Supplier Annual Certifications and Representations

SUPPLIER ANNUAL CERTIFICATIONS AND REPRESENTATIONS

The United States Government requires Goodrich Corporation and Hamilton Sundstrand Corporation (collectively, UTC Aerospace Systems or “UTAS”) on behalf of its legal entities, subsidiaries and affiliates to obtain the completed and signed certifications contained herein. These certifications are required annually and will be effective for one year.

Supplier must complete Sections 1 through 12, Section 30 and all applicable Sections set forth in Table 1.

NOTE: The penalty for making false statements in offers is set forth in 18 U.S.C. 1001. (if a

Table 1Red numbers indicate referenced sections.

For Solicitations: / Complete Sections:
Manufacturers of Defense Articles / 13 – 18 plus all below that apply
Over $10,0001 / 19-24
Over $25,0002 / 25
Over $30.0003 / 26
Over $150,0004 / 27 & 28
Where UTAS is Prime, Supplier is First-Tier and Over $25,0005 / 29

ERP Supplier Code /Codes: (UTC use only)

Supplier Company Name: Supplier Address:

Congressional District:

Cage Code:

Duns Number:

Primary NAICS Code (6-digit):

SAM (System for Award Management) Registration Date, active until:

When does your fiscal year start and end?

**Supplier must provide with this submission its latest revision Form W-9**

1. Type of Business Organization

The supplier, by checking the applicable box below, represents that it operates as:

Individual / Non-Profit Organization / Corporation / State or Local Government Agency
Partnership / Limited Liability Corporation / Division / Corporation, Incorporation Under the Laws of the State of:
.
Joint Venture / Limited Liability Partner / Subsidiary / Years in Business

2. Parent Company

Check (√) oneSupplier is, is not owned (more than 50% voting rights) or controlled by a common parent business concern. If yes, please complete information below.

Name:

Address:

Address 2:

City: State: Country: Postal Code:

Parent Duns #:

United States Owned Yes, No

If No, Non-U.S. Owned But Incorporated in the U.S. Yes, No

3. Union Contract

In order to fulfill requirements to notify customers in the event of actual or anticipated labor strikes, we request the following Information:

Check (√) one Supplier has does not have a union at this location. If Yes, please complete information below. For multiple unions please attach additional information.

Union name:

Contract expiration date:

4. Business Size

Small Large United Technologies Corp., affiliated entity

NOTICE: Under 15 U.S.C. 645 (d), any person who misrepresents a firm's status as

established pursuant to Sections 8(a), 8(d), 9, 15, 31 or 36 of the Small Business Act or any other

provision of the Federal Law that specifically references Section 8(d) for a definition

of program eligibility, shall (1) be punished by the imposition of fine, imprisonment, or

be ineligible for participation in programs conducted under the authority of the act.

Socio-economic Classifications (Check all that apply)

Self Certified Minority Owned (MBE)

Certified MBE: Must provide a copy: NMSDC or State Certification

Self Certified WOSB/WBE

Certified WOSB/WBE: Must provide a copy: WBENC or State Certification

Native American Owned (NA)

Alaskan Native American Owned (ANA)

Veteran Owned (VOSB)

Service Disabled Veteran Owned (SDVOSB)

Severely Handicapped

Historically Black Colleges and Universities / Minority Institutions

Self Certified SDB (Small Disadvantaged Business)

HUB Zone (HUB): Must provide a copy :: SBA Hub Zone Letter of Certification

5. Preference for Domestic Specialty Metals

(OR A PART(S) THAT HAS A MILITARY REQUIREMENT OR APPLICATION (REFERENCED ON THE DRAWING OR OTHER APPLICABLE DOCUMENTS), THE SELLER AGREES TO COMPLY WITH THE FOLLOWING:

PER DFARS 252.225-7008-7009: If the part(s) or assemblies for this order contain “Specialty Metals” (defined as titanium, zirconium, alloys consisting of nickel, iron-nickel, cobalt, titanium, or zirconium, or certain steel alloys), then these “Specialty Metals” must be MELTED in the United States or in a Qualified Country as defined in the Defense Federal Acquisition Regulation Supplement 225.003(9), which are (Austria, Australia, Belgium, Canada, Denmark, Egypt, Federal Republic of Germany, Finland, France, Greece, Israel, Italy, Luxembourg, Netherlands, Norway, Portugal, Spain, Switzerland, Turkey, Sweden, United Kingdom of Great Britain, and Northern Ireland). This requirement applies to every sub-tier under contract with your company supporting military parts for UTC Aerospace Systems, therefore, this requirement must be flowed down to every level in that supply chain.

