Attachment 9: Representations Certifications and Other Statements of Offerors

FA8650-22-S-5002 (Amendment 3)
Attachment 9

AFRL/RX Functional Materials Open BAA
Attachment 9
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. 1. Provisions listed below the table require Fill-in information or disclosures from the offeror, partial text is listed for ease of completing.
a. In the table provisions applicable to this requirement are listed that either have no fill-ins or fill-ins are required to be completed in SAM.gov.
b. The Contracting Officer (PCO) has inserted fill-ins within the table when applicable to that provision. c. 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. i. 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

52.203-11

Certification and Disclosure Regarding Payments to
Influence Certain Federal Transactions

Greater than $150K

52.204-7 –
Section L/I

System for Award Management (Oct 2018)

All

52.204-17

Ownership or Control of Offeror (Aug 2020)

All

FA8650-22-S-5002 (Amendment 3)
Attachment 9

52.204-20

Predecessor of Offeror (Aug 2020)

All

52.204-8

Annual Representations and Certifications (Feb 2024)