National Aeronautics and Space Administration (NASA) 

Small Business Innovation Research (SBIR) Ignite Solicitation 

 

FIRM CERTIFICATIONS

Please read carefully the following certification statements. 

• The Federal government relies on the information to determine whether the business is eligible for a Small 

 Business Innovation Research (SBIR) Program award. A similar certification will be used to ensure continued 

 compliance with specific program requirements during the life of the funding agreement. The definitions for the 

 terms used in this certification are set forth in the Small Business Act, SBA regulations (13 C.F.R. Part 121), the 

 SBIR Policy Directive and also any statutory and regulatory provisions referenced in those authorities. 

• If the funding agreement officer believes that the business may not meet certain eligibility requirements at the 

 time of award, they are required to file a size protest with the U.S. Small Business Administration (SBA), who will 

 determine eligibility. At that time, SBA will request further clarification and supporting documentation in order to 

 assist in the verification of any of the information provided as part of a protest. If the funding agreement officer 

 believes, after award, that the business is not meeting certain funding agreement requirements, the agency may 

 request further clarification and supporting documentation in order to assist in the verification of any of the 

 information provided. 

• Even if correct information has been included in other materials submitted to the Federal government, any action 

 taken with respect to this certification does not affect the Government's right to pursue criminal, civil or 

 administrative remedies for incorrect or incomplete information given in the certification. Each person signing this 

 certification may be prosecuted if they have provided false information.

1. The Awardee business concern meets the ownership and control requirements set forth in 13 CFR 

121.702. 

IMPORTANT: The Awardee business concern must meet the ownership and control requirements set forth in 13 

CFR 121.702 to participate in this solicitation. For more information, go to https://www.ecfr.gov/.

Yes No

2. If a corporation, all corporate documents (namely: articles of incorporation and any amendments, 

articles of conversion, by-laws and amendments, shareholder meeting minutes showing director 

elections, shareholder meeting minutes showing officer elections, organizational meeting minutes, all 

issued stock certificates, stock ledger, buy-sell agreements, stock transfer agreements, voting 

agreements, and documents relating to stock options, including the right to convert non-voting stock or 

debentures into voting stock) evidence that it meets the ownership and control requirements set forth in 

13 C.F.R. §121.702.

Yes N/A

If N/A, explain why:
3. If a partnership, the partnership agreement evidences that it meets the ownership and control 

requirements set forth in 13 C.F.R. §121.702.

Yes N/A

If N/A, explain why:

4. If a limited liability corporation, the articles of organization and any amendments, and operation 

agreement and amendments, evidence that it meets the ownership and control requirements set forth in 

13 C.F.R. §121.702.

Yes N/A

If N/A, explain why:

5. The birth certificates, naturalization papers, or passports show that any individuals it relies upon to 

meet the eligibility requirements are U.S. citizens or permanent resident aliens in the United States.

Yes N/A

If N/A, explain why:

6. The Awardee business concern has no more than 500 employees, including the employees of its 

Affiliates. 

IMPORTANT: The SBC must certify that it has no more than 500 employees (including the employees of its 

affiliates) in order to be eligible for Phase I or Phase II solicitations.

Yes No

6a. The number of employees, including the employees of its affiliates is:
7. SBA has not issued a size determination currently in effect finding that this business concern 

exceeds the 500 employee size standard. 

IMPORTANT: The offeror must be able to certify that the above statement is true in order to be eligible to apply.

True False

8. The SBIR Awardee has registered itself on SBA's database as majority-owned by venture capital 

operating companies, including hedge funds or private equity firms.

Yes No N/A

If N/A, explain why:

9. It is a Covered Small Business Concern (a small business concern that: (a) was not majority-owned 

by multiple venture capital operating companies (VCOCs), hedge funds, or private equity firms on the 

date on which it submitted an application in response to an SBIR solicitation; and (b) on the date of the 

SBIR award, which is made more than 9 months after the closing date of the solicitation, is majorityowned by multiple venture capital operating companies, hedge funds, or private equity firms).

Yes No

10. The firm is owned by a faculty member or a student of an institution of higher education (as defined 

in 20 U.S.C. section 1001).

Yes No

11. The offeror qualifies as a (select all that apply): 

For all definitions, go to https://www.sba.gov/federal-contracting/contracting-assistance-programs.

Socially and Economically Disadvantaged SBC Women-owned SBC

HUBZone-owned SBC Veteran-owned SBC

Service-Disabled Veteran-owned SBC None Listed

12. Race of the offeror (select all that apply):

American Indian or Alaska Native Native Hawaiian or Other Pacific Islander

Asian White

Black or African American Do not wish to provide
13. Ethnicity of the offeror:

Hispanic or Latino Not Hispanic or Latino Do not wish to provide

14. It is a corporation that has some unpaid Federal tax liability that has been assessed, for which all 

judicial and administrative remedies have not been exhausted or have not lapsed, and that is not being 

paid in a timely manner pursuant to an agreement with the authority responsible for collecting the tax 

liability. 

