(AcquisitionofLeaseholdInterestsinRealProperty) / SolicitationNumber
RFP No. 272396
004 / Dated
10/22/2014
Completeappropriateboxes,signtheform,andattachtooffer.
TheOfferormakesthefollowingRepresentationsandCertifications. NOTE: The"Offeror,"asusedonthisform,istheownerofthepropertyoffered,notanindividualoragentrepresentingtheowner.
1.52.219-1-SMALLBUSINESSPROGRAMREPRESENTATIONS(APR2011)
(a)(1)TheNorthAmericanIndustryClassificationSystem(NAICS)codeforthisacquisitionis 531190.
(2)Thesmallbusinesssizestandardis$35.5Millioninannualaveragegrossrevenueoftheconcernforthelast3fiscalyears.
(3)Thesmallbusinesssizestandardforaconcernwhichsubmitsanofferinitsownname,otherthanonaconstructionorservicecontract,butwhichproposestofurnishaproductwhichitdidnotitselfmanufacture,is500employees.
(b)Representations.
(1)Theofferorrepresentsaspartofitsofferthatit[]is,[]isnotasmallbusinessconcern.
(2)[Completeonlyiftheofferorrepresenteditselfasasmallbusinessconcerninparagraph(b)(1)ofthisprovision.]Theofferorrepresents,forgeneralstatisticalpurposes,thatit[]is,[]is not,asmalldisadvantagedbusinessconcernas definedin13CFR124.1002.
(3)[Completeonlyiftheofferorrepresenteditselfasasmallbusinessconcerninparagraph(b)(1)ofthisprovision.]Theofferorrepresentsaspartofitsofferthatit[]is,[]isnotawomen-ownedsmallbusinessconcern.
(4)Women-ownedsmallbusiness(WOSB)concerneligibleundertheWOSBProgram.[Completeonlyiftheofferorrepresenteditselfasawomen-ownedsmallbusinessconcerninparagraph(b)(3)ofthisprovision.]Theofferorrepresentsaspartofitsofferthat—
(i)It[]is,[]is notaWOSBconcerneligibleunderthe WOSBProgram,hasprovidedalltherequireddocumentstotheWOSBRepository,andnochangeincircumstancesoradversedecisionshavebeenissuedthataffectsitseligibility;and
(ii)It[]is,[]is notajointventurethatcomplies withtherequirementsof13CFRpart127,andtherepresentationinparagraph(b)(4)(i)ofthisprovisionisaccurateinreferencetotheWOSBconcernorconcernsthatareparticipating inthejointventure.[TheofferorshallenterthenameornamesoftheWOSBconcernorconcernsthat areparticipating inthe jointventure: .]EachWOSBconcernparticipatinginthejointventureshallsubmitaseparatesignedcopyoftheWOSBrepresentation.
(5)Economicallydisadvantagedwomen-ownedsmallbusiness(EDWOSB)concern.[Completeonlyiftheofferorrepresenteditselfasawomen-ownedsmallbusinessconcerneligibleundertheWOSBProgramin(b)(4)ofthisprovision.]Theofferorrepresentsaspartofitsofferthat—
(i)It[]is,[]is notanEDWOSBconcerneligibleundertheWOSBProgram,hasprovidedalltherequireddocumentstotheWOSBRepository,andnochange incircumstancesoradversedecisionshavebeenissuedthataffectsitseligibility;and
(ii)It[]is,[]is notajointventurethatcomplies withtherequirementsof13CFRpart127,andtherepresentationinparagraph(b)(5)(i)ofthisprovisionisaccurateinreferencetotheEDWOSBconcernorconcernsthatareparticipatinginthejointventure.[TheofferorshallenterthenameornamesoftheEDWOSBconcernorconcernsthatareparticipatinginthejointventure:
.]EachEDWOSBconcernparticipatinginthejointventureshallsubmitaseparatesignedcopyoftheEDWOSBrepresentation.
