9. Sealed offers in original and

In advertised procurement "oller" and "offeror" shall be construed to mean bid and bidder

SOLICITATION

copies for furnishing the supplies or services in the Schedule will be received at the place specified in block 8, or local time,

until

if handcarried, in the depository located in

In compliance with the above, the undersigned agrees, if this offer is accepted with calendar days (60 calendar days unless a different period is inserted by the offeror) from the date for receipt of offers specified above, to furnish any of all items upon which prices are offered at the price set opposite each item, delivered at the designated point(s), within the time specified in the schedule

(b) Page 2 of Standard Form 33.

REPRESENTATIONS, CERTIFICATIONS AND ACKNOWLEDGMENTS

REPRESENTATIONS (Check or complete all applicable boxes or blocks.)

He is, is not, a small business concern. If offeror is a small business concern and is not the manufacturer of the supplies offered, he also represents that all supplies to be furnished hereunder will not, be manufacturered or produced by a small business concern

in the United States, its possessions, or Puerto Rico.

will,

He is, is not, a minority business enterprise. A minority business enterprise is defined as a "business, at least 50 percent of which is owned by minority group members or, in case of publicly owned businesses, at least 51 percent of the stock of which is owned by minority group members." For the purpose of this definition, minority group members are Negroes, Spanish-speaking American persons, American-Orientals, American-Indians, American Eskimos, and American-Aleuts.

3.

4.

REGULAR DEALER – MANUFACTURER (Applicable only to supply contracts exceeding $10,000.) manufacturer of, the supplies offered,

He is a regular dealer in

CONTINGENT FEE (See par. 15 on SF 33-A.)

(a) He has, has not, employed or retained any company or persons (other than a full-time bona fide employee working solely for the offeror) to solicit or secure this contract, and (b) he has, has not, paid or agreed to pay any company or person (other than a fulltime bona fide employee working solely for the offeror) any fee, commission, percentage, or brokerage fee contingent upon or resulting from the award of this contract; and agrees to furnish information relating to (a) and (b) above, as requested by the Contracting Officer. (Interpretation of the representation, including the term "bona fide employee," see Code of Federal Regulations, Title 41, Subpart 1-1.5.)

5.

of

TYPE OF BUSINESS ORGANIZATION

He operates as an individual, a partnership, a nonprofit organization, corporation, incorporated under the laws of the State

AFFILIATION AND IDENTIFYING DATA (Applicable only to advertised solicitations.
Each offeror shall complete (a) and (b) if applicable, and (c) below:

SPECIMEN

te in the blocks below the name and main office address of

(a) He is, is not, owned or controlled by a parent company. (See paron SF 33-A.) (b) If the offeror is owned or controlled by a parent company,

the parent company:

NAME OF PARENT COMPANY AND MAIN OFFICE ADDRESS [include ZIP code)

(C) EMPLOYER'S IDENTIFICATION NUMBER(SEE PAR, 17 on SF 33-AJ OFFEROR'S EL NO.

7.

EQUAL OPPORTUNITY (a) He

PARENT COMPANY'S EL NO.

has, has not, participated in a previous contract or subcontract subject either to the Equal Opportunity clause herein or the clause originally contained in section 301 of Executive Order No. 10925, or the clause contained in Section 201 of Executive Order No. 11114; that he has, has not, filed all required compliance reports; and that representations indicating submission of required compliance reports, signed by proposed subcontractors, will be obtained prior to subcontract awards. (The above representation need not be submitted in connection with contracts or subcontracts which are exempt from the equal opportunity clause.)

(b) The bidder (or offeror) represents that (1) he has developed and has on file, has not developed and does not have on file, at each establishment affirmative action programs as required by the rules and regulations of the Secretary of Labor (41 CFR 60-1 and 60-2) or (2) he has not previously had contracts subject to the written affirmative action programs requirement of the rules and regulations of the Secretary of Labor. (The above representation shall be completed by each bidder for offeror) whose bid (offer) is $50,000 or more and who has 50 or more employees.)

CERTIFICATIONS (Check or complete all applicable boxes or blocks)

1. BUY AMERICAN CERTIFICATE

The offeror certifies as part of his offer, that: each end product, except the end products listed below, is a domestic end product (as defined in the clause entitled, "Buy American Act"); and that components of unknown origin have been considered to have been mined, produced, or manufactured outside the United States,

EXCLUDED END PRODUCTS

COUNTRY OF ORIGIN

Standard Form 33 Page 2 (REV, 3.77)

(c) Page 3 of Standard Form 33.

