AMENDMENT OF SOLICITATION/MODIFICATION OF CONTRACT 1. CONTRACT ID CODE

0001

2. AMENDMENT/MODIFICATION NO.

See Block 14

4. REQUISITION/PURCHASE REQ. NO. 5. PROJECT NO. (If applicable)

6. ISSUED BY CODE SPE3S1 7. ADMINISTERED BY (If other than Item 6) CODE

8. NAME AND ADDRESS OF CONTRACTOR (No., street, county, State and ZIP Code)

CODE FACILITY CODE

SPE3S121R0003

X

2021 JAN 05

10A. MODIFICATION OF CONTRACT/ORDER NO.

10B. DATED (SEE ITEM 13)

11. THIS ITEM ONLY APPLIES TO AMENDMENTS OF SOLICITATIONS

X The above numbered solicitation is amended as set forth in Item 14. The hour and date specified for receipt of Offers is extended, X is not extended.

or (c) By separate letter or telegram which includes a reference to the solicitation and amendment numbers. FAILURE OF YOUR ACKNOWLEDGMENT TO BE RECEIVED AT THE PLACE 

DESIGNATED FOR THE RECEIPT OF OFFERS PRIOR TO THE HOUR AND DATE SPECIFIED MAY RESULT IN REJECTION OF YOUR OFFER. If by virtue of this amendment you 

desire to change an offer already submitted, such change may be made by telegram or letter, provided each telegram or letter makes reference to the solicitation 

 and this amendment, and is received prior to the opening hour and date specified.

1 copies of the amendment; (b) By acknowledging receipt of this amendment on each copy of the offer submitted;

Offers must acknowledge receipt of this amendment prior to the hour and date specified in the solicitation or as amended, by one of the following methods:

12. ACCOUNTING AND APPROPRIATION DATA (If required)

 A. THIS CHANGE ORDER IS ISSUED PURSUANT TO: (Specify authority) THE CHANGES SET FORTH IN ITEM 14 ARE MADE IN THE CONTRACT ORDER NO. 

 IN ITEM 10A.

B. THE ABOVE NUMBERED CONTRACT/ORDER IS MODIFIED TO REFLECT THE ADMINISTRATIVE CHANGES (such as changes in paying office, appropriation

date, etc. ) SET FORTH IN ITEM 14, PURSUANT TO THE AUTHORITY OF FAR 43.103(b).

C. THIS SUPPLEMENTAL AGREEMENT IS ENTERED INTO PURSUANT TO AUTHORITY OF:

 E. IMPORTANT: Contractor is not, is required to sign this document and return copies to issuing office.

14. DESCRIPTION OF AMENDMENT/MODIFICATION (Organized by UCF section headings, including solicitation/contract subject matter where feasible.)

Except as provided herein, all terms and conditions of the document referenced in Item 9A or 10A, as heretofore changed, remains unchanged and in full force and effect.

15A NAME AND TITLE OF SIGNER (Type or print)

NSN 7540-01-152-8070 

Previous edition unusable

STANDARD FORM 30 (REV. 10-83)

Prescribed by GSA FAR (48 CFR) 53.243

15B. CONTRACTOR/OFFEROR 16B. UNITED STATES OF AMERICA

(Signature of Contracting Officer) (Signature of person authorized to sign)

16A. NAME AND TITLE OF CONTRACTING OFFICER (Type or print)

(a) By completing Items 8 and 15, and returning

DLA TROOP SUPPORT 

SUBSISTENCE SUPPLY CHAIN 

700 ROBBINS AVENUE 

PHILADELPHIA PA 19111-5096 

 15C. DATE SIGNED 16C. DATE SIGNED

D. OTHER (Specify type of modification and authority)

1/13/2021

3. EFFECTIVE DATE

See Attached Continuation Sheet(s).

(X)

CHECK ONE

9A. AMENDMENT OF SOLICITATION NO.

9B. DATED (SEE ITEM 11) 

13. THIS APPLIES ONLY TO MODIFICATIONS OF CONTRACTS/ORDERS. 

 IT MODIFIES THE CONTRACT/ORDER NO. AS DESCRIBED IN ITEM 14.

PAGE 1 OF 23
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I. The following changes apply to Solicitation SPE3S1-R-21-0003: 

 

A. The specification listed below has been added or updated and incorporated into this contract. The specification is 

available at the Subsistence Frozen Site: http://www.dla.mil/TroopSupport/Subsistence/Operational-rations/frozen/

 PCR-T-008 Tortillas, Packaged in a Flexible Pouch, Shelf Stable 

 

B. On page 16, section VIII Technical/Quality Date subsection (A)(1), NSN/Item Description 

 1. Delete: 

8920-01-691-4844 Tortilla, Whole Grain; 2.1 oz. (60 gm) flex pg., PCR-T-008, Flavor 3-A full description has not yet 

been approved. The applicable information will be provided via Amendment as soon as it is available. 

