Fillable Printable Representations And Certifications
Fillable Printable Representations And Certifications
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Representations And Certifications
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INITIALS: &
LESSOR GOVERNMENT
REPRESENTATIONS AND CERTIFICATIONS
(Acquisition of Leasehold Interests in Real Property)
Solicitation Number Dated
Complete appropriate boxes, sign the form, and attach to offer.
The Offeror makes the following Representations and Certifications. NOTE: The "Offeror," as used on
this form, is the owner of the property offered, not an individual or agent representing the owner.
1. 52.219-1 - SMALL BUSINESS PROGRAM REPRESENTATIONS (APR 2011)
(a) (1) The North American Industry Classification System (NAICS) code for this acquisition
is 531190.
(2) The small business size standard is $20.5 Million in annual average gross revenue of
the concern for the last 3 fiscal years.
(3) The small business size standard for a concern which submits an offer in its own
name, other than on a construction or service contract, but which proposes to furnish
a product which it did not itself manufacture, is 500 employees.
(b) Representations.
(1) The offeror represents as part of its offer that it
[ ]
is,
[ ]
is not a small business
concern.
(2) [
Complete only if the offeror represented itself as a small business concern in
paragraph (b)(1) of this provision
.] The offeror represents, for general statistical
purposes, that it
[ ]
is,
[ ]
is not, a small disadvantaged business concern as defined
in 13 CFR 124.1002.
(3) [
Complete only if the offeror represented itself as a small business concern in
paragraph (b)(1) of this provision
.] The offeror represents as part of its offer that it
[ ]
is,
[ ]
is not a women-owned small business concern.
(4) Women-owned small business (WOSB) concern eligible under the WOSB Program.
[
Complete only if the offeror represented itself as a women-owned small business
concern in paragraph (b)(3) of this provision.
] The offeror represents as part of its offer
that—
(i) It
[ ]
is,
[ ]
is not a WOSB concern eligible under the WOSB Program, has
provided all the required documents to the WOSB Repository, and no change
in circumstances or adverse decisions have been issued that affects its
eligibility; and
(ii) It
[ ]
is,
[ ]
is not a joint venture that complies with the requirements of 13 CFR
part 127, and the representation in paragraph (b)(4)(i) of this provision is
accurate in reference to the WOSB concern or concerns that are participating
in the joint venture. [
The offeror shall enter the name or names of the WOSB
concern or concerns that are participating in the joint venture:
]
Each WOSB concern participating in the joint venture shall submit a separate
signed copy of the WOSB representation.
(5) Economically disadvantaged women-owned small business (EDWOSB) concern.
[
Complete only if the offeror represented itself as a women-owned small business
concern eligible under the WOSB Program in (b)(4) of this provision.
] The offeror
represents as part of its offer that—
GSA 3518 (REV. 5/2013)GENERAL SERVICES ADMINISTRATION
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(i) It
[ ]
is,
[ ]
is not an EDWOSB concern eligible under the WOSB Program, has
provided all the required documents to the WOSB Repository, and no change
in circumstances or adverse decisions have been issued that affects its
eligibility; and
(ii) It
[ ]
is,
[ ]
is not a joint venture that complies with the requirements of 13 CFR
part 127, and the representation in paragraph (b)(5)(i) of this provision is
accurate in reference to the EDWOSB concern or concerns that are
participating in the joint venture. [
The offeror shall enter the name or names of
the EDWOSB concern or concerns that are participating in the joint venture:
]
Each EDWOSB concern participating in the joint venture shall submit a
separate signed copy of the EDWOSB representation.
(6) [
Complete only if the offeror represented itself as a small business concern in
paragraph (b)(1) of this provision
.] The offeror represents as part of its offer that it
[ ]
is,
[ ]
is not a veteran-owned small business concern.
(7) [
Complete only if the offeror represented itself as a veteran-owned small business
concern in paragraph (b)(6) of this provision
.] The offeror represents as part of its offer
that it
[ ]
is,
[ ]
is not a service-disabled veteran-owned small business concern.
