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DSCR K8H: OFFEROR REPRESENTATIONS/CERTIFICATIONS AND FILL-IN INFORMATION ELECTRONIC COMMERCE (EC)
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Section: K
DPACS Code: K8H
BSM Code: K13C01
Clause Number: 52.213-9004
Type: DLAD
Clause last updated: 2004-07
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Date of text: 1999-08
K8H 52.213-9004 Offeror Representations, DLAD (AUG 1999)
Certifications, and
Fill-In Information
Electronic Commerce
(a) Offerors are required to provide the following socio
economic and other data in a coded, rather than a fill-in, format.
This provision consolidates, to the maximum extent practicable, all
applicable representations and certifications (other than those
provided on an annual basis) and fill-in portions of clauses and
provisions from the Federal Acquisition Regulation (FAR), the
Defense FAR Supplement (DFARS), and the DLA Acquisition Directive
(DLAD).
(b) This provision constitutes a recordation of the
representations, certifications, and other data requirements
contained in the individual provisions incorporated herein by
reference via the citation(s) at each numbered paragraph. It is
not intended to supersede those provisions, except that the
requirement for marking certain boxes or otherwise entering
information individually into these cited provisions is hereby
replaced by the requirement to complete this provision 52.213-9004.
The offeror is reminded that all provisions incorporated herein
by reference remain binding in their entirety. Any penalties for
misrepresentation contained in the referenced provisions (e.g.,
penalties for misrepresentation of business status under FAR 52.219-1,
paragraph (d)(2), still apply. Furthermore, additional information
required by the individual provisions to be provided "at the time of"
or "with" the offer must be transmitted elsewhere in your response
or sent/faxed under separate cover (as appropriate) concurrently
with your transmitting this transaction to the Government.
(c) The offeror may electronically access the full text of
each referenced provision at, or through links provided at:
http://www.procregs.hq.dla.mil/regs. The offeror may also request
that that the contracting officer provide the hard-copy full text
of any DLAD or local provision(s) referenced below.
(d) The following provision segments, identified, where
necessary, to a specific line item number(s), must be completed
by the offeror.
01 FAR 52.204-3, Taxpayer Identification [also, FAR
52.212-3, Offeror Representations and Certifications - Commercial
Items (paragraph (b)), when used for commercial items].
01A Enter one of the following: TIN (without dashes); or
the appropriate code from the list below; or state other basis why
TIN is not required._______________________________________.
BA = TIN has been applied for.
TIN is not required because:
FO = Offeror is a nonresident alien, foreign corporation,
or foreign partnership that does not have income effectively connected
with the conduct of a trade or business in the U.S., and
does not have an office or place of business or a fiscal paying agent
in the U.S.
FG = Offeror is an agency or instrumentality of a foreign
government.
GT = Offeror is an agency or instrumentality of the Federal
government.
01B Select one code from the following list that
identifies the offeror's type of organization. If other than those
listed, provide identification: ____________________.
PM = Corporate entity (not tax-exempt).
OE = Corporate entity (tax-exempt).
SP = Sole proprietorship.
PA = Partnership.
GE = Government entity (Federal, State, or local).
FG = Foreign government.
WE = International organization per 26 CFR 1.6049-4.
01C If offeror is owned or controlled by a common parent,
enter Common Parent Name. (Enter "NA" if not applicable.)
01D If offeror is owned or controlled by a common parent,
enter Common Parent TIN (without dashes). (Enter "NA" if not
applicable.)
02 FAR 52.209-1, Qualification Requirements.
(Applies only to an acquisition subject to a qualification
requirement. When qualification applies, 02A and at least one of
the items from 02B through 02F must contain an entry other
than "NA.")
02A Enter the individual line item number for which
qualification information is applicable. Enter "ALL" if, and only
if, the responses to 02B through 02F are the same for all line
items in your offer. Enter "NA" if the solicitation does not
contain a qualification requirement. (NOTE: If information is
being provided for individual line item numbers, segments 02A
through 02F should be repeated as many times as necessary)
_____________________.
02B Enter Manufacturer's Name or CAGE code.
(Enter "NA" if clause not applicable.)
____________________________________________________________.
02C Enter Source Name or CAGE code. (Enter "NA" if clause
not applicable.) ___________________________________________________.
02D Enter Item Name. (Enter "NA," if clause not
applicable.)________________________________________________________.
02E Enter Service Identification. (Enter "NA" if clause
not applicable, or "NK" if service identification is not known).
____________________________________________________________.
02F Enter Test Number. (Enter "NA" if clause not
applicable, or "NK" if test number is not known.)