 

 2. Insert: 

8920-01-691-4844 Tortilla, Whole Grain; 2.1 oz. (60 gm) flex pg., PCR-T-008, Flavor 3 

 

 C. On Page 23, Section X; immediately following line X. INSPECTION AND ACCEPTANCE REQUIREMENTS and preceding 

A. Quality Assurance Requirements for Ration Component Production Plants and Ration Sub Assembly and 

Assembly Plants, insert: 

 

THE PROCEDURES FOR INSPECTION AND ACCEPTANCE WILL BE AS FOLLOWS: 

 

FAR Clauses 52.246-2 and 52.246-11 are incorporated in full text in this solicitation and the resultant contract (s) and 

shall be cited to properly enforce the Higher Level Contract Quality requirements. 

Origin inspection shall be contractor paid United States Department of Agriculture, Agricultural Marketing Service, 

Specialty Crops Program, Specialty Crops Inspection Division (USDA,AMS) inspection in accordance with Provision 

9023, General Inspection Requirements, unless otherwise specified by this solicitation/contract. When USDA,AMS is 

designated cognizance for the support of the Government's quality assurance requirements, the responsibilities and 

authorities cited in the regulations, policies, etc. of the respective agency and those regulations, policies, etc. to 

which that agency is subject, are applicable to the contract in conjunction with the quality assurance requirements 

of the contract. Optional contractor testing provided by Provision 9024, Alternative Inspection Requirements for 

Selected Items, is applicable unless otherwise specified by this solicitation/contract. 

 

Those quality assurance provisions (product, packaging, packing, and regulatory requirements, procedures, and 

inspections) specified in Section E of this solicitation, and, as amended by this solicitation, those quality assurance 

provisions specified in the applicable component's technical requirements documents (ex. MIL-PRF- 44073, 

Performance-based Contract Requirements (PCR)) are required for contractor and United States Department of 

Agriculture, Agricultural Marketing Service, Specialty Crops Program, Specialty Crops Inspection Division (USDA-
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AMS) inspection. DLA Provision 9023 is incorporated in full text in this solicitation and resultant contracts(s). In 

addition, the following procedures will be used for inspection and acceptance. If there is a conflict between the 

following inspection and acceptance procedures and those stated in DLA Provision 9023, then the provisions cited 

in the following inspection and acceptance procedures shall control. 

 

ASQ/ANSI Z1.4 -2003 (R2018), SAMPLING PROCEDURES AND TABLES FOR INSPECTION BY ATTRIBUTES, is the edition 

currently available at the ANSI webstore, and the edition of the standard referenced for use with this solicitation/

contract. This latest standard is a reaffirmation of ANSI/ASQ Z1.4 -2003 (R2013), and the (R2013) edition may be used 

in place of the (R2018). Except as related to the inspection of supplies for the presence of defects categorized as 

critical by this solicitation and its supporting documents, the procedures found in ASQ/ANSI Z1.4-2003, paragraph 

titled “8. NORMAL, TIGHTENED AND REDUCED INSPECTION”, apply for Government verification inspection. ASQ/

ANSI Z1.4, sub-paragraph “8.5 LIMIT NUMBERS FOR REDUCED INSPECTION” is applicable for use with this 

solicitation/contract. Where contractor end-item inspection is required, the contractor must select for end item 

examination, as a minimum, the same number of samples selected by the Government for end item inspection. 

 

Applicable to all Contractor Lot Offer Submittal Packages. The contractor's submittal package for each food 

component lot and each final assembly lot, shall contain the offeror's documentation that the end-item primary 

packaging materials in contact with the food and any substances packaged within and in contact with the packaged 

end-item food shall not contain per- or polyfluoroalkyl substances. Offeror's may offer Supplier's Certificates of 

Conformance as documentation. End-item compliance with the absence of per- or polyfluoroalkyl substances shall 

be verified, and may be verified by means of a supplier's Certificate of Conformance. Any substance in contact with 

the end-item food that cannot be verified as a compliant substance shall be cause for rejection of the lot. 

 

D. On page 36, Section X: 

 

1. Delete the fourth full paragraph of section titled “Method 1”: 

 

Standard rework procedures (SRP) for specific foreign material situations may be addressed under the contractor's 

documented QSP, Section XII - Corrective and Preventive Action Program. (see E-4-G.B.6.). SRP's shall only be 

submitted to DLA for foreign material inherent to a specific food product or ingredient. Screws, plastic pieces, 

bandages, metal fragments, glass, etc., are not inherent to ingredients used in food products and a SRP for these 

types of foreign material shall not be submitted to DLA for consideration and approval. SRPs submitted to DLA for 

review and approval shall have a title beginning with “Standard Rework Procedure for...”. SRPs may be referenced, as 

applicable, in the corrective action plan that the contractor provides for a specific instance (along with any relevant 

specific details). 