Do you comply with DFARS 252.225-7008-7009? YES, NO -Reason: . If you do not comply with this requirement, contact your UTC Aerospace Systems buyer(s).

6. Report of Performance Outside of the United States

As prescribed in DFAR 252.225.7003, The supplier shall submit, with its offer, a report of intended performance outside the United States and Canada if—

(1) The offer exceeds $12.5 million in value; and

(2) The offeror is aware that the offeror or a first-tier subcontractor intends to perform any part of the contract outside the United States and Canada that—

(i) Exceeds $650,000 in value; and

(ii) Could be performed inside the United States or Canada.

7. FAA Repair, Overhaul, Modification or Inspection

Does your company perform any FAA repairs, overhauls, modifications or inspections as defined in CFR Title 14, Part 145 either as a FAA approved Repair Station or under contract from a FAA approved Repair Station?

Yes No (If No, go to next sub-section for non-certified Repair Stations)

Is your company an FAA approved Repair Station? (CFR Title 14, Part 145)

Yes No (If No – go to item 7 below)

If you respond “Yes” to question 2, please provide the date the certification was issued or review and identify the types of repairs the station is rated to perform.

Do you perform maintenance, repairs, overhauls, modifications or inspections and approve for return to service components which belong to air carriers? (CFR Title 14, Part 121)

Yes No

Do you have an FAA approved Anti-Drug and Alcohol Misuse Prevention Program?

Yes No

Is your FAA approved Anti-Drug and Alcohol Misuse Prevention Program identified on your Operations Specifications with page A-449?

Yes No

Do you subcontract any maintenance, repairs, overhauls, modifications or inspections to sub-tier contractors?

Yes No

(If Yes, do you ensure that these companies have a FAA approved Anti-Drug and Alcohol Misuse Prevention Program?)

YesNo

The following only applies to non-certificated Repair Stations

Do you subcontract any maintenance, repairs, overhauls, modifications or inspections for a UTC

Aerospace Systems business?

YesNo

(If Yes, do you have a FAA approved Anti-Drug and Alcohol Misuse Prevention Program in place?)

Yes No

If Yes, please provide Plan number:

8. Subcontractor (Supplier) Code of Business Ethics (FAR 52.203-13)

In accordance with FAR 52.203-13, supplier must maintain specific written standards of conduct. The rule applies to all new contracts and subcontracts (except for commercial item contracts and contracts to be performed entirely outside of United States) that are expected to exceed $5 million and have a performance period of 120 days or more.

Meeting the above criteria supplier must have the following requirements in place:

• Have written code of business ethics and conduct;
• Provide copy of written code to each employee on the contracted project;
• Promote compliance with the code; and
• Establish an ongoing awareness program, with sufficient internal controls to facilitate discovery of improper conduct.

Do you have program in place which meets the requirements specified above?

Yes No

If your response was "No" identify your plan to comply: (Unlimited entry field)

9. Customs Administration C-TPAT

Do you participate or are certified in a supply chain security program administered by your government’s customs administration? YES, NO. If answered YES, please indicate the name of the security program .

10. HS14722 Materials of Concern, Requirements Specification for Procured Parts- (Hamilton Sundstrand contracts only.)

Supplier hereby certifies by signing this document that the supplier is in compliance with HS14722, “Controlled Materials for Procured Parts.” Supplier is responsible for managing “Hazardous Materials” in supplier-designed articles, supplier specifications and work instructions required to be developed and delivered on Hamilton Sundstrand purchase orders and contracts.

11. Aerospace Insurance as per UTC Standard Terms & Conditions Sec. 23.

For Suppliers Manufacturing Flight Safety Parts:

Supplier agrees to secure and carry as a minimum the following insurance with respect to all work

to be performed under UTAS purchase orders when providing product, component parts, materials or work to be incorporated in aircraft where such products, parts or materials are classified as Flight Safety Parts (FSP) or its equivalent per the UTC Standard Terms and Conditions of Purchase Section 23.2 . A valid certificate of Liability Insurance naming UTC and buyer as the Certificate Holder must be submitted as validation of this information. For Suppliers Manufacturing Non-Flight Safety Parts:

Supplier agrees to secure and carry as a minimum the following insurance with respect to all work

to be performed under UTAS purchase orders: Commercial General Liability Insurance per UTC Standard Terms and Conditions listing UTC and buyer as the Certificate Holder must be submitted as validation of this information.

