cern, including its affiliates, which is independently owned and operated, is not dominant in the field of operation in which it is contracting and can further qualify under the criteria concerning number of employees, average annual receipts, or other criteria, as prescribed by the Small Business Administration.) (See Code of Fdeeral Regulations, Title 13, Part 12, as amended, which contains detailed definitions and related procedures.)

NOTE. The penalty for making false statements in offers is prescribed in 18 U.S.C. 1001.

2. TYPE OF ORGANIZATION

He operates as an () Individual, ( ) State or Local Agency, ( ) Partnership, ( ) Joint Venture, ( ) Nonprofit, ( ) Educational Institution, () Corporation organized and existing under the laws of the State of

3. REGULAR DEALER-MANUFACTURER

REPRESENTATION

(Applicable only to supply contracts exceeding $10,000.) He is a () regular dealer in () manufacturer of, the supplies covered by this proposal.

4. CONTINGENT FEE REPRESENTATION (Applicable only to proposals in which the aggregate amount involved exceeds $2,500.) Offeror represents: (a) That he () has, () has not, employed or retained any company or person (other than a full-time bona fide employee working solely for the offeror) to solicit or secure this contract, and (b) that he () has, () has not, paid or agreed to pay any company or person (other than a full-time 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 too (a) and (b) above as requested by the contracting officer. (NOTE.-For interpretation of representation, including the term "bona fide employee," see Code of Federal Regulations, Title 41, Chapter 1, Subpart 1

1.5.)

5. EQUAL OPPORTUNITY CERTIFICATION

a. Have you participated in any contractual agreement which contained the Equal Employment Opportunity Clause prescribed in Executive Orders 10925, 1114, or 11246? ( ) Yes. ( ) No.

b. Were you required pursuant to the rules and regulations of Equal Employment Opportunity (41 CFR 60-1) to file a compliance report as the result of such contractual agreement?

() Yes. ( ) No. If "Yes," answer question (c).

c. Did you file the necessary compliance report in accordance with the instructions contained on the appropriate report form-SF40, SF-41, or EEO-1 (SF-100).

6. CERTIFICATION OF NONSEGREGATED
FACILITIES

By the submission of this offer, the offeror 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 certifies further that he will not maintain or provide for his employees any segregated facilities at any of his establishments, and that he will not permit his employees to perform their services at any location, under his control, where segregated facilities are maintained. The offeror, or subcontractor agrees that a breach of this certification is a violation of the equal opportunity clause of this contract. As used 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 fact 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 will obtain identical certification 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 the following notice to such proposed subcontractors (except where proposed subcontractors have submitted identical certification for specific time periods).

NOTICE TO PROSPECTIVE SUBCONTRACTORS OF REQUIREMENT FOR CERTIFICATIONS OF NONSEGREGATED FACILITIES

A certification of nonsegregated facilities, as required by the May 9, 1967, order (32 FR 7439, May 19, 1967) on elimination of segregated facilities, by the Secretary of Labor 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.-Failure of an offeror to agree to the certification of nonsegregated facilities shall render his offer nonresponsive to the terms of solicitations involving awards of contracts exceeding $10,000 which are not exempt from the provisions of the equal opportunity clause.

7. BUY AMERICAN CERTIFICATE

(Applies to proposals involving end products as defined by FPR 1-6.101.) The offeror hereby certifies that each end product, except the end product listed below, is a domestic source 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 (show country of origin for each excluded end product).

8. DUPLICATION OF COST

The contractor represents and certifies that any charges contemplated and included in his estimate of cost for performance are not duplicative of any charges against any other Government contract, subcontract, or other Government source.

9. PLACE OF PERFORMANCE

Following is the name and location of the plant or place of business where the item(s)

1 For definition of "cost or pricing data," see FPR § 1-3.807-3.

2 Describe the proposal, quotation, request for price adjustments, or other submission involved, giving appropriate identifying number (e.g., RFP No.