 

2. Insert: 

 

Standard rework procedures (SRP) for specific foreign material situations may be addressed under the contractor's 

documented QSP, Section XII - Corrective and Preventive Action Program. (see X.I.2.f.). SRP's shall only be submitted 

to DLA for foreign material inherent to a specific food product or ingredient. Screws, plastic pieces, bandages, metal 

fragments, glass, etc., are not inherent to ingredients used in food products and a SRP for these types of foreign 

material shall not be submitted to DLA for consideration and approval. SRPs submitted to DLA for review and 

approval shall have a title beginning with “Standard Rework Procedure for...”. SRPs may be referenced, as applicable, 

in the corrective action plan that the contractor provides for a specific instance (along with any relevant specific 

details). 

 

E. On page 37, Section X: 
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 1. Delete the second full paragraph after the section title “Method 2”: 

 

Standard rework procedures (SRP) for specific foreign material situations may be addressed under the contractor's 

documented QSP, Section XII - Corrective and Preventive Action Program. (see E-4-G.B.6.). SRPs may be referenced, as 

applicable, in the corrective action plan that the contractor provides for a specific instance (along with any relevant 

specific details). 

 

2. Insert: 

 

Standard rework procedures (SRP) for specific foreign material situations may be addressed under the contractor's 

documented QSP, Section XII - Corrective and Preventive Action Program. (see X.I.2.f.). SRPs may be referenced, as 

applicable, in the corrective action plan that the contractor provides for a specific instance (along with any relevant 

specific details). 

 

 

F. Page 40, Section X: 

 

1. Delete: 

 

J. Requests for Rework, Waiver, Deviation, or Reinspection of Nonconforming Supplies, and Requests for Product 

Substitutions, or Extensions of Components Assemble-by Time Limits 

 

2. Insert: 

 

J. Requests for Rework, Waiver, Deviation, or Reinspection of Nonconforming Supplies, and Requests for Product 

Substitutions, or Extensions of Components Assembly Time Limits 

 

G. Page 52 of Section X: 

 

1. Delete line ATTACHMENT 3 PRESUMPTIVE POSITIVE QUESTIONAIRE 

 

2. Insert: 

 

 ATTACHMENT 3 MICRO TEST RESULTS QUESTIONAIRE 

ATTACHMENT 4 PRIMARY, SECONDARY, ANCILLARY MRE COMPONENT CLASSIFICATION 

 

 H. Page 55 of Section X: 

 

1. Delete Attachment 3 - PRESUMPTIVE POSITIVE QUESTIONAIRE in its entirety, up to and including 21. Any product 

lot found nonconforming due to microbiological testing will NOT be accepted by the government under any 

condition. Retesting or reworking confirmed positive lots is not authorized. 

 

2. Insert: 

 

Attachment 3 - MICRO TEST RESULTS QUESTIONAIRE 
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PART A - Recommended Actions Following NOTIFICATION OF ANY LABORATORY MICROBIOLOGICAL TEST RESULT 

OTHER THAN A CONFORMING MICROBIOLOGICAL TEST RESULT 

 

1. Don't Panic! Now is the time to review your operations and gather data. The following actions are 

recommended when nonconforming Microbiological test results are detected or a presumptive positive alert for 

Salmonella or Escherichia coli (E. coli) has been issued by the USDA National Science Laboratory performing the 

test. 

 

2. Identify, segregate, and place suspect lot on medical hold. 

 

3. Identify all ingredients used in suspect lot by manufacturer and lot number. 

 

4. Identify all other products/lots with ingredients in common to the suspect lot. If other products/lots were 

produced with any of the same ingredients (manufacturer and lot number) as the suspect lot, locate, segregate, 

and place those lots on medical hold. 

 

5. Do not produce any further products/lots with the same ingredients (manufacturer and lot number) as the 

suspected lot, place these ingredients on medical hold. 

 

6. If currently producing with the same ingredients (manufacturer and lot number) as the suspected lot, ensure 

the product is identified, segregated, and placed on medical hold. 

 

 Steps 2-6 are to ensure that suspect product and/or common ingredients from suspected lot do not enter the 

supply chain. Recommend a spreadsheet be developed listing end products by lots against ingredients by lots. 

 

7. Identify all lots produced after the suspect lot for which the same equipment was used in blending, processing, 

and/or packaging. 

 

8. Identify when involved equipment was wet washed and sanitized prior to and after the production of the 

suspect lot. 

 

9. Review all production, maintenance, sanitation, and QA records for the day before and the day of suspect lot 

production. 

 

10. Review visitor logs for the day before and day of production. 

 

11. Review employee records for the day before and the day of production. 

 

12. Review facility environmental conditions (e.g., temporary standing water due to heavy rains; broken windows 

or doors; storage areas, etc.) for the day before and day of production. 

