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NA
<br /> SMALL BUSINESS(Set pa 33-4 1
<br /> r 14 or SF
<br /> `le D.4..7 Is not,a small business:pacrrn.I,'uiicror is a small business concern and is nor the manufacturer of the supplies offered,he also repro .tits that
<br /> r upplcs.t,be furnished hereunder D tLiil, a ill no be manufactured or produced by a small business concern in the United States,its posse ions"or
<br /> r i\7 Rico
<br /> r'„GL'LAR DEALER—MANUFACTURER r,ip!ol,rablr on!! !o tupp4 contract:exceeding St0.00O.) NA
<br /> tic is a D regular dealer in D manufacturer of. the supplies offered.
<br /> CONTINGENT FEE are par. 13 on SF 33—A.) NA
<br /> is I He 0 hss,0 has not,employed'or retained any company or person(other than.r ful/.,time. bona fide employe working solely for the offeror)
<br /> cr, this cons:re e, and (h) he h] has ❑has nor,paid or agreed to pay any•company or person(other than a fat J to soli,
<br /> :rr.r)any fee..commission,percen:aFc,u: b:oi;erage fee contingent upon or resultiingfrom the award of this contract;and agrees CO finish nfo ru On rel:r.
<br /> to (a: a r.4 (b) above„as requested ti)•the Contracting Officer,(For interpretation of the representation, including 1hr term •'bona fide employer."a Code o
<br /> ecerri Repd.rtioos. Title 41,Subpart 1-1 5) of
<br /> a TYPE OF BUSINESS ORGANIZATION NA
<br /> He operates as 0 an individual, D a]partnership,0 a nonprofit organization,0 a corporation,incorporated under the lases of the Stare of
<br /> -
<br /> _. _
<br /> S.. AFFILIATION AND IDENTIFYING DATA(r(Dplirableonly to adterrhed solicitations) _
<br /> Each offeror 01a11 complete (a) and (b) if applicable.and (c) below:
<br /> (a) He D is.Q is not,owned or controlled by a parent company.(See par, 16 oa SF 33-A,)
<br /> (b) 1f the offeror is owned or controlled by a parent company.he shall enter in the blocks below the name and main office address attic parent-company;
<br /> Name of Parent company and main office address_
<br /> (include Zip Cade) _ ....__ '---
<br /> (c) Employer's identification number(See par, 17 on 5F 33-4 —,----
<br /> c. EQUAL OPPORTUNITY N ietodt EJ, No.) (Porno Cosepa,rya E.1, No.)
<br /> He()has.0 has not;participated in a previous contract or subcontract subject either to the Equal Opportunity clause herein or the clause originally con-
<br /> tained in section 301 of Executive Ord No. 10925,or the clause contained in section 201 of Executive Order No 11114;that he 0 has.0 has not.filed all
<br /> :egaired compliance reports;and that representations indicating submission of required compliance reports,signed by proposed subcontractors.will be obtained
<br /> ;nior to subcontract awards,(Ti e abort representation nerd not be ruba:irled le connection with rontnrrts or jrtbroatraw ulbtrb.err etiarpt front the dam)
<br /> ' BUY AMERICAN CERTIFICATE I
<br /> 'The offeror hereby certifies that each end product,except the end products listed below,is a domestic source end product (as defined in the dowse entitled
<br /> Buy American Ace );and that components of unknown origin have been considered to have been mined,produced,or manufactured outside the United Stara.
<br /> =AMMO END PRODUCTS
<br /> COUNTRY OP ORIGIN
<br /> 5.. CERTIFICATION OF INDEPENDENT PRICE DETERMINATION pre par, 18 on SF 33-4,)
<br /> (a) By submission of this offer, the offeror certifies,and in the case of a joint offer,each parry thereto N testifies as to its own organization,that in ten
<br /> 4'ITh this pr Urmissiont: "`
<br /> (I) The prices iii-this offer have been arrived at independently,without consultation.communication,or agreement,for the purpose of restricting compe
<br /> rition,as to any matter relating to such prices with any ocher offeror or with any competitor;
<br /> dire (2) Unless otherwise required by law,the prices which have been quoted in this offer have not been knowingly disclosed by the offeror and`+ill nn
<br /> ctly of indirect
<br /> ly to to nt other 1orrto any competitor;and of an advertised procurement or prior to award in the case of a negotiated procurement.
<br /> (3) No attempt has been made or fall be made by the offeror tolinduce any other person or firm to submit or not to submit an offer for the
<br /> restricting competition.
