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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: 2003-07
K8H 52.213-9004 Offeror Representations, DLAD (JUL 2003)
Certifications, and
Fill-In Information
Electronic Commerce.
(a) Offerors are required to provide the following
socioeconomic and other data in a coded, rather than a fill-in,
format. This provision consolidates, to the maximum extent
practicable, most of the 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 remindedthat 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.dla.mil/j-3/j-336/icps.htm. The offeror may
also request 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), shall 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 one of the following:
INDIVIDUAL LINE ITEM NUMBER for which qualification
information is applicable.
"ALL" if, and only if, the responses to 02B through 02F
are the same for all line items in your offer.
"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 one of the following:
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.
"ALL" if, and only if, the response to 03B is the same for
all line items in your offer.
"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 the representation in clause
52.211-9000, Government Surplus Material (Apr 2002).
NA = Not applicable
04 FAR 52.219-1, SMALL BUSINESS REPRESENTATION/TYPE OF BUSINESS
04a The offeror certifies as part of his offer that it is a
_______________ business type. (Select only one code from the list below.)
B = Small Business Concern (Use this code if your firm
is a small business concern, as defined in FAR 52.219-1, paragraph (c), and no
other code below applies.)
C = Nonprofit Institution. (Use this code if you are a
business entity organized and operated exclusively for charitable or scientific
purposes, and you are exempt from Federal income taxation under Section 501 of
the Internal Revenue Code, as described in FAR 31.701.)
E = Educational Institution. (Use this code if you are
an institution of higher education (i.e., college or university) other than a
historically black college or university or minority institution.)
F = Historically Black College or University (HBCU).
(Use this code if you are a historically black college or university, as defined
in FAR 2.101.)
G = JWOD Participating Nonprofit Agency. (Use this code if
you are a nonprofit agency-serving people who are blind, or those with other severe
disabilities, as defined in FAR 8.701.)
P = Minority Institution. (Use this code if you are a
minority institution, other than a historically black college or university, as
defined in FAR 2.101.)
X = Intragovernmental. (Use this code if you are a Federal
Agency, Government corporation, or other Government agency, such as Federal Prison
Industries (UNICOR).)
M = Small Disadvantaged Business Concern (Use this code
if your firm is a small disadvantaged business concern, as defined in FAR
52.219-1(b)(2)).
W = Woman-owned Small Business Concern (Use this code
if your firm is a woman-owned small business concern, as defined in FAR 52.219-1,
paragraph (c).)
T = Veteran-Owned Small Business Concern (Use this code
if your firm is a veteran-owned small business concern, as defined in FAR 52.219-1,
paragraph (c), and code R does not apply.)
R = Service-Disabled Veteran-Owned Small Business Concern
(Use this code if your firm is a service-disabled veteran-owned small business
concern, as defined in FAR 52.219-1, paragraph (c).)
U = Woman-Owned Small Disadvantaged Business Concern (Use
this code if your firm is a both a woman-owned small business and a small disadvantaged
business.) See citations for definitions at codes M and W, above.
K = Small Disadvantaged, Service-Disabled Veteran-Owned
Small Business Concern (Use this code if your firm is both a small disadvantaged
business and a service-disabled veteran-owned small business.) See citations for
definitions at codes M and R, above.
L = Small Disadvantaged, Other Veteran-Owned Small Business
Concern (Use this code if your firm is both a small disadvantaged business and a
veteran-owned small business (but not a service-disabled veteran-owned small
business).) See citations for definitions at codes M and T, above.
N = Woman-Owned, Service-Disabled Veteran-Owned Small
Business Concern (Use this code if your firm is both a woman-owned small business
and a service-disabled veteran-owned small business.) See citations for definitions
at codes W and R, above.
V = Woman-Owned, Other Veteran-Owned Small Business Concern
(Use this code if your firm is both a woman-owned small business and a veteran-owned
small business (but not a service-disabled veteran-owned small business).)
See citations for definitions at codes W and T, above.
Y = Woman-Owned, Small Disadvantaged, Service-Disabled
Veteran-Owned Small Business Concern (Use this code if your firm is a woman-owned
small business, a small disadvantaged business, and a service-disabled veteran-owned
small business.) See citations for definitions at codes W, M, and R, above.