 

 Steps 7-12 are to determine if something happened the day of production or the day prior that may have lead to 

contamination of the product or its ingredients. 

 

13. Consider conducting a full sanitation cycle (for example, wet wash and sanitize equipment/line) on the line the 

suspect lot was produced on. Also consider a full sanitation cycle on any other line that common ingredients 

(manufacturer and lot number) to the suspect lot were use in. 

 
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14. Determine relationships between the suspect lot all other products with respect to: a) equipment/

environment; b) personnel; and c) ingredients. 

 

15. Review collected data for completeness and await results of confirmation testing; you are now prepared 

should the presumptive be confirmed as an actual positive. In your review if you identify a probable/possible 

source of contamination you should take immediate corrective action and notify the government. 

 

16. The government may require additional inspection/review prior to certification of products offered during the 

interim period between notification of presumptive positive and the results of the confirmation test. To include, 

but not limited, to certification/verification that the offered lot has no relationship (equipment/environment; 

personnel; ingredients) to the presumptive lot. 

 

17. Review the collected data from recent environmental sampling to help identify a probable/possible source of 

contamination. 

 

PART B - Required Actions Following NOTIFICATION OF CONFIRMED POSITIVE 

 Laboratory Analysis for Salmonella, Listeria monocytogenes and Escherichia coli (E. coli) 

 bacteria strains such as E. coli O157:H7, which can produce a Shiga-like toxin.

 

18. Panic! -- only if you have not followed the Part A recommended immediate actions when notified of the 

presumptive positive. 

 

19. Develop a detailed report with the above gathered information. It is the responsibility of the contractor to 

provide the government a detailed report indicating the probable/possible source of contamination, relationships 

between the suspect lot and all other government products, and a corrective action plan to prevent recurrence. 

 

20. Once the government has a full detailed report from the contractor the government will determine what 

further action(s) is/are required to ensure offered products meet government requirements. 

 

21. Further actions may include, but are not limited to, increased auditing by the U.S. Army Public Health Center, 

additional product testing, tightened inspection requirements that could include increased sample sizes and 

modified testing procedures, additional testing of other lots/products, testing of raw ingredients, performing 

additional environmental sampling in production areas associated with the microbiological failure, submission of 

manufacturers certificates, or condemnation. 

 

22. Any product lot found nonconforming due to microbiological testing will NOT be accepted by the 

government under any condition. Retesting or reworking confirmed positive lots is not authorized.” 

 

 

 I. Page 56 of Section X: 

 

 

1. Near the top of the page, immediately after line Form (CONTINUED), insert: 

 

Attachment 4 - PRIMARY, SECONDARY, ANCILLARY MRE COMPONENT CLASSIFICATION 

 

PRIMARY COMPONENTS 

 

8920-01-479-1847 Cookies, Regular, Chocolate Chip, Plain, Crisp, Individual Serving Package 
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8920-01-610-1980 Cookies, Regular, Oatmeal, Chocolate Chunk, Crisp, Individual Serving Package 

8920-01-490-3557 Cookies, Regular, Oatmeal, Plain, Crisp Individual Serving Package 

8920-01-579-3687 Muffin Top, Maple, Trans Fat Free 

8920-01-620-9442 Pound Cake, Applesauce, Trans Fat Free 

8920-01-458-0130 Pound Cake, Lemon Poppy Seed, Trans Fat Free 

8920-01-545-1391 Pound Cake, Marble Trans Fat Free 

8920-01-348-4694 Pound Cake, Vanilla, Trans Fat Free 

8920-01-691-5153 Bread, Whole Wheat, Sliced 

8920-01-610-1857 Snack Bread, Fortified, White Wheat Snack Bread, Single Pack 

8920-01-525-3622 Tortillas, Plain 

8920-01-621-2384 Tortillas, Chipotle 

8920-01-691-4844 Tortilla, Whole Grain” 

 

J. FAR Clause 52.212-3 (OCT 2020) on Page 98 of the solicitation is hereby deleted in its entirety and replaced with FAR 

Clause 52.212-3 (NOV 2020) 

52.212-3 OFFEROR REPRESENTATIONS AND CERTIFICATIONS --COMMERCIAL ITEMS (NOV 2020) ALTERNATE I (DEC 

2019) 

The Offeror shall complete only paragraph (b) of this provision if the Offeror has completed the annual 

representations and certification electronically in the System for Award Management (SAM) accessed through https://

www.sam.gov. If the Offeror has not completed the annual representations and certifications electronically, the 

Offeror shall complete only paragraphs (c) through (v) 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 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 -- 

(6) 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 

(7) Performed by any person under the age of 18 pursuant to a contract the enforcement of which can be 

accomplished by process or penalties. 

“Highest-level owner” means the entity that owns or controls an immediate owner of the offeror, or that owns or 

controls one or more entities that control an immediate owner of the offeror. No entity owns or exercises control of 

the highest level owner. 