(6)[Completeonlyiftheofferorrepresenteditselfasasmallbusinessconcerninparagraph(b)(1)ofthisprovision.]Theofferorrepresentsaspartofitsofferthatit[]is,[]isnotaveteran-ownedsmallbusinessconcern.
(7)[Completeonlyiftheofferorrepresenteditselfasaveteran-ownedsmallbusinessconcerninparagraph(b)(6)ofthisprovision.]Theofferorrepresentsaspartofitsofferthatit[]is,[]isnotaservice-disabledveteran-ownedsmallbusinessconcern.
(8)[Completeonlyiftheofferorrepresenteditselfasasmallbusinessconcerninparagraph(b)(1)ofthisprovision.]Theofferorrepresents,aspartofitsoffer,that—
(i)It[]is,[]is notaHUBZonesmallbusinessconcernlisted,onthedateofthisrepresentation,ontheListofQualifiedHUBZoneSmallBusinessConcernsmaintainedbytheSmallBusinessAdministration,andnomaterialchangesinownershipandcontrol,principaloffice,orHUBZoneemployeepercentagehaveoccurredsinceitwascertifiedinaccordancewith13CFRPart126;and
(ii)It[]is,[]is notaHUBZonejoint venturethatcomplieswiththerequirementsof13CFRPart126,andtherepresentationinparagraph(b)(8)(i)ofthisprovisionisaccurateforeachHUBZonesmallbusinessconcernparticipatingintheHUBZonejointventure.[TheofferorshallenterthenamesofeachoftheHUBZonesmallbusinessconcernsparticipatingintheHUBZonejointventure:
.]EachHUBZonesmallbusinessconcernparticipatingintheHUBZonejointventureshallsubmitaseparatesignedcopyoftheHUBZonerepresentation.
(c)Definitions.Asusedinthisprovision—
“Economicallydisadvantagedwomen-ownedsmallbusiness(EDWOSB)concern”meansasmallbusinessconcernthatisatleast51percentdirectlyandunconditionallyownedby,andthemanagementanddailybusinessoperationsofwhicharecontrolledby,oneormorewomenwhoarecitizensoftheUnitedStatesandwhoareeconomicallydisadvantagedinaccordancewith13CFRpart127.Itautomaticallyqualifiesasawomen-ownedsmallbusinessconcerneligibleundertheWOSBProgram.
“Service-disabledveteran-ownedsmallbusinessconcern”—
(1)Meansasmallbusinessconcern—
(i)Notlessthan51percentofwhichisownedbyoneormoreservice-disabledveteransor,inthecaseofanypubliclyownedbusiness,notlessthan51percentofthestockofwhichisownedbyoneormoreservice-disabledveterans;and
(ii)Themanagementanddailybusinessoperationsofwhicharecontrolledbyoneormoreservice-disabledveteransor,inthecaseofaservice-disabledveteranwithpermanentandseveredisability,thespouseorpermanentcaregiverofsuchveteran.
(2)“Service-disabledveteran”meansaveteran,asdefinedin38U.S.C.101(2),withadisabilitythatisservice-connected,asdefinedin38U.S.C.101(16).
“Smallbusinessconcern”meansaconcern,includingitsaffiliates,thatisindependentlyownedandoperated,notdominantinthefieldofoperationin whichitisbiddingonGovernmentcontracts,andqualifiedasasmallbusinessunderthecriteriain13CFRPart121andthesizestandardinparagraph(a)ofthis provision.
“Veteran-ownedsmallbusinessconcern”meansasmallbusinessconcern—
(1)Notlessthan51percentofwhichisownedbyoneormoreveterans(asdefinedat38U.S.C.101(2))or,inthecaseofanypubliclyownedbusiness,notlessthan51percentofthestock of whichisownedbyoneormoreveterans;and
(2)Themanagementanddailybusinessoperationsofwhicharecontrolledbyoneormoreveterans.
