concern, including its affiliates, that is independently owned and operated, 

not dominant in the field of operation in which it is bidding on Government contracts, and qualified as a small 

business under the criteria in 13 CFR Part 121 and size standards in this solicitation.

“Subsidiary” means an entity in which more than 50 percent of the entity is owned—

(1) Directly by a parent corporation; or

(2) Through another subsidiary of a parent corporation.

“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 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 the 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

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

“Women-owned small business (WOSB) concern eligible under the WOSB Program (in accordance with 13 

CFR part 127),” means a small business concern that is at least 51 percent directly and unconditionally owned 

by, and the management and daily business operations of which are controlled by, one or more women who are 

citizens of the United States.

(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 

SAMwebsite.

(2) The offeror has completed the annual representations and certifications electronically via the SAM 

website accessed through https://www.acquisition.gov. After reviewing the SAM database information, 

the offeror verifies by submission of this offer that the representation 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), 

except for paragraphs ____________. [Offeror to identify the applicable paragraphs at (c) through (o) 

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 
28

this solicitation only, and do not result in an update to the representations and certifications posted 

electronically on SAM.]

(c) Offerors must complete the following representations when the resulting contract is to 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)(8) and (c)(9) only if this solicitation is expected to exceed the simplified 

acquisition threshold.

(6) WOSB concern eligible under the WOSB Program. [Complete only if the offeror represented itself 

as a women-owned small business concern in paragraph (c)(5) of this provision.] The offeror represents 

that—

(i) It [_] is, [_] is not a WOSB concern eligible under the WOSB Program, has provided all the 

required documents to the WOSB Repository, and no change in circumstances or adverse 

decisions have been issued that affects its eligibility; and

(ii) It [_] is, [_] is not a joint venture that complies with the requirements of 13 CFR part 127, 

and the representation in paragraph (c)(6)(i) of this provision is accurate for each WOSB concern 

eligible under the WOSB Program participating in the joint venture. [The offeror shall enter the 

name or names of the WOSB concern eligible under the WOSB Program and other small 

businesses that are participating in the joint venture: _________.] Each WOSB concern eligible 

under the WOSB Program participating in the joint venture shall submit a separate signed copy 

of the WOSB representation.

(7) Economically disadvantaged women-owned small business (EDWOSB) concern. [Complete only if 

the offeror represented itself as a WOSB concern eligible under the WOSB Program in (c)(6) of this 

provision.] The offeror represents that—

(i) It [_] is, [_] is not an EDWOSB concern, has provided all the required documents to the 

WOSB Repository, and no change in circumstances or adverse decisions have been issued that 

affects its eligibility; and

(ii) It [_] is, [_] is not a joint venture that complies with the requirements of 13 CFR part 127, 

and the representation in paragraph (c)(7)(i) of this provision is accurate for each EDWOSB 

concern participating in the joint venture. [The offeror shall enter the name or names of the 

EDWOSB concern and other small businesses that are participating in the joint venture: 

_____________.] Each EDWOSB concern participating in the joint venture shall submit a 

separate signed copy of the EDWOSB representation.

(8) 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 
29

paragraph (c)(1) of this provision.] The offeror represents that it [_] is, a women-owned business 

concern.

(9) 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:

___________________________________________

(10) [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 SAM Dynamic Small Business 

Search database maintained by the Small Business Administration , 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)(10)(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: ________________.]

(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 changes in ownership and control, principal 

office, or HUBZone employee percentage have occurred since it was certified in accordance with 

13 CFR part 126; and

(ii) It [_] is, [_] is not a HUBZone 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 each 

HUBZone small business concern participating in the HUBZone joint venture. [The offeror shall 

enter the names of each of the HUBZone small business concerns participating in the HUBZone 

joint venture: __________.] Each HUBZone small business concern participating in the 

HUBZone 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.
30

(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 $150,000.) 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, 

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 for other than COTS items, 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, i.e., an end product that is not a COTS item and does not meet the 

component test in paragraph (2) of the definition of “domestic end product.” The terms “commercially 

available off-the-shelf (COTS) item,” “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.

(g)

(1) Buy American Act -- Free Trade Agreements -- Israeli Trade Act Certificate. (Applies only if the 

clause at FAR 52.225-3, 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 for other than COTS items, the 

offeror has considered components of unknown origin to have been mined, produced, or 

manufactured outside the United States. The terms “Bahrainian, Moroccan, Omani, Panamanian, 

or Peruvian end product,” “commercially available off-the-shelf (COTS) item,” “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.”
31

(ii) The offeror certifies that the following supplies are Free Trade Agreement country end 

products (other than Bahrainian, Moroccan, Omani, Panamanian, or Peruvian 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, Moroccan, Omani, Panamanian, or 

Peruvian 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) or 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, i.e., an end product that is not a COTS item and does not meet the 

component test in paragraph (2) of the definition of “domestic end product.”