3 This date shall be the date when the price negotiations were concluded and the contract price was agreed to. The responsibility of the contractor is not limited by the personal knowledge of the contractor's negotiator if the contractor had information reasonably available (see § 1-3.807-5 (a)) at the time of agreement showing that the negotiated price is not based on accurate, complete, and current data.

4 This date should be as close as practicable to the date when the price negotiations were concluded and the contract price was agreed upon.

11. CERTIFICATION OF INDEPENDENT PRICE

DETERMINATION

a. By submission of this proposal, each offeror certifies and in the case of a joint bid or proposal, each party thereto, certifies as to its own organizations, that in connection with this procurement:

(1) The prices in this proposal 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 competition;

(2) Unless otherwise required by law, the prices which have been quoted in this proposal have not been knowingly disclosed by the offeror and will not knowingly be disclosed by the prior to award, 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 a proposal for the purpose of restricting competition.

b. Each person signing this proposal 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) He is not the person in the offeror's organization responsible within that organization for the decision as to 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.

c. This certification is not applicable to a foreign offeror submitting a proposal for a contract which requires performance or delivery outside the United States, its possessions, and Puerto Rico.

d. A proposal will not be considered for award where (a) (1), (a) (3), or (b) above has been deleted or modified. Where (a) (2) above has been deleted or modified, the proposal will not be considered for award unless the offeror furnishes with the proposal a signed statement which sets forth in detail the circumstances of the disclosure and the head of the agency, or his designee, determines that such disclosure was not made for the purpose of restricting competition.

12. PRICE STABILIZATION CERTIFICATION (a) The offeror (Contractor) certifies that he is in compliance with the price stabilization requirements of Executive Order 11723, dated June 13, 1973, and amendments thereof, and the regulations of the Cost of

Living Council as set forth in title 6, Code of Federal Regulations, Part 140, or any additions or revisions to title 6.

13. DISCLOSURE STATEMENT-COST ACCOUNTING

PRACTICES AND CERTIFICATION

Any contract in excess of $100,000 resulting from this solicitation, except when the price negotiated is based on: (a) Established catalog or market prices of commercial items sold in substantial quantities to the general public, or (b) prices set by law or regulation, shall be subject to the requirements of the Cost Accounting Standards Board. Any offeror submitting a proposal which, if accepted, will result in a contract subject to the requirements of the Cost Accounting Standards Board must, as a condition of contracting, submit a disclosure statement as required by regulations of the Board. The disclosure statement must be submitted as a part of the offeror's proposal under this solicitation (see 1, below) unless (i) the offeror, together with all divisions, subsidiaries, and affiliates under common control, did not receive net awards of negotiated defense prime contracts during the period July 1, 1970, through June 30, 1971, totaling more than $30 million (see 2, below), (ii) the offeror has already submitted a disclosure statement disclosing the practices used in connection with the pricing of this proposal (see 3, below) or (iii) postaward submission has been authorized by the contracting officer.

CAUTION.-A practice disclosed in a disclosure statement shall not, by virtue of such disclosure, be deemed to be a proper, approved, or agreed to practice for pricing proposals or accumulating and reporting contract performance cost data.

() 1. CERTIFICATION OF CONCURRENT SUBMISSION OF DISCLOSURE STATEMENTS

The offeror hereby certifies that he has submitted, as a part of his proposal under this solicitation, copies of the disclosure statements as follows: (i) Original and one copy to the cognizant contracting officer; (ii) one copy to the cognizant contract auditor; and (iii) one copy to the Cost Accounting Standards Board, 441 G Street NW., Washington, D.C. 20548.

The offeror further certifies that practices used in estimating costs in pricing this proposal are consistent with the cost accounting practices disclosed in this disclosure statement. For additional exemptions, see Federal Procurement Regulations, Temporary Regulation 27 and supplements thereto.