“Women-ownedsmallbusinessconcern”meansasmallbusinessconcern—
(1)Thatisatleast51percentownedbyoneormore women;or,inthecaseofanypubliclyownedbusiness,atleast51percentofthestock of whichisownedbyoneormorewomen;and
(2)Whosemanagementanddailybusinessoperationsarecontrolledbyoneormorewomen.
“Women-ownedsmallbusiness(WOSB)concerneligibleundertheWOSBProgram”(inaccordancewith13CFRpart127),meansasmallbusinessconcernthatisatleast51percentdirectlyandunconditionallyownedby,andthemanagementanddailybusinessoperationsofwhicharecontrolledby,oneormorewomenwhoarecitizensoftheUnitedStates.
(d)Notice.
(1)Ifthissolicitationisforsupplies andhasbeensetaside,inwholeorinpart,forsmallbusinessconcerns,thentheclauseinthissolicitationprovidingnoticeoftheset-asidecontainsrestrictionsonthesourceoftheenditemstobefurnished.
(2)Under15U.S.C.645(d),anypersonwhomisrepresentsafirm’sstatusasabusinessconcernthatissmall,HUBZonesmall,smalldisadvantaged,service-disabledveteran-ownedsmall,economicallydisadvantagedwomen-ownedsmall,orwomen-ownedsmalleligibleundertheWOSBPrograminordertoobtainacontracttobeawardedunderthepreferenceprogramsestablishedpursuanttosection8,9,15,31,and36oftheSmallBusinessActoranyotherprovisionofFederallawthatspecificallyreferencessection8(d)foradefinitionofprogrameligibility,shall—
(i)Bepunishedbyimpositionoffine,imprisonment,orboth;
(ii)Besubjecttoadministrativeremedies,includingsuspensionanddebarment;and
(iii)BeineligibleforparticipationinprogramsconductedundertheauthorityoftheAct.
2.52.204-5-WOMEN-OWNEDBUSINESS(OTHERTHANSMALLBUSINESS)(MAY1999)
(a)Definition."Women-ownedbusinessconcern,"asusedinthisprovision,meansaconcernwhichisatleast51percentownedbyoneormorewomen;orinthecaseofanypubliclyownedbusiness,atleast51percentofitsstockisownedbyoneormorewomen;andwhosemanagementanddailybusinessoperationsarecontrolledbyoneormorewomen.
(b)Representation.[CompleteonlyiftheOfferorisawomen-ownedbusinessconcernandhasnot representeditselfasasmallbusinessconcerninparagraph(b)(1)ofFAR52.219-1,SmallBusinessProgramRepresentations,ofthissolicitation.]TheOfferorrepresentsthatit[]isawomen-ownedbusinessconcern.
3.52.222-22-PREVIOUSCONTRACTSANDCOMPLIANCEREPORTS(FEB1999)
(Applicablewhentheestimatedvalueoftheacquisitionexceeds$10,000)TheOfferorrepresentsthat—
(a)It[]has,[]hasnotparticipatedinapreviouscontractorsubcontractsubjecttotheEqualOpportunityclauseofthissolicitation;
(b)It[]has,[]hasnotfiledallrequiredcompliancereports;and
(c)Representationsindicatingsubmissionofrequiredcompliancereports,signedbyproposedsubcontractors,willbeobtainedbeforesubcontractawards. (ApprovedbyOMBunderControlNumber1215-0072.)
4.52.222-25-AFFIRMATIVE ACTIONCOMPLIANCE(APR1984)
(Applicablewhentheestimatedvalueoftheacquisitionexceeds$10,000)TheOfferorrepresentsthat—
(a)It[]hasdevelopedandhasonfile,[]hasnotdevelopedanddoesnothaveonfile,ateachestablishmentaffirmativeactionprogramsrequiredbytherulesandregulationsoftheSecretaryofLabor(41CFR60-1and60-2),or
(b)It[]hasnotpreviouslyhadcontractssubjecttothewrittenaffirmativeactionprogramsrequirementoftherulesandregulationsoftheSecretaryofLabor.(ApprovedbyOMBunderControlNumber1215-0072.)