“Immediate owner” means an entity, other than the offeror, that has direct control of the offeror. Indicators of control 

include, but are not limited to, one or more of the following: Ownership or interlocking management, identity of 

interests among family members, shared facilities and equipment, and the common use of employees. 

“Inverted domestic corporation,” means a foreign incorporated entity that meets the definition of an inverted 

domestic corporation under 6 U.S.C. 395(b), applied in accordance with the rules and definitions of 6 U.S.C. 395(c). 
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“Manufactured end product” means any end product in product and service codes (PSCs) 1000-9999, except -- 

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

(2) Product or Service Group (PSG) 87, Agricultural Supplies; 

(3) PSG 88, Live Animals; 

(4) PSG 89, Subsistence; 

(5) PSC 9410, Crude Grades of Plant Materials; 

(6) PSC 9430, Miscellaneous Crude Animal Products, Inedible; 

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

(8) PSC 9610, Ores; 

(9) PSC 9620, Minerals, Natural and Synthetic; and 

(10) PSC 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. 

“Predecessor” means an entity that is replaced by a successor and includes any predecessors of the predecessor. 

“Reasonable inquiry” has the meaning provided in the clause 52.204-25, Prohibition on Contracting for Certain 

Telecommunications and Video Surveillance Services or Equipment. 

“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 -- 
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(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 

(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” -- 

 (1) 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. 

 (2) Affiliates, as used in this definition, means business concerns, one of whom directly or indirectly controls or 

has the power to control the others, or a third party or parties control or have the power to control the others. In 

determining whether affiliation exists, consideration is given to all appropriate factors including common ownership, 

common management, and contractual relationships. SBA determines affiliation based on the factors set forth at 13 

CFR 121.103. 

“Small disadvantaged business concern, consistent with 13 CFR 124.1002,” means a small business concern under the 

size standard applicable to the acquisition, that-- 

(1) Is at least 51 percent unconditionally and directly owned (as defined at 13 CFR 124.105) by-- 

(i) One or more socially disadvantaged (as defined at 13 CFR 124.103) and economically disadvantaged (as defined at 

13 CFR 124.104) individuals who are citizens of the United States; and 

(ii) Each individual claiming economic disadvantage has a net worth not exceeding $750,000 after taking into account 

the applicable exclusions set forth at 13 CFR 124.104(c)(2); and 

(2) The management and daily business operations of which are controlled (as defined at 13.CFR 124.106) by 

individuals, who meet the criteria in paragraphs (1)(i) and (ii) of this definition. 
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“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. 

“Successor” means an entity that has replaced a predecessor by acquiring the assets and carrying out the affairs of the 

predecessor under a new name (often through acquisition or merger). The term “successor” does not include new 

offices/divisions of the same company or a company that only changes its name. The extent of the responsibility of 

the successor for the liabilities of the predecessor may vary, depending on State law and specific circumstances. 

“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 in SAM.

(2) The offeror has completed the annual representations and certifications electronically in SAM accessed through 

http://www.sam.gov. After reviewing SAM information, the Offeror verifies by submission of this offer that the 

representations and certifications currently posted electronically at FAR 52.212-3, Offeror Representations and 

Certifications--Commercial Items, have been entered or updated in the last 12 months, are current, accurate, 

complete, and applicable to this solicitation (including the business size standard(s) applicable to the NAICS code(s) 

referenced for this solicitation), at the time this offer is submitted and are incorporated in this offer by reference (see 

FAR 4.1201), except for paragraphs __. [Offeror to identify the applicable paragraphs at (c) through (u) of this 

provision that the offeror has completed for the purposes of this solicitation only, if any. These amended 

representation(s) and/or certification(s) are also incorporated in this offer and are current, accurate, and complete as 

of the date of this offer. Any changes provided by the offeror are applicable to this solicitation only, and do not result 

in an update to the representations and certifications posted electronically on SAM.] 

(c) Offerors must complete the following representations when the resulting contract will be performed in the United 
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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, that it □is, □is not a small disadvantaged business concern 

as defined in 13 CFR124.1002. 

           (5) Women-owned small business concern. [Complete only if the offeror represented itself as a small business concern 

in paragraph (c)(1) of this provision.] The offeror represents that it □ is, □ is not a women-owned small business 

concern. 

 (6) 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. 

 Note: Complete paragraphs (c)(8) and (c)(9) only if this solicitation is expected to exceed the simplified 

acquisition threshold. 

           (8) Women-owned business concern (other than small business concern). [Complete only if the offeror is a womenowned business concern and did not represent itself as a small business concern in paragraph (c)(1) of this provision.] The 
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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) 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)(10)(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 Order11246- 

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

                (i)It □ has, □ has not participated in a previous contract or subcontract subject to the Equal Opportunity 

clause of this solicitation; and 

                (ii)It □ has, □ has not filed all required compliance reports. 