(8) [
Complete only if the offeror represented itself as a small business concern in
paragraph (b)(1) of this provision
.] The offeror represents, as part of its offer, that—
(i) It
[ ]
is,
[ ]
is not a HUBZone small business concern listed, on the date of this
representation, on the List of Qualified HUBZone Small Business Concerns
maintained by the Small Business Administration, and no material changes in
ownership and control, principal office, or HUBZone employee percentage
have occurred since it was certified in accordance with 13 CFR Part 126; and
(ii) It
[ ]
is,
[ ]
is not a HUBZone joint venture that complies with the requirements
of 13 CFR Part 126, and the representation in paragraph (b)(8)(i) of this
provision is accurate for each HUBZone small business concern participating in
the HUBZone joint venture. [
The offeror shall enter the names of each of the
HUBZone small business concerns participating in the HUBZone joint venture:
Each HUBZone small business concern participating in the HUBZone joint
venture shall submit a separate signed copy of the HUBZone representation.
(c)
Definitions
. As used in this provision—
“Economically disadvantaged women-owned small business (EDWOSB) concern” means a
small business concern that is at least 51 percent directly and unconditionally owned by, and
the management and daily business operations of which are controlled by, one or more
women who are citizens of the United States and who are economically disadvantaged in
accordance with 13 CFR part 127. It automatically qualifies as a women-owned small
business concern eligible under the WOSB Program.
“Service-disabled veteran-owned small business concern”—
(1) Means a small business concern—
(i) Not less than 51 percent of which is owned by one or more service-disabled
veterans or, in the case of any publicly owned business, not less than 51
percent of the stock of which is owned by one or more service-disabled
veterans; and
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(ii) The management and daily business operations of which are controlled by one
or more service-disabled veterans or, in the case of a service-disabled veteran
with permanent and severe disability, the spouse or permanent caregiver of
such veteran.
(2) “Service-disabled veteran” means a veteran, as defined in 38 U.S.C.101(2)
, with a
disability that is service-connected, as defined in 38 U.S.C. 101(16).
“Small business concern” means a concern, including its affiliates, that is independently
owned and operated, not dominant in the field of operation in which it is bidding on
Government contracts, and qualified as a small business under the criteria in 13 CFR
Part 121 and the size standard in paragraph (a) of this provision.
“Veteran-owned small business concern” means a small business concern—
(1) Not less than 51 percent of which is owned by one or more veterans (as defined at 38
U.S.C. 101(2)) or, in the case of any publicly owned business, not less than 51
percent of the stock of which is owned by one or more veterans; and
(2) The management and daily business operations of which are controlled by one or
more veterans.
“Women-owned small business concern” means a small business concern—
(1) That is at least 51 percent owned by one or more women; or, in the case of any
publicly owned business, at least 51 percent of the stock of which is owned by one or
more women; and
(2) Whose management and daily business operations are controlled by one or more
women.
“Women-owned small business (WOSB) concern eligible under the WOSB Program” (in
accordance with 13 CFR part 127), means a small business concern that is at least 51
percent directly and unconditionally owned by, and the management and daily business
operations of which are controlled by, one or more women who are citizens of the United
States.
(d) Notice.
(1) If this solicitation is for supplies and has been set aside, in whole or in part, for small
business concerns, then the clause in this solicitation providing notice of the set-aside
contains restrictions on the source of the end items to be furnished.
(2) Under 15 U.S.C. 645(d)
, any person who misrepresents a firm’s status as a business
concern that is small, HUBZone small, small disadvantaged, service-disabled veteran-
owned small, economically disadvantaged women-owned small, or women-owned
small eligible under the WOSB Program in order to obtain a contract to be awarded
under the preference programs established pursuant to section 8, 9, 15, 31, and 36 of
the Small Business Act or any other provision of Federal law that specifically
references section 8(d) for a definition of program eligibility, 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 conducted under the authority of the
Act.
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INITIALS: &
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2. 52.204-5 - WOMEN-OWNED BUSINESS (OTHER THAN SMALL BUSINESS) (MAY 1999)
(a)
Definition
. "Women-owned business concern," as used in this provision, means a concern
which is at least 51 percent owned by one or more women; or in the case of any publicly
owned business, at least 51 percent of its stock is owned by one or more women; and
whose management and daily business operations are controlled by one or more women.