5.552.203-72 REPRESENTATIONBYCORPORATIONSREGARDINGANUNPAIDDELINQUENTFEDERALTAXLIABILITYORAFELONYCONVICTIONUNDERANYFEDERAL LAW(DEVIATION)(APR2012)
(a)InaccordancewithSections 630and631of DivisionoftheConsolidatedAppropriations Act,2012(Pub.L.112-74),noneofthefundsmadeavailablebythatActmaybeusedtoenterintoacontractactionwithanycorporationthat---
(1)HasanyunpaidFederaltaxliabilitythathasbeenassessed,forwhichalljudicialandadministrativeremedieshavebeenexhaustedorhavelapsed,andthatisnotbeingpaidinatimelymannerpursuanttoanagreementwiththeauthorityresponsibleforcollectingthetaxliability,wheretheawardingagencyisawareoftheunpaidtaxliability,unlesstheagencyhasconsideredsuspensionordebarmentofthecorporationandmadeadeterminationthatthisfurtheractionisnotnecessarytoprotecttheinterestsoftheGovernment,or
(2)Wasconvicted,orhadanofficeroragentofsuchcorporationactingonbehalfofthecorporationconvictedofafelonycriminalviolationunderanyFederallawwithinthepreceding24months,wheretheawardingagencyisawareoftheconviction,unlesstheagencyhasconsideredsuspensionordebarmentofthecorporationorsuchofficer
oragentandmadeadeterminationthatthisactionis notnecessarytoprotecttheinterestsoftheGovernment.
(b)TheContractorrepresentsthat—
(1)Itis[]isnot[]acorporationthathas anyunpaidFederaltax liabilitythathasbeenassessed,forwhichalljudicialandadministrativeremedieshavebeenexhaustedorhavelapsed,andthatisnotbeingpaidinatimelymannerpursuanttoanagreementwiththeauthorityresponsibleforcollectingthetaxliability.
(2)Itis[]isnot[]acorporationthatwasconvicted,orhadanofficer oragentofthecorporationactingonbehalfofthecorporation,convictedofafelonycriminalviolationunderanyFederallawwithinthepreceding24months.
6.52.203-02-CERTIFICATEOFINDEPENDENTPRICEDETERMINATION(APR1985)
(Applicablewhentheestimatedvalueoftheacquisitionexceedsthesimplifiedleaseacquisitionthreshold)
(a)TheOfferorcertifiesthat—
(1)Thepricesinthisofferhavebeenarrivedatindependently,without,forthepurposeofrestrictingcompetition,anyconsultation,communication,oragreementwithanyotherOfferororcompetitorrelatingto(i)thoseprices,(ii)theintentiontosubmitanoffer,or
(iii)themethodsorfactorsusedtocalculatethepricesoffered;
(2)Thepricesinthisofferhave notbeenandwillnot beknowinglydisclosedbytheOfferor,directlyor indirectly,toanyotherOfferororcompetitorbefore bidopening(inthecaseofa sealedbidsolicitation)orcontractaward(inthecaseofanegotiatedsolicitation)unlessotherwiserequiredbylaw;and
(3)Noattempthasbeen madeorwillbe madeby theOfferortoinduceanyotherconcerntosubmitornottosubmitanofferforthepurposeofrestrictingcompetition.