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

                (i)It □ has developed and has on file, □ has not developed and does not have on file, at each establishment, 

affirmative action programs required by rules and regulations of the Secretary of Labor (41 CFR parts 60-1 and 60-2), 

or 

                (ii)It □ has not previously had contracts subject to the written affirmative action programs requirement of the 

rules and regulations of the Secretary of Labor. 

 (e) Certification Regarding Payments to Influence Federal Transactions (31 http://uscode.house.gov/ 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 Certificate. (Applies only if the clause at Federal Acquisition Regulation (FAR) 52.225-1, Buy 

American-Supplies, is included in this solicitation.) 
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 (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-Supplies.” 

 (2) Foreign End Products: 

 LINE ITEM 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-Free Trade Agreements-Israeli Trade Act Certificate. (Applies only if the clause at FAR 52.225-3, Buy 

American-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-Free Trade Agreements -Israeli Trade Act.” 

 (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-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 COUNTRY OF ORIGIN 

 __________ _____________________ 

__________ _____________________ 

__________ _____________________ 

 
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 [List as necessary] 

 (iii) The offeror shall list those supplies that are foreign end products (other than those listed in paragraph (g)

(1)(ii) of this provision) as defined in the clause of this solicitation entitled “Buy American-Free Trade AgreementsIsraeli 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 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-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-Free Trade Agreements-Israeli Trade Act”: 

 Canadian End Products: 

LINE ITEM 

 _______________________________ 

_______________________________ 

_______________________________ 

 

 [List as necessary] 

 (3) Buy American-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-Free Trade Agreements-Israeli Trade Act”: 

 Canadian or Israeli End Products: 
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LINE ITEM COUNTRY OF ORIGIN 

 __________ _____________________ 

__________ _____________________ 

__________ _____________________ 

 

 [List as necessary] 

 (4) Buy American-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-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 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 COUNTRY OF ORIGIN 

 __________ _____________________ 

__________ _____________________ 
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__________ _____________________ 

 

 [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 statute. The Government will consider for award only 

offers of U.S.-made or designated country end products unless the Contracting Officer determines that there are no 

offers for such products or that the offers for such products are insufficient to fulfill the requirements of the 

solicitation. 

 (h) Certification Regarding Responsibility Matters (Executive Order 12689). (Applies only if the contract value is 

expected to exceed the simplified acquisition threshold.) The offeror certifies, to the best of its knowledge and belief, 

that the offeror and/or any of its principals - 

           (1)□ Are, □ are not presently debarred, suspended, proposed for debarment, or declared ineligible for the 

award of contracts by any Federal agency; 

           (2)□ Have, □ have not, within a three-year period preceding this offer, been convicted of or had a civil 

judgment rendered against them for: commission of fraud or a criminal offense in connection with obtaining, 

attempting to obtain, or performing a Federal, state or local government contract or subcontract; violation of Federal 

or state antitrust statutes relating to the submission of offers; or commission of embezzlement, theft, forgery, bribery, 

falsification or destruction of records, making false statements, tax evasion, violating Federal criminal tax laws, or 

receiving stolen property; 

           (3)□ Are, □ are not presently indicted for, or otherwise criminally or civilly charged by a Government entity with, 

commission of any of these offenses enumerated in paragraph (h)(2) of this clause; and 

           (4)□ Have, □ have not, within a three-year period preceding this offer, been notified of any delinquent Federal 

taxes in an amount that exceeds the threshold at 9.104-5(a)(2) for which the liability remains unsatisfied. 

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

 (A) The tax liability is finally determined. The liability is finally determined if it has been assessed. A liability is 

not finally determined if there is a pending administrative or judicial challenge. In the case of a judicial challenge to 

the liability, the liability is not finally determined until all judicial appeal rights have been exhausted. 

 (B) The taxpayer is delinquent in making payment. A taxpayer is delinquent if the taxpayer has failed to pay 

the tax liability when full payment was due and required. A taxpayer is not delinquent in cases where enforced 

collection action is precluded. 

 (ii) Examples. 

(A) The taxpayer has received a statutory notice of deficiency, under I.R.C. §6212, which entitles the taxpayer to seek 

Tax Court review of a proposed tax deficiency. This is not a delinquent tax because it is not a final tax liability. Should 

the taxpayer seek Tax Court review, this will not be a final tax liability until the taxpayer has exercised all judicial 

appeal rights. 

 (B) The IRS has filed a notice of Federal tax lien with respect to an assessed tax liability, and the taxpayer 

has been issued a notice under I.R.C. §6320 entitling the taxpayer to request a hearing with the IRS Office of Appeals 
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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 products. 

LINE ITEM LISTED COUNTRY OF ORIGIN 

 __________ ___________________________ 

__________ ___________________________ 

__________ ___________________________ 

 

 (2) Certification. [If the Contracting Officer has identified end products and countries of origin in paragraph (i)(1) of 

this provision, then the offeror must certify to either (i)(2)(i) or (i)(2)(ii) by checking the appropriate block.] 