IMPORTANT: The offeror must be able to certify that the above statement is false in order to be eligible to apply.

True False

15. The corporation was convicted, or had an officer or agent acting on behalf of the corporation 

convicted, or a felony criminal violation under a Federal law within the preceding 24 months. 

IMPORTANT: The offeror must be able to certify that the above statement is false in order to be eligible to apply.

True False

16. The offeror will not provide covered telecommunications equipment or services to the Government 

in the performance of any contract, subcontract or other contractual instrument resulting from the 

solicitation (as per section 2.3.1 FAR 52.204-24 of the solicitation).

True False

If false, include the information below as a PDF along with your submission files. 

 

For covered equipment: 

• The entity that produced the covered telecommunications equipment (include entity name, unique entity identifier, 

 CAGE code, and whether the entity was the original equipment manufacturer (OEM) or a distributor, if known); 

• A description of all covered telecommunications equipment offered (include brand; model number, such as OEM 

 number, manufacturer part number, or wholesaler number; and item description, as applicable); and 

• Explanation of the proposed use of covered telecommunications equipment and any factor relevant to 

 determining if such use would be permissible under the prohibition in paragraph (b)(1) of this provision. 

 

For covered services: 

• If the service is related to item maintenance: A description of all covered telecommunications services offered 

 (include on the item being maintained: brand; model number, such as OEM number, manufacturer part number, 

 or wholesaler number; and item description (as applicable); or 

• If not associated with maintenance, the Product Service Code (PSC) of the service being provided; an 

 explanation of the proposed use of covered telecommunications services, and any factors relevant to determining 

 if such use would be permissible under the prohibition in paragraph (b)(1) of this provision.

17. The offeror does not use covered telecommunications equipment or services, or use any equipment, 

system, or service that uses covered telecommunications equipment or services (as per section 2.3.1 

FAR 52.204-24 of this solicitation).

True False
If false, include the information below as a PDF along with your submission files. 

 

For covered equipment: 

• The entity that produced the covered telecommunications equipment (include entity name, unique entity identifier, 

 CAGE code, and whether the entity was the original equipment manufacturer (OEM) or a distributor, if known); 

• A description of all covered telecommunications equipment offered (include brand; model number, such as OEM 

 number, manufacturer part number, or wholesaler number; and item description, as applicable); and 

• Explanation of the proposed use of covered telecommunications equipment and any factor relevant to 

 determining if such use would be permissible under the prohibition in paragraph (b)(1) of this provision. 

 

For covered services: 

• If the service is related to item maintenance: A description of all covered telecommunications services offered 

 (include on the item being maintained: brand; model number, such as OEM number, manufacturer part number, 

 or wholesaler number; and item description (as applicable); or 

• If not associated with maintenance, the Product Service Code (PSC) of the service being provided; an 

 explanation of the proposed use of covered telecommunications services, and any factors relevant to determining 

 if such use would be permissible under the prohibition in paragraph (b)(1) of this provision.

18. The offeror does not provide covered telecommunications equipment or services as a part of its 

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

other contractual instrument (as per section 2.3.2 FAR 52.204-26).

True False

19. Verify that your firm has registered in SBA's Company Registry at www.sbir.gov by providing the 

SBC Control ID # and including a PDF of the registration confirmation along with your submission files. 

IMPORTANT: The firm must be registered with the SBA's company registry in order to be eligible to apply. The 

offeror must include the PDF of the registration confirmation.

I understand that the information submitted may be given to Federal, State and local 

agencies for determining violations of law and other purposes.

I am an officer of the business concern authorized to represent it and sign this 

certification on its behalf. By signing this certification, I am representing on my own 

behalf, and on behalf of the business concern that the information provided in this 

certification, the application, and all other information submitted in connection with 

this application, is true and correct as of the date of submission. I acknowledge that 

any intentional or negligent misrepresentation of the information contained in this 

certification may result in criminal, civil or administrative sanctions, including but 

not limited to: (1) fines, restitution and/or imprisonment under 18 U.S.C. §1001; (2) 

treble damages and civil penalties under the False Claims Act (31 U.S.C. §3729 et 

seq.); (3) double damages and civil penalties under the Program Fraud Civil 

Remedies Act (31 U.S.C. §3801 et seq.); (4) civil recovery of award funds; (5) 

suspension and/or debarment from all Federal procurement and non-procurement 

transactions (FAR Subpart 9.4 or 2 C.F.R. part 180); and (6) other administrative 

penalties including termination of SBIR/STTR awards.

Name
Title

Business Name