(b)Eachsignatureontheofferisconsideredtobeacertificationbythesignatorythatthesignatory—
(1)IsthepersonintheOfferor'sorganizationresponsiblefordeterminingthepricesbeingofferedinthisbidorproposal,andthatthesignatoryhasnotparticipatedandwillnotparticipateinanyactioncontrarytosubparagraphs(a)(1)through(a)(3)above;or
(2) / (i) / Hasbeenauthorized,inwriting,toactasagentforthefollowingprincipalsincertifyingthatthoseprincipalshavenotparticipated,and willnotparticipate inany
actioncontrarytosubparagraphs(a)(1)through(a)(3)above
[Insert full
nameofperson(s)intheOfferor'sorganizationresponsiblefordeterminingthe
pricesofferedinthisbidorproposal,andthetitleofhisorherpositioninthe
Offeror'sorganization];
(ii) / Asanauthorizedagent,doescertifythattheprincipalsnamedinsubdivision
(b)(2)(i) above have not participated, and will not participate,in anyaction
contrarytosubparagraphs(a)(1)through(a)(3)above;and
(iii) / Asanagent,hasnotpersonallyparticipated,andwillnotparticipate,inaction
contrarytosubparagraphs(a)(1)through(a)(3)above.
(c)IftheOfferordeletes ormodifiessubparagraph(a)(2)above, theOfferormustfurnishwithitsofferasignedstatementsettingforthindetailthecircumstancesofthedisclosure.
7.52.203-11-CERTIFICATIONANDDISCLOSUREREGARDINGPAYMENTSTOINFLUENCECERTAINFEDERALTRANSACTIONS(SEP2007)
(Applicablewhentheestimatedvalueoftheacquisitionexceeds$100,000)
(a)Definitions.Asusedinthisprovision—“Lobbyingcontact”hasthemeaningprovidedat2U.S.C.1602(8).Theterms“agency,”“influencingorattemptingtoinfluence,”“officeroremployeeofanagency,”“person,”“reasonablecompensation,”and“regularlyemployed”aredefinedintheFARclauseofthissolicitationentitled“LimitationonPaymentstoInfluenceCertainFederalTransactions”(52.203-12).
(b)Prohibition.TheprohibitionandexceptionscontainedintheFARclauseofthissolicitationentitled“LimitationonPaymentstoInfluenceCertainFederalTransactions”(52.203-12)areherebyincorporatedbyreferenceinthisprovision.
(c)Certification.Theofferor,bysigningitsoffer,herebycertifiestothebestofitsknowledgeandbeliefthatnoFederalappropriatedfundshavebeenpaidorwillbepaidtoanypersonforinfluencingorattemptingtoinfluenceanofficeroremployeeofanyagency,aMemberofCongress, an officeroremployeeof Congress, oran employeeof a MemberofCongress onitsbehalfinconnectionwiththeawardingofthiscontract.
(d)Disclosure.IfanyregistrantsundertheLobbyingDisclosureActof1995havemadealobbyingcontactonbehalfoftheofferorwithrespecttothiscontract,theofferorshallcompleteandsubmit,withitsoffer,OMBStandardFormLLL,DisclosureofLobbyingActivities,toprovidethenameoftheregistrants.Theofferorneednotreportregularlyemployedofficersoremployeesoftheofferortowhompaymentsofreasonablecompensationweremade.
(e)Penalty.Submissionof this certificationanddisclosureisaprerequisiteformakingorenteringintothiscontractimposedby31 U.S.C.1352.Anypersonwhomakesanexpenditureprohibitedunderthisprovisionorwhofailstofileoramendthedisclosurerequiredtobefiledoramendedbythisprovision,shallbesubjecttoacivilpenaltyofnotlessthan$10,000,andnotmorethan$100,000,foreachsuchfailure.