*Must complete the Supplier Limits and Policy Number fields below. Mark N/A as the policy number in categories that do not apply.

Limits / Aircraft Liability Coverage
Flight Safety Parts / General Liability
UTC MANDATORY LIMITS / $50,000,000 / $5,000,000
*Supplier Limits
*Policy Number

12. Export Compliance

Supplier (or its Parent Company) is is not registered with the Directorate of Defense Trade Controls (DDTC), for United States suppliers as required by Section 122.1 (A) of the International Traffic In Arms Regulations (“ITAR”) who are engaged in the business of either manufacturing or exporting defense articles or furnishing defense services listed on the United State Munitions List.

1. Is your company incorporated in the United States? Yes No

1. Will non-U.S. persons have access to commodities or technology which is controlled by the Department of State or sensitive commodities or technology which is controlled by the Department of commerce? Yes No N/A
2. Does your company have an International Trade Compliance program? Yes No

OR

Your company is a Canadian company (or the Parent company) that manufactures, examines, possesses or transfers controlled goods in Canada and is is not registered with the Canadian Goods Program (CGP).

Expiration date of current registration Select from Drop Down1/31/20162/29/20163/31/20164/30/20165/31/20166/30/20167/31/20168/31/20169/30/201610/31/201611/30/201612/31/20161/31/20172/28/20173/31/20174/30/20175/31/20176/30/20177/31/20178/31/20179/30/201710/31/201711/30/201712/31/2017

We certify and understand, in accordance with ITAR requirements non-United States Persons are not allowed to view or transmit any drawing, document, specification, or technical information that is a part of any UTAS transmitted package. If any non US person might require a need to know, then a specific request will be made to UTAS for clearance. Non-US persons are not authorized on the UTAS site without prior written approval from the UTAS Export Compliance Officer. We understand all Visitors and/or Contractors acting in the performance of any order must submit information for screening prior to arrival at UTAS.

13. “Buy American Act-Trade Agreements” (FAR 52.225-1-4, DFARS 252.225.7000-7001) Only for government contracts, not commercial contracts.

Supplier must certify compliance with the Buy American Act (per FAR 52.225-1-4 and DFARS)

Supplier hereby DOES DOES NOT certify that each deliverable part is a domestic end Product as defined in the above FARS and DFARS, and that components of unknown origin have been considered to have been mined, produced or manufactured outside the United States, a designated country, a NAFTA country or a Caribbean basin country. PROVIDE A LIST OF ALL NON-COMPLIANT PARTS ON SEPARATE ATTACHMENT.

14. Safeguarding of Unclassified Controlled Technical Information (DFARS 252.204-7012) (Nov 2013)

Supplier certifies that it understands and will comply with the safeguarding requirements and procedures to protect unclassified controlled technical information on its unclassified information systems from unauthorized access and disclosure in accordance with the above referenced clause, including the requirement to properly report a “reportable” cyber-incident, as defined and specified in therein.

Yes No

Supplier understands that the requirements of this clause apply to every sub-tier supplier. Supplier certifies that it has policies/procedures in place to ensure compliance with the above referenced clause for itself and all sub-tier suppliers.

Yes No

15. Contractor Counterfeit Electronic Part Detection and Avoidance System (DFARS 252.246-7007) (May 2014)

Supplier understands that the above referenced clause applies if Supplier is furnishing electronic parts in to UTAS in support of a U.S. Government contract. Supplier certifies that it understands and will comply with the requirements in the above referenced clause and shall establish and maintain an acceptable counterfeit electronic part detection and avoidance, as defined and specified in therein.

Yes No

Please note: If Supplier answers “NO” to this question, Supplier is certifying that it is not subject to the Cost Accounting Standards under 41 U.S.C. chapter 15, as implemented in regulations found at 48 CFR 9903.201-1please proceed to the next section of this form.

Supplier understands that the requirements of this clause apply to every sub-tier supplier. Supplier certifies that it has policies/procedures in place to ensure compliance with the above referenced clause for itself and all sub-tier suppliers.