(b)
Representation
. [Complete only if the Offeror is a women-owned business concern and has
not represented itself as a small business concern in paragraph (b)(1) of FAR 52.219-1,
Small Business Program Representations, of this solicitation. ] The Offeror represents that it
[ ]
is a women-owned business concern.
3. 52.222-22 - PREVIOUS CONTRACTS AND COMPLIANCE REPORTS (FEB 1999)
(Applicable when the estimated value of the acquisition exceeds $10,000)
The Offeror represents that—
(a) It
[ ]
has,
[ ]
has not participated in a previous contract or subcontract subject to the Equal
Opportunity clause of this solicitation;
(b) It
[ ]
has,
[ ]
has not filed all required compliance reports; and
(c) Representations indicating submission of required compliance reports, signed by proposed
subcontractors, will be obtained before subcontract awards. (Approved by OMB under
Control Number 1215-0072.)
4. 52.222-25 - AFFIRMATIVE ACTION COMPLIANCE (APR 1984)
(Applicable when the estimated value of the acquisition exceeds $10,000)
The Offeror represents that—
(a) 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 (41 CFR 60-1 and 60-2), or
(b) It
[ ]
has not previously had contracts subject to the written affirmative action programs
requirement of the rules and regulations of the Secretary of Labor. (Approved by OMB
under Control Number 1215-0072.)
5. 552.203-72 REPRESENTATION BY CORPORATIONS REGARDING AN UNPAID
DELINQUENT FEDERAL TAX LIABILITY OR A FELONY CONVICTION UNDER
ANY FEDERAL LAW (DEVIATION) (APR 2012)
(a) In accordance with Sections 630 and 631 of Division of the Consolidated Appropriations Act,
2012 (Pub. L. 112-74), none of the funds made available by that Act may be used to enter
into a contract action with any corporation that---
(1) Has any unpaid Federal tax liability that has been assessed, for which all judicial and
administrative remedies have been exhausted or have lapsed, and that is not being
paid in a timely manner pursuant to an agreement with the authority responsible for
collecting the tax liability, where the awarding agency is aware of the unpaid tax
liability, unless the agency has considered suspension or debarment of the
corporation and made a determination that this further action is not necessary to
protect the interests of the Government, or
(2) Was convicted, or had an officer or agent of such corporation acting on behalf of the
corporation convicted of a felony criminal violation under any Federal law within the
preceding 24 months, where the awarding agency is aware of the conviction, unless
the agency has considered suspension or debarment of the corporation or such officer
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INITIALS: &
LESSOR GOVERNMENT
or agent and made a determination that this action is not necessary to protect the
interests of the Government.
(b) The Contractor represents that—
(1) It is [ ] is not [ ] a corporation that has any unpaid Federal tax liability that has been
assessed, for which all judicial and administrative remedies have been exhausted or
have lapsed, and that is not being paid in a timely manner pursuant to an agreement
with the authority responsible for collecting the tax liability.
(2) It is [ ] is not [ ] a corporation that was convicted, or had an officer or agent of the
corporation acting on behalf of the corporation, convicted of a felony criminal violation
under any Federal law within the preceding 24 months.
6. 52.203-02 - CERTIFICATE OF INDEPENDENT PRICE DETERMINATION (APR 1985)
(Applicable when the estimated value of the acquisition exceeds the simplified lease acquisition
threshold)
(a) The Offeror certifies that—
(1) The prices in this offer have been arrived at independently, without, for the purpose of
restricting competition, any consultation, communication, or agreement with any other
Offeror or competitor relating to (i) those prices, (ii) the intention to submit an offer, or
(iii) the methods or factors used to calculate the prices offered;
(2)
The prices in this offer have not been and will not be knowingly disclosed by the Offeror,
directly or indirectly, to any other Offeror or competitor before bid opening (in the case
of a sealed bid solicitation) or contract award (in the case of a negotiated solicitation)
unless otherwise required by law; and
(3) No attempt has been made or will be made by the Offeror to induce any other concern
to submit or not to submit an offer for the purpose of restricting
competition.