8.52.209-5 - CERTIFICATIONREGARDINGRESPONSIBILITYMATTERS(APR2010)
(Applicablewhentheestimatedvalueoftheacquisitionexceedsthesimplifiedleaseacquisitionthreshold)
(a)(1)TheOfferorcertifies,tothebestofitsknowledgeandbelief,that—
(i)TheOfferorand/oranyofitsPrincipals—
(A)Are[]arenot[]presentlydebarred,suspended,proposedfordebarment,ordeclaredineligiblefortheawardofcontractsbyanyFederalagency;
(B)Have[]havenot[],withinathree-yearperiodprecedingthisoffer,beenconvictedoforhadaciviljudgmentrenderedagainstthemfor:commissionoffraudoracriminaloffenseinconnectionwithobtaining,attemptingtoobtain,orperformingapublic(Federal,State,orlocal)contractorsubcontract;violationofFederalorStateantitruststatutesrelatingtothesubmissionofoffers;orcommissionofembezzlement,theft,forgery,bribery,falsificationordestructionofrecords,makingfalsestatements,taxevasion,violatingFederalcriminaltaxlaws,orreceivingstolenproperty(ifofferorchecks“have”,theofferorshallalsosee52.209-7,ifincludedinthissolicitation);
(C)Are[]arenot[]presentlyindictedfor,orotherwisecriminallyorcivillychargedbyagovernmentalentitywith,commissionofanyoftheoffensesenumeratedinparagraph(a)(1)(i)(B)ofthisprovision;
(D)Have[],havenot[],withinathree-yearperiodprecedingthisoffer,beennotifiedofanydelinquentFederaltaxesinanamountthatexceeds
$3,000forwhichtheliabilityremainsunsatisfied.
(1)Federaltaxesareconsidereddelinquentifbothofthefollowingcriteriaapply:
(i)Thetaxliabilityisfinallydetermined.Theliabilityisfinallydeterminedifithasbeenassessed.Aliabilityisnotfinallydeterminedifthereisapendingadministrativeorjudicialchallenge.Inthecaseofajudicialchallengetotheliability,theliabilityisnotfinallydetermineduntilalljudicialappealrightshavebeenexhausted.
(ii)Thetaxpayerisdelinquentinmakingpayment.Ataxpayerisdelinquentifthetaxpayerhasfailedtopaythetaxliabilitywhenfullpaymentwasdueandrequired.Ataxpayerisnotdelinquentincaseswhereenforcedcollectionactionisprecluded.
(2)Examples.
(i)Thetaxpayerhasreceivedastatutorynoticeofdeficiency,underI.R.C.§6212,whichentitlesthetaxpayertoseekTaxCourtreviewofaproposedtaxdeficiency.Thisisnotadelinquenttaxbecauseitisnotafinaltaxliability.ShouldthetaxpayerseekTaxCourtreview,thiswillnotbeafinaltaxliabilityuntilthetaxpayerhasexercisedalljudicialappealrights.
(ii)TheIRShasfiledanoticeofFederaltaxlienwith respecttoanassessedtaxliability,andthetaxpayerhasbeenissuedanoticeunderI.R.C.§6320entitlingthetaxpayertorequestahearingwiththeIRSOfficeofAppealscontestingthelienfiling,andtofurtherappealtotheTaxCourtiftheIRSdeterminestosustainthelienfiling.Inthecourseofthehearing,thetaxpayeris entitledtocontesttheunderlyingtaxliabilitybecausethetaxpayerhashadnoprioropportunitytocontesttheliability.This isnotadelinquenttaxbecauseitisnotafinaltaxliability.Shouldthetaxpayerseektaxcourtreview,thiswillnotbeafinaltaxliabilityuntilthe taxpayerhasexercisedalljudicialappealrights.
(iii)ThetaxpayerhasenteredintoaninstallmentagreementpursuanttoI.R.C.§6159.Thetaxpayerismakingtimelypaymentsandisinfullcompliancewiththeagreementterms.Thetaxpayerisnotdelinquentbecausethetaxpayerisnotcurrentlyrequiredtomakefullpayment.
(iv)Thetaxpayerhasfiledforbankruptcyprotection.Thetaxpayerisnotdelinquentbecauseenforcedcollectionactionisstayedunder11U.S.C.362(theBankruptcyCode).
(ii)TheOfferorhas[]hasnot[],withinathree-yearperiodprecedingthisoffer,hadoneormorecontractsterminatedfordefaultbyanyFederalagency.