____________________________________________________________.
03 FAR 52.211-5, Material Requirements.
03A Enter the individual line item number for which the
offeror proposes to furnish "other than new" (used) material; or
reconditioned/remanufactured material; or unused former Government
Surplus property. Enter "ALL" if, and only if, the response to 03B
is the same for all line items in your offer. Enter "NA" here and
in 03B if the provision is not applicable. (NOTE: If information
is being provided for individual line item numbers, segments 03A
and 03B should be repeated as many times as necessary.)
_____________________________________________________________.
03B Select one of the following codes to describe the
material the offeror intends to furnish:___________. If any code
other than "NA" is entered, the offeror shall provide a list under
separate cover describing such material in accordance with
paragraphs (c) or (d) of the cited clause.
ON = Other than new (used)
RI = Reconditioned/Remanufactured Item
SU = New, Unused Government Surplus (If surplus material
is offered, offeror must also complete provision 52.211-9000,
Surplus Material.
NA = Not applicable
04 FAR 52.219-1, Small Business Program Representations;
(DoD [also, FAR 52.212-3, Offeror Representations and Certifications -
Commercial Items (paragraph (c)), when used for commercial items].
04A The offeror represents as part of its offer that it is
a ____________________ business type. (Select only one code from
the list below.)
B = Small Business (Use this code if your firm is
a small business concern, as defined in FAR 52.219-1, paragraph (c).)
M = Small Disadvantaged Business (Use this code if
your firm is a small disadvantaged business concern, as defined in
FAR 52.219-1(b)(2) or FAR 52.219-23(a)).
U = Woman-owned Small Disadvantaged Business (Use
this code if your firm is a woman-owned small business, as defined
in FAR 52.219-1, paragraph (c), small disadvantaged business, as
defined in FAR 52.219-1(b)(2) or FAR 52.219-23(a)).
W = Woman-owned Small Business (Use this code if
your firm is a woman-owned small business, as defined in FAR
52.219-1, paragraph (c).)
A = Large Business (Use this code if your firm is
not included in any of the above categories.)
05 FAR 52.222-22, Previous Contracts and Compliance
Reports (Applies to offers exceeding $10,000 when FAR 52.222-26
applies.)
05A (Completion of segment 05A also serves as the offeror's
representation that it will obtain, prior to subcontract awards,
representations signed by proposed subcontractors indicating
submission of required compliance reports.) Select one code from the
following list that identifies the offeror's submission of required
compliance reports:________________.
Y4 = Has participated in a previous contract subject
to applicable Equal Opportunity coverage, and filed all required
compliance reports.
Y5 = Has participated in a previous contract subject
to applicable Equal Opportunity coverage, and has not filed all
required compliance reports.
N4 = Has not participated in a previous contract
requiring compliance reports.
NA = Not applicable.
06 FAR 52.222-25, Affirmative Action Compliance.
(Applies to offers exceeding $10,000 when FAR 52.222-26 applies.)
06A The offeror represents as part of its offer that
(select one code from the following list):______________.
Y6 = The offeror has developed and has on file
required affirmative action programs.
N6 = The offeror has not developed and does not have
on file required affirmative action programs.
NH = The offeror has not had previous contracts
subject to the written affirmative action program requirements.
NA = Not applicable.
07 FAR 52.223-3, Hazardous Material Identification and
Material Safety Data; DFARS 252.223-7001, Hazard Warning Labels;
DLAD 52.223-9000, Material Safety Data Sheets and Hazard Warning
Labels. (Completion of segment 07 serves as the offeror's
representation that it will submit for each item as required prior
to award, a Material Safety Data Sheet (MSDS) prepared in accordance
with paragraph (a)(2) of the cited DLAD clause and a copy of the
Hazard Warning Label, in accordance with referenced Hazard
Communication Standard, Federal Standard, and any other requirement
contained in the cited clauses.)
07A Enter the individual line item number for which the
labeling/MSDS requirements described above apply. Enter "ALL" if,
and only if, the response to 07B is the same for all line items in
your offer. Enter "NA" if the provisions are not applicable.
(NOTE: If information is being provided for individual line item
numbers, segments 07A and 07B should be repeated as many times as
necessary.) __________________________.
07B Select the code that indicates whether hazardous
material(s) will be supplied:_____________. If code Y7 is entered,
in addition to the MSDS(s) and Hazard Warning Label(s), the offeror
must provide under separate cover a list, in accordance with
paragraph (b) of the cited FAR clause, of hazardous materials
intended to be furnished. Also on that list, the offeror shall
indicate the statute in accordance with which each such hazardous
material will be labeled. (See paragraph (c) of the cited DFARS
clause.)
Y7 = The offeror proposes to furnish hazardous
material.