(b) Each signature on the offer is considered to be a certification by the signatory that the
signatory—
(1)
Is the person in the Offeror's organization responsible for determining the prices being
offered in this bid or proposal, and that the signatory has not participated and will not
participate in any action contrary to subparagraphs (a)(1) through (a)(3) above; or
(2) (i)
Has been authorized, in writing, to act as agent for the following principals in
certifying that those principals have not participated, and will not participate in any
action contrary to subparagraphs (a)(1) through (a)(3) above
[ Insert full name of person(s) in the Offeror's organization responsible for
determining the prices offered in this bid or proposal, and the title of his or her
position in the Offeror's organization ];
(ii) As an authorized agent, does certify that the principals named in subdivision
(b)(2)(i) above have not participated, and will not participate, in any action
contrary to subparagraphs (a)(1) through (a)(3) above; and
(iii) As an agent, has not personally participated, and will not participate, in action
contrary to subparagraphs (a)(1) through (a)(3) above.
(c) If the Offeror deletes or modifies subparagraph (a)(2) above, the Offeror must furnish with its
offer a signed statement setting forth in detail the circumstances of the disclosure.
7. 52.203-11 - CERTIFICATION AND DISCLOSURE REGARDING PAYMENTS TO INFLUENCE
CERTAIN FEDERAL TRANSACTIONS (SEP 2007)
(Applicable when the estimated value of the acquisition exceeds $100,000)
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(a)
Definitions.
As used in this provision—“Lobbying contact” has the meaning provided at
2 U.S.C. 1602(8)
. The terms “agency,” “influencing or attempting to influence,” “officer or
employee of an agency,” “person,” “reasonable compensation,” and “regularly employed” are
defined in the FAR clause of this solicitation entitled “Limitation on Payments to Influence
Certain Federal Transactions” (52.203-12
).
(b)
Prohibition
. The prohibition and exceptions contained in the FAR clause of this solicitation
entitled “Limitation on Payments to Influence Certain Federal Transactions” ( 52.203-12
) are
hereby incorporated by reference in this provision.
(c)
Certification
. The offeror, 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.
(d)
Disclosure
. If any registrants under the Lobbying Disclosure Act of 1995 have made a
lobbying contact on behalf of the offeror with respect to this contract, the offeror shall
complete and submit, with its offer, OMB Standard Form LLL, Disclosure of Lobbying
Activities, to provide the name of the registrants. The offeror need not report regularly
employed officers or employees of the offeror to whom payments of reasonable
compensation were made.
(e)
Penalty
. Submission of this certification and disclosure is a prerequisite for making or
entering into this contract imposed by 31 U.S.C. 1352
.Any person who makes an
expenditure prohibited under this provision or who fails to file or amend the disclosure
required 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.
8. 52.209-5 - CERTIFICATION REGARDING RESPONSIBILITY MATTERS (APR 2010)
(Applicable when the estimated value of the acquisition exceeds the simplified lease acquisition
threshold)
(a) (1) The Offeror certifies, to the best of its knowledge and belief, that—
(i) The Offeror and/or any of its Principals—
(A) Are
[ ]
are not
[ ]
presently debarred, suspended, proposed for
debarment, or declared ineligible for the award of contracts by any
Federal agency;
(B) 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 (if offeror checks “have”, the offeror shall also see
52.209-7
, if included in this solicitation);
(C) Are
[ ]
are not
[ ]
presently indicted for, or otherwise criminally or civilly
charged by a governmental entity with, commission of any of the
offenses enumerated in paragraph (a)(1)(i)(B) of this provision;
(D) Have
[ ]
, have not
[ ]
, within a three-year period preceding this offer,
been notified of any delinquent Federal taxes in an amount that exceeds
$3,000 for which the liability remains unsatisfied.