 (i) The offeror will not supply any end product listed in paragraph (i)(1) of this provision that was mined, 

produced, or manufactured in the corresponding country as listed for that product. 

 (ii) The offeror may supply an end product listed in paragraph (i)(1) of this provision that was mined, 

produced, or manufactured in the corresponding country as listed for that product. The offeror certifies that it has 

made a good faith effort to determine whether forced or indentured child labor was used to mine, produce, or 

manufacture any such end product furnished under this contract. On the basis of those efforts, the offeror certifies 

that it is not aware of any such use of child labor. 

 (j) Place of manufacture. (Does not apply unless the solicitation is predominantly for the acquisition of 

manufactured end products.) For statistical purposes only, the offeror shall indicate whether the place of 

manufacture of the end products it expects to provide in response to this solicitation is predominantly- 

           (1)□ In the United States (Check this box if the total anticipated price of offered end products manufactured in 

the United States exceeds the total anticipated price of offered end products manufactured outside the United 

States); or 

           (2)□ Outside the United States. 

 (k) Certificates regarding exemptions from the application of the Service Contract Labor Standards (Certification by the 
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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 Labor Standards wage determination to the solicitation, the offeror shall notify the 

Contracting Officer as soon as possible; and 

 (ii) The Contracting Officer may not make an award to the offeror if the offeror fails to execute the 

certification in paragraph (k)(1) or (k)(2) of this clause or to contact the Contracting Officer as required in paragraph 

(k)(3)(i) of this clause. 

 (l) Taxpayer Identification Number (TIN) ( 26 U.S.C. 6109, 31 U.S.C. 7701). (Not applicable if the offeror is required to 

provide this information to the SAM 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). 
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 (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 CFR1.6049-4; 

 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. 
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(1) Government agencies are not permitted to use appropriated (or otherwise made available) funds for contracts 

with either an inverted domestic corporation, or a subsidiary of an inverted domestic corporation, unless the 

exception at 9.108-2(b) applies or the requirement is waived in accordance with the procedures at 9.108-4. 

 (2) Representation. The Offeror represents that - 

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

                (ii)It □is, □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 e-mail questions concerning sensitive technology to the Department of State at 

CISADA106@state.gov. 

 (2) Representation and Certifications. 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- 

 (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 $3,500 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 (et seq.) (see OFAC's Specially Designated Nationals and Blocked Persons List at https://www.treasury.

gov/resource-center/sanctions/SDN-List/Pages/default.aspx). 

 (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. 

 (p) Ownership or Control of Offeror. (Applies in all solicitations when there is a requirement to be registered in SAM 

or a requirement to have a unique entity identifier in the solicitation). 

           (1) The Offeror represents that it □ has or □ does not have an immediate owner. If the Offeror has more than 

one immediate owner (such as a joint venture), then the Offeror shall respond to paragraph (2) and if applicable, 

paragraph (3) of this provision for each participant in the joint venture. 

 (2)If the Offeror indicates “has” in paragraph (p)(1) of this provision, enter the following information: 

 Immediate owner CAGE code: ____________________. 

 Immediate owner legal name: _____________________. 

 (Do not use a “doing business as” name) 
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          Is the immediate owner owned or controlled by another entity: □ Yes or □ No. 

 (3)If the Offeror indicates “yes” in paragraph (p)(2) of this provision, indicating that the immediate owner is 

owned or controlled by another entity, then enter the following information: 

 Highest-level owner CAGE code: __________________. 

 Highest-level owner legal name: ___________________. 

 (Do not use a “doing business as” name) 

 (q) Representation by Corporations Regarding Delinquent Tax Liability or a Felony Conviction under any Federal Law. 

 (1)As required by sections 744 and 745 of Division E of the Consolidated and Further Continuing Appropriations 

Act, 2015 (Pub. L. 113-235), and similar provisions, if contained in subsequent appropriations acts, The Government 

will not enter into a contract with any corporation that - 

 (i) Has any unpaid Federal tax liability that has been assessed, for which all judicial and administrative 

remedies have been exhausted or have lapsed, and that is not being paid in a timely manner pursuant to an 

agreement with the authority responsible for collecting the tax liability, where the awarding agency is aware of the 

unpaid tax liability, unless an agency has considered suspension or debarment of the corporation and made a 

determination that suspension or debarment is not necessary to protect the interests of the Government; or 

 (ii) Was convicted of a felony criminal violation under any Federal law within the preceding 24 months, where 

the awarding agency is aware of the conviction, unless an agency has considered suspension or debarment of the 

corporation and made a determination that this action is not necessary to protect the interests of the Government. 

