EXECUTIVECOMPENSATIONCERTIFICATION(FAR52.204-10)
InaccordancewithPublic Law109-282 andFAR52.204-10,ReportingExecutiveCompensation forFirst-TierSubcontractAwards(JUL2010), you arerequired to providecertain information pertainingtocompensationofexecutives inorderto be eligible for thissubcontract award.Please answer thefollowingquestion(s) in connectionwiththis requirement:
1. Didyourorganization in the previoustax year havegrossincomefromallsourcesover$300,000?
Yes No
If youanswered“No” to question1 above,you are exempt fromthisreportingrequirement.Pleasesigninthe spacesindicated belowand returnthiscertification tothecognizant APLprocurementrepresentative.If youanswered “Yes,”pleasecompleteTableI and answer thefollowingquestions:
2. Didyourcompanyreceive 80% ormoreofits annualgrossrevenuesfrom Federalcontracts(andsubcontracts),loans, grants(andsubgrants)andcooperativeagreementsinthe preceding fiscalyear?
Yes No
3. Didyourcompanyreceive $25,000,000or moreinannualgrossrevenuesfromFederalcontracts (andsubcontract), loans, grants (and subgrants)andcooperativeagreementsin thepreceding fiscalyear?
Yes No
4. Does thepublicNOT haveaccesstoinformationaboutthecompensationofyourcompany’sexecutivesthrough periodicreportsfiledunder13(a)or15(d) oftheSecuritiesExchange Act0f1934 (15U.S.C.78m(a), 78o(d))orsection6104oftheInternalRevenueCodeof1986?(Todetermineifthepublichasaccess tothe compensationinformation,seethe U.S.Security andExchange Commissiontotalcompensationfilingat
Yes No
If theanswers to questions2, 3 and 4areall “Yes,”you are requiredtoprovidethenames and totalcompensationofeachof thefive mosthighlycompensatedexecutives inyour organization as part ofthis certification,and onanannualbasis forthe lifeofthissubcontract.Providethis compensationinformation inTableIIbelow.Please notethatasrequiredby publiclawand FAR 52.204-10(b), APL willreportthis informationto thegovernment,andthisinformationwillbe made public.Further,pleasenoteyourcontinuingobligationto immediatelynotifyAPL in writingof anychangestopreviouslyreporteddata.
Thiscertificationconcernsa matter within the jurisdiction ofan agency ofthe UnitedStates andthemaking ofa false,fictitious,or fraudulentcertification mayrenderthemaker subject to prosecutionunder Section1001, Title 18,UnitedStatesCode.
CONSENT TO USE OF ELECTRONIC SIGNATURES
BY CHECKING HERE, I AGREE TO THE USE OF ELECTRONIC SIGNATURES AS VALID, LEGALLY BINDING SUBSTITUTES FOR ORIGINAL, HANDWRITTEN SIGNATURES ON THIS DOCUMENT.
Company______
Name (signature)______
Name (printed)______
Title ______Date of execution______
Rev. Date: 10 July 2015
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EXECUTIVECOMPENSATIONCERTIFICATION(FAR52.204-10)
TableI
SubcontractorDUNSNumberSubcontractorParentCompanyDUNSNumber(ifapplicable)
SubcontractorPrimaryAddressMustIncludenine-digitzip codeandCongressionaldistrict.
PrimaryLocationforPerformanceofSubcontract(ifdifferentfromPrimaryAddress).
MustIncludenine-digitzip codeandCongressionalDistrict.
NorthAmericanIndustryClassificationSystem(NAICS)code
TableII
Name / TotalCompensation(asdefinedinFAR52.204-10(a))Executive1
Executive2
Executive3
Executive4
Executive5
TableIII(ForAPLInternalUseOnly)
SubcontractnumberAmountofthesubcontractaward
Dateofthesubcontractaward
Adescriptionoftheproductsorservicesbeingprovided,includingoverallpurposeandexpectedresults
Theprimecontractnumber
Awardingagencynameandcode
Fundingagencynameandcode
Governmentcontractingofficecode
TreasuryAccountSymbol(TAS)asreportedinFPDS
Rev. Date: 10 July 2015
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