<br /> (b) Each person signing this offer certifies that: purpose of
<br /> not participated.( is he person in the offeror's organization responsible within that organization for the decision as to the prices being offered herein and that he has
<br /> and will not participate,in any action contrary to (a) (1) through a
<br /> (2)°(i) Ht is not the �_'� O �) 3 (a) (3) above;or
<br /> that he has been is authorized pro writing te]offft o agent for then persons ensitsa within that organization for the decision as to the prices being offered herein but
<br /> will not participate,in any action coiltraryy to (a) (1) through a) (3)above,and as their agent does hereby sogcert certify.; (ii)he has nor pat'cricipared,and
<br /> will not participate,in any action contrary to (a) (i) through (a) (3)above.
<br /> 9 CERTIFICATION OF NONSEGREqATED FACILITIES
<br /> (Applicable to (I) contracts, (2) subcontracts.and (3)agreements with applicants who are themselves performing federally assisted construction contracts,
<br /> exceeding=10.00p which are nor exempt from the provisions of the Equal Opportunity
<br /> By the submission of this bid,the biddet,offeror,applicant,or subbccontra f certifies chat he does not maintain or provide for his employees any segregated
<br /> raeilities at any of his establishments,andlthat he does not permit his employees to perform their services at any location,under his control,where segregated
<br /> facilities are maintained. He certifies further that he will not maintain or provide for his employers any segregated facilities at any of his establishments,and
<br /> that he will not permit his employees to perform their services at any location,under his control,where segregated facilities are maintained.The bidder,offeror,
<br /> applicant,or subcontractor agrees that a breach of this certification is a violation of the Equal Opportunity I
<br /> the term "'segregated facilities- means an waiting rooms, work areas,rest rooms and wash rooms,restaurants and other eating areas,time clocks,locker
<br /> g q Pportunity a arse in this contract.As used in this ctttifitarion,
<br /> foorcm and l ye s storage
<br /> segregated egatedgbyrexsll cit directive i 'orrare in fact segreoatedroan the basis of race,color,treligionsor, national-origin,because of habit,local
<br /> P' Y, transportation,and housing facilities provided
<br /> custom,or otherwise. He further agrees r'at (except where he has obtarncd identical certifications from proposed subcontractors for specific time periods) he
<br /> will obtain identical certifications from proposed subcontractors prior to the award of subcontracts exceeding$10,000 which are not exempt from the pros isions
<br /> of the Equal Opportunity clause;that he will retain such certifications in his files;and that he will forward the following notice to such proposed subcontrac.
<br /> :o:s (except where the proposed subcontractors have submitted identical certifications for specific time periods):
<br /> 't'one'r to pro:pat::,a arbrontratror,of reg1irrrmenr for rrrrifrrarlon: of nonsegregated facilities.
<br /> 1 Cerrifica[ion of Nonsegregated Facilities must he submitted prior to the award of a subcontract exceeding 510,000 which is not exempt from the +ravi•
<br /> 'inns of the Equal Opportunity clause, Thir certification ma} be submitted either for each subcontract or for all subcontracts during a period (i qua:e:ly,•
<br /> szrniannually or annual)}),NOTE. The pe4altl for rt.,king falsetiatrmrrr$ I,.offer: i:prr:rribed in 19 U..S•.C, 200!.,'
<br /> t=><NOw1EDGMENI or n1,yENDMENTS AMENDtn NT _
<br /> T,s•{Acre:0ctno+led E NO, DI,TE AMENDMENT NQ,'
<br /> 1,Ih•30bs:10600 for ORnr'nod rain:dddom '� PATE
<br /> near na"bered and du4d as folio,,,, I '
<br /> _ —7.________--
<br /> %'QTE.—O`f/rrr nrrrt::rt fort)/fu/l.acrargle.l and tom !ear •_��
<br /> T-art in offer: is prescribed in 18 U.S.0. IOD1. p information at required by chit 5ofiritalion (including attachments)$ The penalty for making fn/:e aatr-
<br /> ]_T]Or afve RSC Or STANDAa4 a *M as,N I •-�-- _^�_�`".��� -- -.
<br /> 1 T?, �teat<€R 1909 — .�,
<br /> Vi wrirw,i,t AI nrY ArrCt
<br /> 1. .. •ra.-ea�090V1 bl�of
<br /> 7 :Yi�T.•..r rhil3;t.'irli!d ',...r1` ,.,.`._ ...,ti . . __... —._,.._, _.. .
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