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(1) Federal taxes are considered delinquent if both of the following
criteria apply:
(i)
The tax liability is finally determined
. The liability is finally
determined if it has been assessed. A liability is not
finally determined if there is a pending administrative or
judicial challenge. In the case of a judicial challenge to
the liability, the liability is not finally determined until all
judicial appeal rights have been exhausted.
(ii)
The taxpayer is delinquent in making payment
. A
taxpayer is delinquent if the taxpayer has failed to pay
the tax liability when full payment was due and required.
A taxpayer is not delinquent in cases where enforced
collection action is precluded.
(2)
Examples
.
(i) The taxpayer has received a statutory notice of
deficiency, under I.R.C. § 6212, which entitles the
taxpayer to seek Tax Court review of a proposed tax
deficiency. This is not a delinquent tax because it is not
a final tax liability. Should the taxpayer seek Tax Court
review, this will not be a final tax liability until the
taxpayer has exercised all judicial appeal rights.
(ii) The IRS has filed a notice of Federal tax lien with
respect to an assessed tax liability, and the taxpayer has
been issued a notice under I.R.C. § 6320 entitling the
taxpayer to request a hearing with the IRS Office of
Appeals contesting the lien filing, and to further appeal to
the Tax Court if the IRS determines to sustain the lien
filing. In the course of the hearing, the taxpayer is
entitled to contest the underlying tax liability because the
taxpayer has had no prior opportunity to contest the
liability. This is not a delinquent tax because it is not a
final tax liability. Should the taxpayer seek tax court
review, this will not be a final tax liability until the
taxpayer has exercised all judicial appeal rights.
(iii) The taxpayer has entered into an installment agreement
pursuant to I.R.C. § 6159. The taxpayer is making timely
payments and is in full compliance with the agreement
terms. The taxpayer is not delinquent because the
taxpayer is not currently required to make full payment.
(iv) The taxpayer has filed for bankruptcy protection. The
taxpayer is not delinquent because enforced collection
action is stayed under 11 U.S.C. 362 (the Bankruptcy
Code).
(ii) The Offeror 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
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business entity (
e.g.
, general manager; plant manager; head of a division or business
segment; and similar positions).
This Certification Concerns a Matter Within the Jurisdiction of an Agency of the United States and
the Making of a False, Fictitious, or Fraudulent Certification May Render the Maker Subject to
Prosecution Under Section 1001, Title 18, United States Code.
(b) The Offeror shall provide immediate written notice to the Contracting Officer if, at any time
prior to contract award, the Offeror 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 Offeror’s responsibility. Failure of
the Offeror to furnish a certification or provide such additional information as requested by
the Contracting Officer may render the Offeror nonresponsible.
(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 an Offeror is not required to exceed that which
is normally possessed by a prudent person in the ordinary course of business dealings.
(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 Offeror
knowingly rendered an erroneous certification, in addition to other remedies available to the
Government, the Contracting Officer may terminate the contract resulting from this
solicitation for default.
9. 52.204-3 - TAXPAYER IDENTIFICATION (OCT 1998)
(a)
Definitions
.
“Common parent,” as used in this provision, means that corporate entity that owns or
controls an affiliated group of corporations that files its Federal income tax returns on a
consolidated basis, and of which the Offeror is a member.
“Taxpayer Identification Number (TIN),” as used in this provision, means the number
required by the Internal Revenue Service (IRS) to be used by the Offeror in reporting income
tax and other returns. The TIN may be either a Social Security Number or an Employer
Identification Number.
(b) All Offerors must submit the information required in paragraphs (d) through (f) of this
provision to comply with debt collection requirements of 31 U.S.C. 7701(c) and 3325(d),
reporting requirements of 26 U.S.C. 6041, 6041A, and 6050M, and implementing regulations
issued by the IRS. If the resulting contract is subject to the payment reporting requirements
described in Federal Acquisition Regulation (FAR) 4.904, the failure or refusal by the Offeror
to furnish the information may result in a 31 percent reduction of payments otherwise due
under the contract.