2. CLEAN AIR AND WATER (Applicable if the bid or offer exceeds $100,000, or the contracting officer has determined that orders under ar indefinite quantity contract in any year will exceed $100,000, or a facility to be used has been the subject of a conviction under the Clean Air Act (42 U.S.C. 1857c-8(c)(1)) or the Federal Water Pollution Control Act (33 U.S.C. 1319(c)) and is listed by EPA, or is not otherwise exempt.)

The bidder or offeror certifies as follows:

(a) Any facility to be utilized in the performance of this proposed contract has, has not, been listed on the Environmental Protection Agency List of Violating Facilities.

(b) He will promptly notify the contracting officer, prior to award, of the receipt of any communication from the Director, Office of Federal Activities, Environmental Protection Agency, indicating that any facility which he proposes to use for the performance of the contract is under consideration to be listed on the EPA list of Violating Facilities.

(c) He will include substantially this certification, including this paragraph (c), in every nonexempt subcontract.

3.

CERTIFICATION OF INDEPENDENT PRICE DETERMINATION (See par. 18 on SF 33-A)

(a) By submission of this offer, the offeror certifies, and in the case of a joint offer, each party thereto certifies as to its own organization, that in connection with this procurement:

(1) The prices in this offer have been arrived at independently, without consultation, communication, or agreement, for the purpose of restricting competition, as to any matter relating to such prices with any other offeror or with any competitor;

(2) Unless otherwise required by law, the prices which have been quoted in this offer have not been knowingly disclosed by the offeror and will not knowingly be disclosed by the offeror prior to opening in the case of an advertised procurement or prior to award in the case of a negotiated procurement, directly or indirectly to any other offeror or to any competitor; and

(3) No attempt has been made or will be made by the offeror to induce any other person or firm to submit or not to submit an offer for that purpose of restricting competition.

(b) Each person signing this offer certifies that:

(1) He is the person in the offeror's organization responsible within that organization for the decision as to the prices being offered herein and that he has not participated, and will not participate, in any action contrary to (a)(1) through (a)(3), above; or

(2) (i) He is not the person in the offeror's organization responsible within that organization for the decision as to the prices being offered herein but that he has been authorized in writing to act as agent for the persons responsible for such decision in certifying that such persons have not participated and will not participate, in any action contrary to (a)(1) through (a)(3) above, and as their agent does hereby so certify; and (ii) he has not participated, and will not participate, in any action contrary to (a)(1) through (a)(3) above.

4.

CERTIFICATION OF NONSEGREGATED FACILITIES (Applicable to (1) contracts, (2) subcontracts, and (3) agreements with applicants who are themselves performing federally assisted construction contracts, exceeding $10,000 which are not exempt from the provisions of the Equal Opportunity clause.) By the submission of this bid, the bidder, offeror, applicant, or subcontractor certifies that he does not maintain or provide for his employees any segregated facilities at any of his establishments, and that he does not permit his employees to perform their services at any location under his control, where segregated facilities are maintained. He tries further that he will not maintain or provide for his employ. ees any segregated facilities at any of his establishments, and that he not permit his employees to perform their services at any location, under his control, where segregated facilities are maintained. The bidder Here, applicant, or subcontractor agrees that a breach of this certification is a violation of the Equal Opportunity clause in this contact Assed in this certification, the term "segregated facilities" means any waiting rooms, work areas, rest rooms and wash rooms, restaurants and other eating areas, time clocks, locker rooms and other storage or dressing areas, parking lots, drinking fountains, recreation or entertainment areas, transportation, and housing facilities provided for employees which are segregated by explicit directive or are in ach segregated on the basis of race, color, religion or national origin, because of habit, local custom, or otherwise. He further agrees that except where he has obtained identical certifications from proposed subcontractors for specific time periods) he win bra identical certifications from proposed subcontractors prior to the award of subcontracts exceeding $10,000 which are not exempt from the provisions of the Equal Opportunity clause; that he will retain such certifications in his files; and that he will forward hollowing notice to such proposed subcontractors (except where the proposed subcontractors have submitted identical certicatons for specific time periods):

A Certification of Nonsegregated Facilities must be submitted prior to the award of a subcontract exceeding $10,000 which is not exempt from the provisions of the Equal Opportunity clause. The certification may be submitted either for each subcontract or for all subcontracts during a period (i.e., quarterly, semiannually, or annually). NOTE: The penalty for making false offers is prescribed in 18 U.S.C. 1001.

AMENDMENT NO.

DATE

AMENDMENT NO.

DATE

ACKNOWLEDGMENT OF AMENDMENTS

The offeror acknowledges receipt of amend. ments to the Soliciation for offers and related documents numbered and dated as follows:

NOTE: Offers must set forth full, accurate and complete information as required by this Solicitation (including attachments). The penalty for making false statements in offers is prescribed in 18 U.S.C. 1001.

Standard Form 33 Page 3 (REV, 3-77)