(2)“Principal,”forthepurposesofthiscertification,meansanofficer,director,owner,partner,orapersonhavingprimarymanagementorsupervisoryresponsibilities withina
businessentity(e.g.,generalmanager;plantmanager;headofadivisionorbusinesssegment;andsimilarpositions).
ThisCertificationConcernsa Matter WithintheJurisdictionofanAgency oftheUnitedStatesandtheMakingofaFalse,Fictitious,orFraudulentCertificationMayRendertheMakerSubjecttoProsecutionUnderSection1001,Title18,UnitedStatesCode.
(b)TheOfferorshallprovideimmediatewrittennoticetotheContractingOfficerif,atanytimepriortocontractaward,theOfferorlearnsthatitscertificationwaserroneouswhensubmittedorhasbecomeerroneousbyreasonofchangedcircumstances.
(c)Acertificationthatanyoftheitemsinparagraph (a)ofthisprovisionexistswillnotnecessarilyresult in withholdingof anawardunderthissolicitation.However,thecertificationwillbeconsideredinconnectionwithadeterminationoftheOfferor’sresponsibility.FailureoftheOfferortofurnishacertificationorprovidesuchadditionalinformationasrequestedbytheContractingOfficermayrendertheOfferornonresponsible.
(d)Nothingcontainedintheforegoingshallbeconstruedtorequireestablishmentofasystemofrecordsinordertorender,ingoodfaith,thecertificationrequiredbyparagraph(a)ofthisprovision. The knowledgeandinformationofanOfferorisnotrequiredtoexceedthatwhichisnormallypossessedbyaprudentpersonintheordinarycourseofbusinessdealings.
(e)Thecertificationinparagraph(a)ofthisprovisionisamaterialrepresentationoffactuponwhichreliancewasplacedwhenmakingaward.IfitislaterdeterminedthattheOfferorknowinglyrenderedanerroneouscertification,inadditiontootherremediesavailabletotheGovernment,theContractingOfficermayterminatethecontractresultingfromthissolicitationfordefault.
9.52.204-3-TAXPAYERIDENTIFICATION(OCT1998)
(a)Definitions.
“Commonparent,”asusedinthisprovision,meansthatcorporateentitythatownsorcontrolsanaffiliatedgroupofcorporationsthatfilesitsFederalincometaxreturnsonaconsolidatedbasis,andofwhichtheOfferorisamember.
“TaxpayerIdentificationNumber(TIN),”asusedinthisprovision,meansthenumberrequiredbytheInternalRevenueService(IRS)tobeusedbytheOfferorinreporting incometaxandotherreturns.TheTINmaybeeitheraSocialSecurityNumberoranEmployerIdentificationNumber.
(b)AllOfferorsmustsubmittheinformationrequiredinparagraphs (d)through (f)ofthisprovisiontocomplywithdebtcollectionrequirementsof31U.S.C.7701(c)and3325(d),reportingrequirementsof26U.S.C.6041,6041A,and6050M, andimplementingregulationsissuedbytheIRS.Iftheresultingcontractissubjecttothepaymentreportingrequirementsdescribed inFederal AcquisitionRegulation(FAR) 4.904,thefailureor refusal bytheOfferortofurnishtheinformationmayresultina31percentreductionofpaymentsotherwisedueunderthecontract.
(c)TheTINmaybeusedbytheGovernmenttocollectandreportonanydelinquentamountsarisingoutoftheOfferor’srelationshipwiththeGovernment(31U.S.C.7701(c)(3)).IftheresultingcontractissubjecttothepaymentreportingrequirementsdescribedinFAR4.904,theTINprovidedhereundermaybematchedwithIRSrecordstoverifytheaccuracyoftheOfferor’sTIN.
(d)TaxpayerIdentificationNumber(TIN).
[]TIN:
______
[]TINhasbeenappliedfor.
