AGREEMENTS, REPRESENTATIONS, AND CERTIFICATIONS (ANNUAL)
This is an annual representation and certification form, valid for 12
months from the date of execution. All sections must be
completed and returned to your Orbital ATK Procurement
Representative.
B.
The Seller represents that:
(a) It
IS exempt (less than 50 employees and no
Government contract/subcontract of $50,000 or more during
prior 12 month period (41CFR60-1.20(e)).
- OR(b) it
HAS developed and has on file
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 (41CFR60-1 and 602).
- OR (c) it
HAS NOT previously had a contract subject to the
written affirmative action program requirements of the rules
and regulations of the Secretary of Labor and will develop a
program within 30 days of the start of any contract issued as
a result of this request (41CFR60-1.20(e)).
GENERAL
Supplier Name
Contact Name
Phone No.
NAICS Code (6-Digit)
DUNS Number
The company/individual identified on the last page (hereafter
referred to as “Seller”) certifies/represents that:
(Check or complete all applicable boxes or blanks.)
A.
C.
SMALL BUSINESS PROGRAM FAR 52.219-1 (OCT 2014)
AND 52.226-2 (OCT 2014)
(a) It
HAS
HAS NOT participated in a previous contract
or subcontract subject to the Equal Opportunity clause; AND
IS NOT a Small Business
(b) It
HAS
HAS NOT filed all required compliance
reports.
(1) If the Seller HAS NOT filed all compliance reports,
represents that it
IS
IS NOT exempt from filing
compliance reports (less than 50 employees and no
Government contract/subcontract of $50,000 or more
during prior 12 month period (41CFR60-1.7(a)).
(2) If representation indicates required reports have not
been filed and are required, CONTRACTOR must submit
said reports within 30 days after subcontract award
(41CFR60-1.7a).
Complete the following only if SELLER is a Small Business:
IS
IS NOT a Small Disadvantaged Business
IS
IS NOT a Women-owned Small Business
IS
IS NOT an Economically Disadvantaged
Women-owned Small Business
IS
IS NOT a Veteran-owned Small Business
IS
IS NOT a Service Disabled Veteran-owned Small
Business
IS
IS NOT a HUBZone Small Business
IS
IS NOT a HUBZone Joint Venture
IS
IS NOT a Minority Institution
IS
IS NOT a Historically Black College or University
This representation must be in compliance with Federal
definitions contained in the Code of Federal
Regulations/Federal Acquisition Regulations (CFR/FAR).
These definitions are available upon request from the
cognizant Orbital ATK buyer or Orbital ATK Small Business
Administrator or at www.sba.gov.
Per 15 U.S.C. 645(d), any person who misrepresents a firm’s
status as one of the above in order to obtain a subcontract
shall: (i) be punished by imposition of fine, imprisonment, or
both; (ii) be subject to administrative remedies, including
suspension and debarment; and (iii) be ineligible for
participation in programs.
FORM FFI-0001 (REV 2-15)
EQUAL OPPORTUNITY (Previous Contract and Compliance
Reports) FAR 52.222-22 (FEB 1999)
The Seller represents that:
Seller represents that it (check one for each line):
IS
AFFIRMATIVE ACTION (check only one section) FAR 52.22225 (APR 1984)
D.
CERTIFICATE OF ETHICAL CONTRACTING
The Seller certifies that it has not, nor has any of its employees,
subcontractors or subcontractors’ employees, received, or
offered, to any person or entity, any gratuities, kickbacks, or
anything of value, relevant to any aspect of such Contract, or
any subtier contract(s) released under such Contract. Further,
Seller agrees to notify Orbital ATK of any such action that it
becomes aware of during the performance of any contract with
Orbital ATK.
E.
SAFETY CERTIFICATION
The Seller certifies that it
HAS
DOES NOT HAVE
outstanding safety violations with OSHA, a Federal Agency or
any other contract or subcontract safety regulation. If violations
are outstanding, Seller shall identify and submit for evaluation by
Orbital ATK prior to any award.
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AGREEMENTS, REPRESENTATIONS, AND CERTIFICATIONS (ANNUAL) Continued
F.
CERTIFICATE REGARDING RESPONSIBILITY MATTERS
FAR 52.209-5 (APR 2010)
(e) The certification in paragraph (a) of this provision is a
material representation of fact upon which reliance was
placed when making award. If it is later determined that the
Seller knowingly rendered an erroneous certification, in
addition to other remedies available to Orbital ATK, the
Buyer may terminate the contract resulting from this
solicitation for default.
