Attachment 12: Representations and Certifications - FAR Contract

Representations, Certifications and Other Statements of Offerors To utilize this form: With cursor click on the below box. “Layout” will appear in the ribbon above. Ensure that “View Gridlines” is selected in order to see fill in boxes.

NAME OF PROPOSER

PROPOSAL TITLE

The following provisions shall be completed and provided with FAR proposals from various AFRL/PZL broad announcement solicitations (Broad Agency Announcement, Advanced Research Announcement, Multiple Authority Announcement) that supplement the annual representations and certifications from SAM.gov. In accordance with FAR 52.252-1, Solicitation Provisions Incorporated by Reference (FEB 1998) these below provisions are incorporated by reference and available in full text at https://www.acquisition.gov/. Completed Representations and Certifications are required to be provided with proposal for a complete offer. Provisions listed below in the table require Fill-in information or disclosures from the offeror, partial text is listed for ease of completing. The provisions applicable to this requirement are listed that either have no fill-ins or fill-ins are required to be completed in SAM.gov. The Contracting Officer (PCO) has inserted fill-ins within the table when applicable to that provision. Below the table, please leave fill-ins blank if assertion for that provision was made in sam.gov for the Contracting Officer to download the FAR & DFARS report. Each provision assertion shall only be completed in one location (SAM.gov or noted below) unless otherwise indicated by the Offeror when additional assertions are specific to the proposal. Any questions, please contact the Procurement Contracting Officer listed within the solicitation.

FAR / DFARS Provision(s)

Title

Applicability of the provisions to this solicitation
52.203-2 – N/A for Cost
Certificate of Independent Price Determination (Apr 1985) Applies to All Firm Fixed Price and Fixed price contracts or Fixed-Price Contract with Economic Price Adjustment 52.204-7 –Section L/I
System for Award Management (Nov 2024)
Applicable
52.204-8
Annual Representations and Certifications (Deviation 2025-O0003 and 2025-O0004)(Mar 2025)Indicated here by the PCO: (a)(1) 541715
(a)(2) 1,500X (i) 52.204-17, Ownership or Control of OfferorX (ii)52.204-20, Predecessor of Offeror__(vi) 52.227-6, Royalty Information __(A) Basic. __(B) Alternate I. Applicable, Paragraph (a)(1) and (a)(2) are indicated by the PCO in the “Title” column to the left.

Paragraph (c)(1) is applicable to this solicitation as indicated in the provision. Paragraph (c)(2) the following are applicable as indicated by the PCO in the “Title” column to the left.