Appendix E - Reps and Certs Supplemental

REPRESENTATIONS AND CERTIFICATIONS SUPPLEMENTAL

Iowa State University (ISU) manages and operates Ames National Laboratory (referred to as the “Laboratory” or “Ames Laboratory”) for the Department of Energy (DOE) as a prime contractor under DOE Contract # DE-AC02-07CH11358 (Prime Contract), as amended. Therefore, all suppliers and subcontractors performing work or supplying goods to the Laboratory will be paid with government funds. To that end, ALL suppliers and subcontractors that desire to be considered for a purchase order or subcontract award valued at $15,000 or more are required to register their company in the Official U.S. Government System for Award Management (SAM) and complete annual representations and certifications electronically in SAM accessed through www.sam.gov.

INSTRUCTIONS

If proposed cost for work is less than $15,000, and your firm IS registered in SAM, then you are only required to provide the information in SECTION I (a) Entity Information, below. If your firm is NOT registered in SAM, then you are required to complete both SECTIONS I (a) Entity Information and I (b) Business Size & I (c) Covered Telecommunications Equipment or Services. HOWEVER, IF PROPOSED PRODUCTS ARE EXPORT CONTROLLED, THEN ALSO COMPLETE SECTION II (1). If your proposed cost for work is $15,000 or more, your firm MUST be registered in SAM, and you are required to complete SECTION I(a) only, & ALL Parts of SECTION II. SUBMIT your Representations and Certifications Supplemental to: Choose from dropdown.

AS USED HEREIN, THE TERM “CONTRACT” SHALL MEAN THE AMES NATIONAL LABORATORY AWARD “AGREEMENT” (ALSO REFERRED TO AS “PURCHASE ORDER” / “SUBCONTRACT”) RESULTING FROM THE OFFEROR’S PROPOSAL; “OFFER” INCLUDES “BID”, “PROPOSAL” AND “QUOTATION”; AND “OFFEROR” INCLUDES “BIDDER”, “PROPOSER”, “QUOTER”, “SUPPLIER”, “SUBCONTRACTOR”, OR “VENDOR” AS MAY BE APPLICABLE.

SECTION I

(a) ENTITY INFORMATION (complete and check all that applies)

(b) BUSINESS SIZE

Business Name:
Click or tap here to enter text.
In addition to 1(a), complete the section below if your proposed offer is less than $15,000 and your firm is NOT registered in SAM. The North American Industry Classification System (NAICS) code that your firm falls under for this purchase is: (Offeror fills in) Click or tap here to enter text.

Your Firm’s Business Size (per FAR 52.219-1) (Select all that apply) ☐ Small Business (SB)
☐ Disadvantaged SB
☐ Women-Owned SB
☐ Veteran-Owned (VO) SB
☐ Service-Disabled VOSB