Reps and Certs Long

Pre-Award Information
Representation and Certifications
(ANL-70B Long Version)

Please have this document executed by an official authorized to sign on behalf of your organization. You are encouraged to register in SAM.GOV via http://www.sam.gov and clicking on “Online Reps and Certs Application.” The clauses from the Federal Acquisition Regulation (FAR) below are the dated versions that appear in the Laboratory’s prime contract with the U.S. Department of Energy, available at https://www.anl.gov/prime-contract on the date this document is executed. By executing this document, you further certify, acknowledge and agree you are under a continuing duty to update the Laboratory in the event of changes to the representations and certifications made in this document.

PART 1 - APPLICABLE FOR ALL OFFERS/SOLICITATIONS

1.1

General Information
Legal Name of Company/Entity:
Unique Entity ID Number (UEI):

(UEI is a unique 12-character alphanumeric ID assigned to an entity by

SAM.GOV

Doing Business As:

(If Applicable)

Company/Entity Physical Street Address:
(Include Zip + 4 Code)

Primary Performance Location:

(If different than address above – Physical Street Address, City, State, Zip +4 Code

Primary Contact:

(for Contract – Name, email, and phone number)

Primary Contact:

(for Contract Close-out – Name, email, and phone number)

Primary Contact:

(for Property Management – Name, email, and phone number)

1.2

Business Organization – Entity Type
Please select Entity Type from the options below:

Business Organization - Entity Type
1.3

State of Incorporation

Small Business Program–https://wvww.sba.gov
Small U.S. Companies/Entities, please select ALL Business Classifications that apply:

1.4

Small Business

Veteran-Owned Small Business

Small-Disadvantaged Business

Service-Disabled Veteran-Owned Small
Business

Woman-Owned Small Business

HubZone

North American Industry Classification System (NAICS) Code Please provide the NAICS Code and Size Standard for the RFP/RFQ Request:

NAICS Code

ANL-70B (Long Version)
January 13, 2025

Size Standard

Argonne National Laboratory

1.5 Required Tax Documentation

Completion of this this representation and certification document serves as confirmation that the appropriate required tax documents (W-/W-8) have been or will be submitted to [email protected] (a secured site). 1) To find the correct IRS tax form, visit the IRS Forms & Publications page: https://www.irs.gov/forms-pubs 2) Should a Social Security Number (SSN) be provided instead of the Federal Employee Identification Number (FEIN),