Yes No

Please note: If Supplier answers “NO” to this question, Supplier is certifying that it is not subject to the Cost Accounting Standards under 41 U.S.C. chapter 15, as implemented in regulations found at 48 CFR 9903.201-1.

16. Fees, Commissions and Political Contributions (ITAR Part 130)

The U.S. Department of State requires that UTAS report certain fees, commissions and political contributions that UTAS and its vendors have paid, offered, or agreed to pay to secure the foreign sale of defense articles or defense services.

Will this Agreement involve direct sales to a non-U.S. armed forces or international organization? / Yes No
Is your company providing defense articles valued at $500,000 or more for eventual use by a non-U.S. armed forces or international organization? / Yes No
Will your company engage any sales representative to secure these sales? / Yes No
Will your company pay or offer to pay any fees*, commissions* or political contributions to secure these sales? (See note below) / Yes No
If your company would make such payments, please identify the estimated amount of these payments over the course of the proposed agreement. Please report the amount in U.S. dollars. / $
If yes to any of the above, please provide the requested information for each individual that will receive the fees, commissions, or political contributions below:
Name / Program / Customer(s) / Fee and Commission Paid to Sales Rep (in U.S. $)?
$
$
$
Add lines if necessary / $

*The term fee or commission does not include:

(1) A political contribution or a payment excluded by ITAR §130.6 from the definition of political contribution;

(2) A normal salary (excluding contingent compensation) established at an annual rate and paid to a regular employee of an applicant, supplier or vendor;

(3) General advertising or promotional expenses not directed to any particular sale or purchaser; or

(4) Payments made, or offered or agreed to be made, solely for the purchase by an applicant, supplier or vendor of specific goods or technical, operational or advisory services, which payments are not disproportionate in amount with the value of the specific goods or services actually furnished.

17. Certification Regarding Knowledge of Child Labor for Listed End Products (FAR 52.222-18)

(1) The offeror will not supply any end product listed in paragraph (b) of this provision that was mined, produced, or manufactured in a corresponding country as listed for that end product.

(2) The offeror may supply an end product listed in paragraph (b) of this provision that was mined, produced, or manufactured in the corresponding country as listed for that product. The offeror certifies that is has made a good faith effort to determine whether forced or indentured child labor was used to mine, produce, or manufacture such end product. On the basis of those efforts, the offeror certifies that it is not aware of any such use of child labor.

18. Prohibition Of Segregated Facilities (FAR 52.222-21)

1. The Seller certifies that it does not and will not maintain or provide for its employees any segregated facilities at any of its establishments and that it does not and will not permit its employees to perform their services at any location under its control where segregated facilities are maintained. The Seller agrees that a breach of this certificate is a violation of the Equal Employment Opportunity clause in any contract or subcontract resulting from this solicitation.

2. “Segregated facilities,” means any waiting rooms, work areas, restrooms and washrooms, restaurants and other eating areas, time clocks, locker rooms and other storage or dressing areas, parking lots, drinking fountains, recreation or entertainment areas, transportation, and housing facilities provided for employees, that are segregated by explicit directive or are in fact segregated on the basis of race, color, religion, or national origin because of habit, local custom, or otherwise.

Complete Parts 19-24 For All Solicitations (Over $10,000) 1

19. Previous Contracts and Compliance Reports (FAR 52.222-22) 1

1. Check (√)Supplier HAS, HAS NOT participated in a previous contract or

one of twosubcontract subject to either (a) FAR 52.222-26, “Equal Opportunity”, (b)

the clause originally contained in Section 310 of Executive Order No.

10925, OR (c) the clause contained in Section 201 of Executive Order

No. 11114.

2. Check (√)Supplier HAS, HAS NOT filed all required compliance reports;

one of twoand representations, signed by subcontractors, indicating submission of

required compliance reports will be obtained before subcontract awards.

1. EXEMPTION: Supplier is , is not exempt from above on the basis that all work related to goods or services sold to UTAS is performed entirely outside the United States by employees who were not recruited within the United States.

20. Affirmative Action Compliance (FAR 52.222-25) 1

Check (√) one

1.Supplier HAS developed and has on file Affirmative Action programs at each establishment as required by the rules and regulations of the Secretary of Labor (41 CFR 60-1 and 60-2)

Supplier HAS Not developed and does not have on file at each establishment, affirmative action programs required by the rules and regulations of the Secretary of Labor (41 CFR 60-1 and 60-2).