N7 = Hazardous material will not be furnished.
08 DFARS 252.225-7000, Buy American Act - Balance of
Payments Program Certificate (applies only if the contract amount
is expected to exceed $2,500 and DFARS 252.225-7001 is included in
the solicitation); and DFARS 252.225-7035, Buy American
Act - North American Free Trade Agreement Implementation
Act - Balance of Payments Program Certificate. (Applies only if the
contract amount is expected to exceed $25,000 and DFARS 252.225-7036
or its Alternate I is included in the solicitation.) [Either or
both of these clauses may serve as the basis for this requirement.]
08A Select one of the following:
Y8 = The offeror certifies that each end product is
a domestic end product, and that components of unknown origin are
considered to have been mined, produced, or manufactured outside
the United States or a qualifying country.
N8 = The offeror certifies that not all end products
are domestic end products, and further certifies the identification
of every non-domestic end product and its country of origin as
provided in paragraphs 09 and 10, below.
NA= Not applicable.
09 DFARS 252.225-7000, Buy American Act - Balance of
Payments Program Certificate. (Applies only if the contract amount
is expected to exceed $2,500 and DFARS 252.225-7001 is included in
the solicitation.)
09A Enter the individual line item number of any end
product that is not a domestic end product. Enter "ALL" if, and only
if, the responses to 09B and 09C are the same for all line items in
your offer.Enter "NA" if the response to 08A is coded "Y8," or if the
provision is not applicable. (NOTE: If information is being provided
for individual line item numbers, segments 09A through 09C should be
repeated as many times as necessary.)
09B The offeror certifies that the end product identified
in 09A, above, is a (select one code from the list below):
QE = Qualifying Country End Product.
NQ = Non-qualifying Country End Product.
NA = Not applicable. (Insert "NA" if the response
to 09A is coded "NA," or if the provision is
otherwise inapplicable.)
09C The offeror certifies that the country of origin of
the end product identified in 09A, above, is as follows. (Select
one of the codes below for a Qualifying Country end product; enter
the name of a nonqualifying country; otherwise, enter "NA" if the
response to 09A is coded "NA," or if the provision is otherwise
inapplicable.)______________________.
AS = Australia NL = Netherlands
BE = Belgium NO = Norway
CA = Canada PO = Portugal
DA = Denmark SP = Spain
EG = Egypt TU = Turkey
GE = Federal Republic Germany UK = United Kingdom of
Great Britain and
FR = France Northern Ireland
GR = Greece AU = Austria
IS = Israel FI = Finland
IT = Italy SW = Sweden
LU = Luxembourg SZ = Switzerland
10 DFARS 252.225-7035, Buy American Act - North American
Free Trade Agreement Implementation Act - Balance of Payments Program
Certificate. (Applies only if the contract amount is expected to
exceed $25,000 and DFARS 252.225-7036 or its Alternate I is included
in the solicitation.)
10A Enter the individual line item number of any end
product that is not a domestic end product. Enter "ALL" if, and only
if, the responses to 10B and 10C are the same for all line items in
your offer. Enter "NA" if the response to 08A is coded "Y8," or if
the provision is not applicable. (NOTE: If information is being
provided for individual line item numbers, segments 10A through 10C
should be repeated as many times as necessary.)
10B The offeror certifies that the end product identified
in 10A, above, is a (select one code from the list below):
QE = Is a qualifying Country (except Canada) End Product.
NE = Is a NAFTA Country End Product (applies to
acquisitions from Canada for $25,000 or more,
and from Mexico for $53,150 or more).
NN = Is an other Non-NAFTA Country End Product.
NA = Not applicable (Insert "NA" if the response to 10A
is coded "NA," or if the provision is otherwise
inapplicable.)
10C The offeror certifies that the country of origin of
the end product identified in 10A, above, is as follows. (Select one
of the codes below for a Qualifying Country, U.S.-made, or NAFTA
end product; enter the name of a nonqualifying country; otherwise,
enter "NA" if the response to 10A is coded "NA," or if the provision
is otherwise inapplicable.)________________________.
AS = Australia NL = Netherlands
BE = Belgium NO = Norway
CA = Canada PO = Portugal
DA = Denmark SP = Spain
EG = Egypt TU = Turkey
GE = Federal Republic Germany UK = United Kingdom of
Great Britain and
FR = France Northern Ireland
GR = Greece AU = Austria
IS = Israel FI = Finland
IT = Italy SW = Sweden
LU = Luxembourg SZ = Switzerland
MX = Mexico
11 DFARS 252.225-7003, Information for Duty-Free Entry
Evaluation.