[]TINisnotrequiredbecause:
[]Offerorisa nonresidentalien,foreign corporation,or foreignpartnership thatdoesnothaveincomeeffectivelyconnectedwiththeconductofatradeorbusinessintheUnitedStatesanddoesnothaveanofficeorplaceofbusinessorafiscalpaying
agentintheUnitedStates;
[]Offerorisanagencyorinstrumentalityofaforeigngovernment;
[]OfferorisanagencyorinstrumentalityoftheFederalgovernment;
(e)Typeoforganization.
[]Soleproprietorship;[]Governmententity(Federal,State,orlocal);
[]Partnership;[]Foreigngovernment;
[]Corporateentity(nottax-exempt);[]Internationalorganizationper26CFR1.6049-
4;
[]Corporateentity(tax-exempt);[] Other ______
(f)CommonParent.
[]Offerorisnotownedorcontrolledbyacommonparentasdefinedinparagraph(a)ofthisprovision.
[]NameandTINofcommonparent:
Name
TIN
______
10.52.204-6–DATAUNIVERSALNUMBERINGSYSTEM(DUNS)NUMBER(APR2008)
(a)Theofferor shallenter,in theblockwithitsnameandaddressonthecoverpageofitsoffer,theannotation“DUNS”or“DUNS+4”followedbytheDUNSnumberor“DUNS+4”thatidentifiestheofferor’s nameandaddress exactlyasstatedin theoffer.TheDUNSnumberisanine-digitnumberassignedbyDunandBradstreet,Inc.TheDUNS+4istheDUNSnumberplusa4-charactersuffixthatmaybeassignedatthediscretionoftheofferortoestablishadditionalCCRrecordsforidentifyingalternativeElectronicFundsTransfer(EFT)accounts(seeSubpart32.11)forthesameconcern.
(b)If theofferordoes not haveaDUNSnumber,itshouldcontactDunand Bradstreet directlytoobtainone.
(1)AnofferormayobtainaDUNSnumber—
(i)ViatheInternetat
(ii)IflocatedoutsidetheUnitedStates,bycontactingthelocalDunandBradstreetoffice.TheofferorshouldindicatethatitisanofferorforaU.S.GovernmentcontractwhencontactingthelocalDunandBradstreetoffice.
(2)Theofferorshouldbepreparedtoprovidethefollowinginformation:
(i)Companylegalbusinessname.
(ii)Tradestyle,doingbusiness,orothernamebywhichyourentityiscommonlyrecognized.
(iii)Companyphysicalstreetaddress,city,stateandZIPCode.
(iv)Companymailingaddress,city,stateandZIPCode(ifseparatefromphysical).
(v)Companytelephonenumber.
(vi)Datethecompanywasstarted.
(vii)Numberofemployeesatyourlocation.
(viii)Chiefexecutiveofficer/keymanager.
(ix)Lineofbusiness(industry).
(x)CompanyHeadquartersnameandaddress(reportingrelationshipwithin yourentity).
11.DUNSNUMBER(JUN2004)
Notwithstandingtheaboveinstructions,inadditiontoinsertingtheDUNSNumberontheoffercoverpage,theOfferorshallalsoprovideitsDUNSNumberaspartofthissubmission:
DUNS#
______
12.CENTRALCONTRACTORREGISTRATION(MAY2012)
TheCentralContractorRegistration(CCR)Systemisacentrallylocated,searchabledatabasewhichassistsinthedevelopment,maintenance,andprovisionofsourcesforfutureprocurements.TheOfferormustberegisteredintheCCRpriortoleaseaward.TheOfferorshallregisterviatheInternetat
[] RegistrationActiveandCopyAttached
[] WillActivateRegistrationandSubmitCopytotheGovernmentPriortoAward
OFFEROR OR AUTHORIZED REPRESENTATIVE / NAME, ADDRESS (INCLUDINGZIP CODE)NAMESTREET
CITY, STATE, ZIP
Signature / TELEPHONE NUMBER
______
Date