Z = Woman-Owned, Small Disadvantaged, Other Veteran-Owned
Small Business Concern (Use this code if your firm is a woman-owned small business,
a small disadvantaged business, and a veteran-owned small business (but not a
service-disabled veteran-owned small business).) See citations for definitions at
codes W, M, and T, above.
A = Large Business (Use this code if your firm is not
included in any of the above categories.)
04B HUBZone Small Business Concern.
Enter "Y" to represent that your firm is a HUBZone small business
concern whose name appears on the List of Qualified HUBZone Small Business
Concerns maintained by the Small Business Administration, and as described in
paragraph (c) of FAR 52.219-3 (Notice of Total HUBZone Set-Aside). Otherwise,
enter "N." ___________.
04C The offeror makes the following representation regarding its
joint venture status:___________. If any code other than "NA" is entered, the
offeror shall provide under separate cover a list of the names of participating
HUBZone small business concerns.
JV = "Y" is entered in 04B, the offeror is a joint venture
that complies with the requirements of 13 CFR Part 126, and the offeror's
representation provided by entry of the "Y" in 04B is accurate for the HUBZone small
business concern(s) participating in the joint venture. [Each HUBZone small business
concern participating in the joint venture shall submit a separate signed copy of the
HUBZone representation.]
JN = "Y" is entered in 04B, but the offeror is not a joint
venture within the requirements of 13 CFR Part 126.
NA = Not applicable. (Use this code if "N" has been entered
in 04B.)
04D If 04A, above, contains a code other than "M," "U," "K,"
"L," "Y," or "Z," insert "NA" on the blank line. If 04A contains any of these
codes, the offeror shall identify the category on which its small disadvantaged
business status is based:________. (Applies to offers exceeding $25,000.)
BA = Black American.
HA = Hispanic American.
AI = Native American (American Indians, Eskimos, Aleuts, or Native
Hawaiians).
AP = Asian-Pacific American (persons with origins from Burma,
Thailand, Malaysia, Indonesia, Singapore, Brunei, Japan, China, Taiwan, Laos, Cambodia
(Kampuchea), Vietnam, Korea, The Philippines, U.S. Trust Territory of the Pacific
Islands (Republic of Palau), Republic of the Marshall Islands, Federated States of
Micronesia, the Commonwealth of the Northern Mariana Islands, Guam, Samoa, Macao, Hong
Kong, Fiji, Tonga, Kiribati, Tuvalu, or Nauru).
SC = Subcontinent Asian (Asian-Indian) American (persons with
origins from India, Pakistan, Bangladesh, Sri Lanka, Bhutan, the Maldives Islands, or
Nepal).
SD = Small disadvantaged individual/concern, based on other than
one of the preceding.
NA = Not applicable (04A contains a "B," "W," "T," "R,", "N,"
or "V").
05 FAR 52.222-22, PREVIOUS CONTRACTS AND COMPLIANCE REPORT
(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 one of the following:
INDIVIDUAL LINE ITEM NUMBER for which the labeling/MSDS
requirements described above apply.
"ALL" if, and only if, the response to 07B is the
same for all line items in your offer.
"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 one of the following:
INDIVIDUAL LINE ITEM NUMBER of any end product that is not a
domestic end product.
"ALL" if, and only if, the responses to 09B and 09C are
the same for all line items in your offer.
"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.
Enter "NA" if the response to 09A is coded "NA," or if the
provision is otherwise inapplicable),_____________________ or
Enter the name of a nonqualifying country, or
Select one of the codes below for a Qualifying Country end
product;
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
FR = France Great Britain and 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 one of the following:
INDIVIDUAL LINE ITEM NUMBER of any end product that is not a
domestic end product.
"ALL" if, and only if, the responses to 10B and 10C are
the same for all line items in your offer.
"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 $56,190 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.
Enter "NA" if the response to 10A is coded "NA," or if the
provision is otherwise inapplicable.)___________________
Enter the name of a nonqualifying country; or
Select one of the codes below for a Qualifying Country, U.S.-made, or NAFTA
end product;
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
FR = France Britain and Northern
Ireland
GR = Greece AU = Austria
IS = Israel FI = Finland
IT = Italy SW =Sweden
LU = Luxembourg SZ = Switzerland
MX = Mexico
11 DLAD 52.217-9002, CONDITIONS FOR EVALUATION AND ACCEPTANCE OF
OFFERS FOR PART NUMBERED ITEMS. (In addition to providing the information
requiredin 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. "Exact product," "alternate product," "superceding part number" and
"previously-approved product" are defined in 52.217-9002.) DSCR NOTE: Failure to
provide the CAGE and part number will result in rejection of your quote in a PACE
automated evaluation and award.