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—Free Trade Agreements—Israeli Trade Act Certificate, Alternate I. 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)(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 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:
32

[List as necessary]

(4) Buy American Act—Free Trade Agreements—Israeli Trade Act Certificate, Alternate III. If Alternate 

III to the clause at 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)(1)(ii) The offeror certifies that the following supplies are Free Trade Agreement 

country end products (other than Bahrainian, Korean, Moroccan, Omani, Panamanian, or 

Peruvian 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, Korean, Moroccan, Omani, Panamanian, 

or Peruvian End Products) or Israeli End Products:

Line Item No.: Country of Origin:

[List as necessary]

(5) 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)(5)(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. 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; and
33

(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 

appear 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(b).]

(1) Listed End Product

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.
34

[_] (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 is 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(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 (or subcontractor in the case of an 

exempt subcontract) 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(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(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(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
35

(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, 31 U.S.C. 7701). (Not applicable if the offeror is 

required to provide this information to the SAM 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), 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 ______________________________________

(m) Restricted business operations in Sudan. By submission of its offer, the offeror certifies that the offeror 

does not conduct any restricted business operations in Sudan.

(n) Prohibition on Contracting with Inverted Domestic Corporations—

(1) Relation to Internal Revenue Code. An inverted domestic corporation as herein defined does not 

meet the definition of an inverted domestic corporation as defined by the Internal Revenue Code 25 

U.S.C. 7874.

(2) Representation. By submission of its offer, the offeror represents that—

(i) It is not an inverted domestic corporation; and

(ii) It is not a subsidiary of an inverted domestic corporation.

(o) Prohibition on contracting with entities engaging in certain activities or transactions relating to Iran.

(1) The offeror shall email questions concerning sensitive technology to the Department of State at 

CISADA106@state.gov.

(2) Representation and Certification. Unless a waiver is granted or an exception applies as provided in 

paragraph (o)(3) of this provision, by submission of its offer, the offeror—
36

(i) Represents, to the best of its knowledge and belief, that the offeror does not export any 

sensitive technology to the government of Iran or any entities or individuals owned or controlled 

by, or acting on behalf or at the direction of, the government of Iran; 

(ii) Certifies that the offeror, or any person owned or controlled by the offeror, does not engage 

in any activities for which sanctions may be imposed under section 5 of the Iran Sanctions Act; 

and

(iii) Certifies that the offeror, and any person owned or controlled by the offeror, does not 

knowingly engage in any transaction that exceeds $3,000 with Iran’s Revolutionary Guard Corps 

or any of its officials, agents, or affiliates, the property and interests in property of which are 

blocked pursuant to the International Emergency Economic Powers Act (50(U.S.C. 1701 et seq.) 

(see OFAC’s Specially Designated Nationals and Blocked Persons List at 

http://www.treasury.gov/ofac/downloads/t11sdn.pdf).

(3) The representation and certification requirements of paragraph (o)(2) of this provision do not apply 

if—

(i) This solicitation includes a trade agreements certification (e.g., 52.212-3(g) or a comparable 

agency provision); and

(ii) The offeror has certified that all the offered products to be supplied are designated country 

end products.

(End of Provision)

Alternate I (Apr 2011). As prescribed in 12.301(b)(2), add the following paragraph (c)(12) to the basic 

provision:

(12) (Complete if the offeror has represented itself as disadvantaged in paragraph (c)(4) or (c)(10) of this 

provision.)

[The offeror shall check the category in which its ownership falls]:

____ Black American.

___ Hispanic American.

___ Native American (American Indians, Eskimos, Aleuts, or Native Hawaiians).

___ Asian-Pacific American (persons with origins from Burma, Thailand, Malaysia, Indonesia, 

Singapore, Brunei, Japan, China, Taiwan, Laos, Cambodia (Kampuchea), Vietnam, Korea, The 

Philippines, U.S. Trust Territory or the Pacific Islands (Republic of Palau), Republic of the Marshall 

Islands, Federated States of Micronesia, the Commonwealth of the Northern Mariana Islands, Guam, 

Samoa, Macao, Hong Kong, Fiji, Tonga, Kiribati, Tuvalu, or Nauru).

___ Subcontinent Asian (Asian-Indian) American (persons with origins from India, Pakistan, 

Bangladesh, Sri Lanka, Bhutan, the Maldives Islands, or Nepal).

___ Individual/concern, other than one of the preceding.

(End of Provision)