(c) The TIN may be used by the Government to collect and report on any delinquent amounts
arising out of the Offeror’s relationship with the Government (31 U.S.C. 7701(c)(3)). If the
resulting contract is subject to the payment reporting requirements described in FAR 4.904,
the TIN provided hereunder may be matched with IRS records to verify the accuracy of the
Offeror’s TIN.
(d)
Taxpayer Identification Number (TIN)
.
[ ]
TIN:
[ ]
TIN has been applied for.
[ ]
TIN is not required because:
[ ]
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
United States and does not have an office or place of business or a fiscal paying
agent in the United States;
[ ]
Offeror is an agency or instrumentality of a foreign government;
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[ ]
Offeror is an agency or instrumentality of the Federal government;
(e)
Type of organization
.
[ ]
Sole proprietorship;
[ ]
Government entity (Federal, State, or local);
[ ]
Partnership;
[ ]
Foreign government;
[ ]
Corporate entity (not tax-exempt);
[ ]
International organization per 26 CFR 1.6049-4;
[ ]
Corporate entity (tax-exempt);
[ ]
Other
(f)
Common Parent
.
[ ]
Offeror is not owned or controlled by a common parent as defined in paragraph (a) of
this provision.
[ ]
Name and TIN of common parent:
Name
TIN
10. 52.204-6 – DATA UNIVERSAL NUMBERING SYSTEM (DUNS) NUMBER (APR 2008)
(a) The offeror shall enter, in the block with its name and address on the cover page of its offer,
the annotation “DUNS” or “DUNS+4” followed by the DUNS number or “DUNS+4” that
identifies the offeror’s name and address exactly as stated in the offer. The DUNS number is
a nine-digit number assigned by Dun and Bradstreet, Inc. The DUNS+4 is the DUNS number
plus a 4-character suffix that may be assigned at the discretion of the offeror to establish
additional CCR records for identifying alternative Electronic Funds Transfer (EFT) accounts
(see Subpart 32.11
) for the same concern.
(b) If the offeror does not have a DUNS number, it should contact Dun and Bradstreet directly to
obtain one.
(1) An offeror may obtain a DUNS number—
(i) Via the Internet at http://fedgov.dnb.com/webform
or if the offeror does not
have internet access, it may call Dun and Bradstreet at 1-866-705-5711 if
located within the United States; or
(ii) If located outside the United States, by contacting the local Dun and Bradstreet
office. The offeror should indicate that it is an offeror for a U.S. Government
contract when contacting the local Dun and Bradstreet office.
(2) The offeror should be prepared to provide the following information:
(i) Company legal business name.
(ii) Tradestyle, doing business, or other name by which your entity is commonly
recognized.
(iii) Company physical street address, city, state and ZIP Code.
(iv) Company mailing address, city, state and ZIP Code (if separate from physical).
(v) Company telephone number.
(vi) Date the company was started.
(vii) Number of employees at your location.
(viii) Chief executive officer/key manager.
(ix) Line of business (industry).
(x) Company Headquarters name and address (reporting relationship within your
entity).
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INITIALS: &
LESSOR GOVERNMENT
11. DUNS NUMBER (JUN 2004)
Notwithstanding the above instructions, in addition to inserting the DUNS Number on the offer
cover page, the Offeror shall also provide its DUNS Number as part of this submission:
DUNS Number
12. CENTRAL CONTRACTOR REGISTRATION (MAY 2012)
The Central Contractor Registration (CCR) System is a centrally located, searchable database
which assists in the development, maintenance, and provision of sources for future procurements.
The Offeror must be registered in the CCR prior to lease award. The Offeror shall register via the
Internet at https://www.acquisition.gov
. To remain active, the Offeror/Lessor is required to update
or renew its registration annually.
[ ]
Registration Active and Copy Attached
[ ]
Will Activate Registration and Submit Copy to the Government Prior to Award
OFFEROR OR
AUTHORIZED
REPRESENTATIVE
NAME, ADDRESS (INCLUDING ZIP CODE)
NAME
STREET
CITY, STATE, ZIP
Signature
TELEPHONE NUMBER
Date
GSA 3518 (REV. 5/2013) PAGE 10GENERAL SERVICES ADMINISTRATION