11A Enter one of the following:
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 acquisition identification description (AID) of this solicitation.
"ALL" if the exact product(s) as specified in the
solicitation will be provided for all line items in your offer.
"NONE" if only alternate products to the products referred to in the AID of this
solicitation will be provided for all line items.
"NA" if the solicitation does not pertain to part-numbered items.
(NOTE: If information is being provided for individual line item numbers,
segments 11A, 11B and 11C should be repeated as many times as necessary
11B If 11A contains an entry other than "None" or "NA", enter the
CAGE Code which pertains to the exact AID part number being offered.
"NA" if the solicitation does not pertain to part-numbered items.
"None" if an alternate product to the product referred to in the AID of this
solicitation is being offered.
11C If 11A contains an entry other than "None" or "NA", enter the
exact AID part number which pertains to the item being offered.
"NA" if the solicitation does not pertain to part-numbered items.
"None" if an alternate product to the product referred to in the AID of this
solicitation is being offered.
12 DLAD 52.217-9002, CONDITIONS FOR EVALUATION AND ACCEPTANCE OF
OFFERS FOR PART NUMBERED ITEMS. (See instructions in parentheses at 11.
above.)
12A Enter one of the following:
INDIVIDUAL LINE ITEM NUMBER for which the offeror intends to
provide an alternate product to the product referred to in the AID of this
solicitation.
"ALL" if alternate products to the product referred to
in the AID will be provided for all line items in your offer.
"NONE" if only the exact product(s) will be provided
for all line items.
"NA" if the solicitation does not pertain to part-
numbered items.
(NOTE: If information is being provided for individual line item numbers,
segments 12A through 12E should be repeated as many times as necessary.)
__________________.
12B If 12A 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:
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, NAME OF THE APPROVING AUTHORITY.
"NF" if the alternate product has not previously been furnished and approved.
"NONE" if the exact product is being offered.
"NA" if the solicitation does not pertain to part-numbered items.
12C If 12A contains an entry other than "NONE" or "NA," enter the
CAGE code which pertains to the part number being offered.
"NONE" if the exact product is being offered.
"NA" if the solicitation does not pertain to part-numbered items.
12D If 12A contains an entry other than "NONE" or "NA", enter the
part number which pertains to the item being offered.
"NONE" if the exact product is being offered.
"NA" if the solicitation does not pertain to part-numbered items.
12E If 12A contains an entry other than "NONE" or "NA", enter
"AB" if you are offering an alternate product that has not
been previously approved (this includes a previously reverse-engineered product
that is not currently cited in the AID),
"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 AID of the solicitation.
"NONE" if the exact product is being offered.
"NA" if the solicitation does not pertain to part-numbered items
NOTE: For each alternate product to the product referred to in the AID of
this solicitation, the offeror must furnish the drawings, specifications, and
other data required by 52.217-9002. In addition, for items that have previously
been reverse-engineered but are not currently cited in the AID, the offeror must
provide with this offer the data package and other requirements established in
paragraph (c)(2) of 52.217-9002.
13 DLAD 52.233-9001, DISPUTES: AGREEMENT TO USE ALTERNATIVE
DISPUTES RESOLUTION (ADR).
13A Select one of the following codes to indicate the offeror's
position regarding the acceptability of this ADR clause:
A = The offeror accepts the clause
B = The offeror opts out of this clause and does not desire to
negotiate alternate wording
14 FAR 52.222-18 CERTIFICATION REGARDING KNOWLEDGE OF CHILD LABOR
FOR LISTED END PRODUCTS.
14A Select one of the following codes to indicate the offeror's
furnishing of any end product listed at http://www.dol.gov/ilab/regs/eo13126/main.htm:
"Y15" The offeror will not supply any end product from the list provided
above, that was mined, produced, or manufactured in a corresponding country as listed
for that end product.
"M15" The offeror may supply an end product from the list provided
above. The offeror certifies that it 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.
(End of provision)
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