 (2) The Offeror represents that - 

                (i)It is □ is not □ a corporation that has any unpaid Federal tax liability that has been assessed, for which all 

judicial and administrative remedies have been exhausted or have lapsed, and that is not being paid in a timely 

manner pursuant to an agreement with the authority responsible for collecting the tax liability; and 

                (ii)It is □ is not □a corporation that was convicted of a felony criminal violation under a Federal law within the 

preceding 24 months. 

 (r) Predecessor of Offeror. (Applies in all solicitations that include the provision at 52.204-16, Commercial and 

Government Entity Code Reporting.) 

           (1) The Offeror represents that it □ is or □ is not a successor to a predecessor that held a Federal contract or 

grant within the last three years. 

 (2)If the Offeror has indicated “is” in paragraph (r)(1) of this provision, enter the following information for all 

predecessors that held a Federal contract or grant within the last three years (if more than one predecessor, list in 

reverse chronological order): 

 Predecessor CAGE code: (or mark “Unknown”). 

 Predecessor legal name:

 (Do not use a “doing business as” name). 
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 (s)[Reserved]. 

 (t) Public Disclosure of Greenhouse Gas Emissions and Reduction Goals. Applies in all solicitations that require offerors 

to register in SAM (12.301(d)(1)). 

 (1) This representation shall be completed if the Offeror received $7.5 million or more in contract awards in the 

prior Federal fiscal year. The representation is optional if the Offeror received less than $7.5 million in Federal contract 

awards in the prior Federal fiscal year. 

 (2) Representation. [Offeror to check applicable block(s) in paragraph (t)(2)(i) and (ii)]. 

(i) The Offeror (itself or through its immediate owner or highest-level owner) □ does, □ does not publicly disclose 

greenhouse gas emissions, i.e., makes available on a publicly accessible website the results of a greenhouse gas 

inventory, performed in accordance with an accounting standard with publicly available and consistently applied 

criteria, such as the Greenhouse Gas Protocol Corporate Standard. 

                (ii) The Offeror (itself or through its immediate owner or highest-level owner) □does, □does not publicly 

disclose a quantitative greenhouse gas emissions reduction goal, i.e., make available on a publicly accessible website 

a target to reduce absolute emissions or emissions intensity by a specific quantity or percentage. 

 (iii)A publicly accessible website includes the Offeror's own website or a recognized, third-party greenhouse 

gas emissions reporting program. 

 (3)If the Offeror checked “does” in paragraphs (t)(2)(i) or (t)(2)(ii) of this provision, respectively, the Offeror shall 

provide the publicly accessible website(s) where greenhouse gas emissions and/or reduction goals are reported:

_________________. 

 (u) 

(1)In accordance with section 743 of Division E, Title VII, of the Consolidated and Further Continuing Appropriations 

Act, 2015 (Pub. L. 113-235) and its successor provisions in subsequent appropriations acts (and as extended in 

continuing resolutions), Government agencies are not permitted to use appropriated (or otherwise made available) 

funds for contracts with an entity that requires employees or subcontractors of such entity seeking to report waste, 

fraud, or abuse to sign internal confidentiality agreements or statements prohibiting or otherwise restricting such 

employees or subcontractors from lawfully reporting such waste, fraud, or abuse to a designated investigative or law 

enforcement representative of a Federal department or agency authorized to receive such information. 

 (2) The prohibition in paragraph (u)(1) of this provision does not contravene requirements applicable to 

Standard Form 312 (Classified Information Nondisclosure Agreement), Form 4414 (Sensitive Compartmented 

Information Nondisclosure Agreement), or any other form issued by a Federal department or agency governing the 

nondisclosure of classified information. 

 (3) Representation. By submission of its offer, the Offeror represents that it will not require its employees or 

subcontractors to sign or comply with internal confidentiality agreements or statements prohibiting or otherwise 

restricting such employees or subcontractors from lawfully reporting waste, fraud, or abuse related to the 

performance of a Government contract to a designated investigative or law enforcement representative of a Federal 

department or agency authorized to receive such information (e.g., agency Office of the Inspector General). 

 (v) Covered Telecommunications Equipment or Services Representation. Section 889(a)(1)(A) and section 889 (a)(1)

(B) of Public Law 115-232 
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 (1) The offeror shall review the list of excluded parties in the System of Award Management System (SAM) 

(https://www.sam.gov) for entities excluded from receiving federal awards for “covered telecommunications 

equipment or services as part of its offered products or services to the Government in the performance of any 

contract, subcontract, or other contractual instrument. 

 (2) The Offeror represents that - 

(i) It □ does, □ does not provide covered telecommunications equipment or services as part of its offered 

products or services to the Government in the performance of any contract, subcontract, or other contractual 

instrument 

 (ii) After conducting a reasonable inquiry for purposes of this representation, that it □ does, □ does not use 

covered telecommunications equipment or services, or any equipment, system, or service that uses covered 

telecommunications equipment or services. 

(End of Provision) 

 

II. All other terms and conditions of the solicitation remain the same.