(a)(1) The Seller certifies, to the best of its knowledge and
belief, that:
(i)
The Seller and/or any of its principals:
ARE
ARE NOT presently debarred,
suspended, proposed for debarment, or declared
ineligible for the award of contracts by any
Federal agency;
G. CERTIFICATION AND DISCLOSURE REGARDING
PAYMENTS TO INFLUENCE CERTAIN FEDERAL
TRANSACTIONS FAR 52.203-11 (SEPT 2007)
HAVE
HAVE NOT, within a three-year
period preceding this offer, been convicted of or
had a civil judgment rendered against them for:
commission of fraud or a criminal offense in
connection with obtaining, attempting to obtain, or
performing a public (Federal, state or local)
contract or subcontract; violation of Federal or
state antitrust statutes relating to the submission
of offers; or commission of embezzlement, theft,
forgery, bribery, falsification or destruction of
records, making false statements, tax evasion,
violating Federal criminal tax laws, or receiving
stolen property;
a)
The definitions and prohibitions contained in the clause at
FAR 52.203-12, Limitation on Payments to Influence Certain
Federal Transactions are hereby incorporated by reference
into this Certification.
b)
Certification: The Seller, by signing its offer, hereby certifies
to the best of its knowledge and belief that no Federal
appropriated funds have been paid or will be paid to any
person for influencing or attempting to influence an officer or
employee of any agency, a Member of Congress, an officer
or employee of Congress, or an employee of a Member of
Congress on its behalf in connection with the awarding of
this contract.
ARE
ARE NOT presently indicted for, or
otherwise criminally or civilly charged by a
Government entity with commission of any of the
offenses enumerated above;
c)
Disclosure: If any registrants under the Lobbying Disclosure
Act of 1995 have made a lobbying contact on behalf of the
SELLER with respect to this contract, the Seller shall
complete and submit, with its offer, OMB Standard Form
LLL, Disclosure of Lobbying Activities, to provide the name
of the registrants. The Seller need not report regularly
employed officers or employees of the Seller to whom
payments of reasonable compensation were made.
d)
Penalty: Submission of this certification and disclosure is a
prerequisite for making or entering into a contract imposed
by section 31 U.S.C 1352. Any person who makes an
expenditure prohibited under this provision or who fails to
file or amend the disclosure form to be filed or amended by
this provision, shall be subject to a civil penalty of not less
than $10,000, and not more than $100,000, for each such
failure.
HAVE
HAVE NOT, within a three-year
period preceding this offer, been notified of any
delinquent Federal taxes (as defined in clause
52.209-5) in an amount that exceeds $3,000 for
which the liability remains unsatisfied.
(ii) The Seller
HAS
HAS NOT, within a three
year period preceding this offer, had one or more
contracts terminated for default by any Federal
Agency.
(2) “Principal,” for the purposes of this certification,
means an officer, director, owner, partner, or a person
having primary management or supervisory
responsibilities within a business entity (e.g., general
manager; plant manager; head of a division or
business segment; and similar positions).
(b) The Seller shall provide immediate written notice to the
cognizant Orbital ATK Buyer if, at any time prior to
contract award, the Seller learns that its certification was
erroneous when submitted or has become erroneous by
reason of changed circumstances.
(c) A certification that any of the items in paragraph (a) of
this provision exists will not necessarily result in
withholding of an award under this solicitation. However,
the certification will be considered in connection with a
determination of the Seller’s responsibility. Failure of the
Seller to furnish a certification or provide such additional
information as requested by the Orbital ATK Buyer may
render the Seller nonresponsible.
H.
SIGNATURE
By signature hereto, or to an offer incorporating these
representations and certifications, the Seller certifies that they
are accurate, current, and complete and that it is aware of the
penalty prescribed in 18 U.S.C. 1001 for making false
statements in offers.
Supplier Name
Signature
Printed Name
Title
Date
(d) Nothing contained in the foregoing shall be construed to
require establishment of a system of records in order to
render, in good faith, the certification required by
paragraph (a) of this provision. The knowledge and
information of a Seller is not required to exceed that
which is normally possessed by a prudent person in the
ordinary course of business dealings.
FORM FFI-0001 (REV 2-15)
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