11A Enter the individual line item number for which
duty-free entry information is being provided. Enter "ALL" if, and
only if, the responses to 11B through 11E are the same for all line
items in your offer. Enter "NA" if the provision is not applicable.
(NOTE: If information is being provided for individual line item
numbers, segments 11A through 11E should be repeated as many times
as necessary.)
11B Does the offeror propose to furnish either a domestic
end product with nonqualifying country components for which the
offeror requests duty-free entry, or a foreign end product consisting
of end items, components, or material of foreign origin other than
those for which duty-free entry is to be accorded?
Y9 = Yes
N9 = No
NA = Not applicable
11C Are such foreign supplies now in the United States?
YD = Yes
ND = No
NA = Not Applicable
11D Has the duty on such foreign supplies been paid?
YP = Yes
NP = No
NA = Not Applicable
11E If the response to 11D is "NP," enter amount included
in offer price to cover applicable duty that has not been paid;
otherwise, enter 0 (zero); if not applicable, enter "NA":
12 DLAD 52.217-9002, Conditions for Evaluation and
Acceptance of Offers for Part Numbered Items. (In addition to
roviding the information required in 12A, 12B, 12C, 13A, 13B,
13C, 13D, and 13E, below, the offeror shall provide the
manufacturer's name and part number in the appropriate segment
of this transaction.)
12A Enter the individual line item number for which
the offeror intends to provide the exact product (including
manufacturer's name, cage code and part number) referred to in the
procurement item description (PID) of this solicitation. Enter
"ALL" if the exact product(s) as specified in the solicitation will
be provided for all line items in your offer. Enter "NONE" if only
alternate products will be provided for all line items. Enter
"NONE" if only alternate products will be provided for all line items.
Enter "NA" if the solicitation does not pertain to part-numbered items.
(NOTE: If information is being provided for individual line item
numbers, segments 12A, 12B and 12C should be repeated as many times
as necessary.)___________________________.
12B If 12A contains an entry other than "None" or "NA",
enter the CAGE Code which pertains to the exact PID part number being
offered. Enter "NA" if the solicitation does not pertain to
part-numbered items. Enter "None" if an alternate product is being
offered.__________________________.
12C If 12A contains an entry other than "None" or "NA",
enter the exact PID part number which pertains to the item being
offered. Enter "NA" if the solicitation does not pertain to
part-numbered items. Enter "None" if an alternate product is being
offered.____________________________.
13 DLAD 52.217-9002, Conditions for Evaluation and
Acceptance of Offers for Part Numbered Items. (Same as above.)
13A Enter the individual line item number for which the
offeror intends to provide an alternate product to the product
referred to in the procurement item description (PID) of this
solicitation. Enter "ALL" if alternate products to those specified
in the solicitation will be provided for all line items in your
offer. Enter "NONE" if only the exact product(s) will be provided
for all line items. Enter "NA" if the solicitation does not pertain
to part-numbered items. (NOTE: If information is being provided for
individual line item numbers, segments 13A through 13E should be
repeated as many times as necessary.) _________________________.
13B If 13A contains an entry other than "NONE" or "NA",
and if the alternate product specified has been previously furnished
to the Government or otherwise evaluated and approved, enter the
contract or solicitation number under which it was furnished or approved.
If the alternate product has been previously approved outside of a
solicitation/contract process, enter the name of the approving
authority. Enter "NF" if the alternate product has not previously
been furnished and approved. Enter "NONE" if the exact product is
being offered. Enter "NA" if the solicitation does not pertain to
part-numbered items.___________________.
13C If 13A contains an entry other than "NONE" or "NA,"
enter the CAGE code which pertains to the part number being offered.
Enter "NONE" if the exact product is being offered. Enter "NA" if
the solicitation does not pertain to part-numbered items.
_________________________.
13D If 13A contains an entry other than "NONE" or "NA",
enter the part number which pertains to the item being offered.
Enter "NONE" if the exact product is being offered. Enter "NA" if
the solicitation does not pertain to part-numbered items.
__________________________.
13E If 13A contains an entry other than "NONE" or "NA",
enter "AB" if you are offering an alternate product that has not
been previously approved, "PA" if this is a previously approved
alternate product, or "SN" if this is a part number that supersedes
the part number cited in the procurement item description (PID) of
the solicitation. Enter "NONE" if the exact product is being
offered. Enter "NA" if the solicitation does not pertain to
part-numbered items ____________________.
NOTE: For each alternate product item, the offeror must furnish
under separate cover the drawings, specifications, and other data
required by paragraphs (c)(1) and (c)(2) of the cited provision.
In addition, for items that have previously been reverse-engineered,
the offeror must provide with this offer the data package and
other requirements established in paragraph (e) of the cited
provision.
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