(j) Noncompetitive procurements.-For noncompetitive procurements, the RFP shall include the transmittal letter, the offeror's representations and certifications, and the instructions relative to cost and pricing data. The following are the minimum instructions that should be included in the RFP.

INSTRUCTIONS TO OFFEROR

The following instructions establish the acceptable minimum requirements for the format and content of proposals. Special attention is directed to the requirements for technical and business proposals to be submitted in accordance with instructions herein.

GENERAL INSTRUCTIONS

(1) The proposal shall be based on a---type of contract. In addition to the special provisions of this solicitation, any ensuing contract will include the general provisions for

Any additional clauses required by public law, Executive order, or procurement regulations, in effect at the time of execution of the proposed contract, will be included.

(2) The proposal shall be signed by an official authorized to bind your organization. copies of your proposal shall be sub

mitted to: (Insert complete address as to where the proposal is to be sent and mailing instructions.)

(3) You may, at your discretion, submit alternative proposals, or proposals which deviate from the requirements: Provided, That you also submit a proposal for performance of the work as specified in the statement of work. Such proposals may be considered if overall performance would be improved or not compromised; and if they are in the best interests of the Government. Alternative proposals, or deviations from any requirements of this solicitation shall be clearly identified. (4) The proposal submitted in response to the request for proposal may contain technical data which you or your subcontractor(s) do not want used or disclosed for any purpose other than evaluation of your proposal. The use and disclosure of any such data may be so restricted; Provided, That you mark the cover sheet of the proposal

with the following legend, specifying the pages of the proposal which are to be restricted in accordance with the conditions of the legend.

"Technical data contained in pages

of this proposal shall not be used or disclosed, except for evaluation purposes, Provided, That if a contract is awarded to this offeror as a result of or in connection with the submission of this proposal the Government shall have the right to use or disclose this technical data to the extent provided in the contract. This restriction does not limit the Government's right to use or disclose technical data obtained from another source without restriction."

The Government assumes no liability for disclosure or use of unmarked technical data and may use or disclose the data for any purpose and may consider that the proposal was not submitted in confidence and therefore releasable under the Freedom of Information Act (5 U.S.C. 552).

(5) The Government reserves the right to reject any or all proposals received. It is understood that your proposal will become a part of the official file on this matter without obligation to the Government. [38 FR 24644, Sept. 10, 1973]

§ 3-16.5002 Contract forms.
§ 3-16.5002-1 Negotiated
(Form HEW-554).

Contract

Negotiated Contract, Form HEW-554, is the cover page of the contract and must be executed to reflect mutual agreement by the contracting parties. § 3-16.5002-2

Contents of Contract (Form HEW-555).

Contents of Contract, Form HEW-555, shall be used to list the contents of the contract including applicable "Special Provisions" by article number and name, and "General Provisions" (Forms HEW313, 314, 315, 316, or others) which are appropriate to the type of contract consumated.

§ 3-16.5002-3 Special Provisions (Form HEW-556).

Each contract shall include a section headed "Special Provisions" (Form HEW-556 is optional for this purpose) to describe the scope of work, schedulings, special terms, conditions, and additions, modification, and substitutions, to General Provisions, if any, as authorized by § 3-16.5003. § 3-16.5002-4

General Provisions.

The appropriate General Provisions set forth in this § 3-16.5002-4 shall be incorporated by the contracting officer in all contracts to which this Subpart 3-16.50 applies.

(a) Form HEW-313 (Rev. 8/64), General Provisions (Negotiated Fixed-Price Contract With Non-Profit Organizations).

(b) Form HEW-314 (Rev. 8/64), General Provisions (Negotiated Fixed-Price Contract With Profit Making Organization).

(c) Form HEW-315 (Rev. 8/64), General Provisions (Negotiated Cost-Reimbursement Contract).

(d) Form HEW-316 (Rev. 8/64), General Provisions (Negotiated Cost-PlusA-Fixed-Fee Contract).

§ 3-16.5002-5 Standard

Form 30, Amendment of Solicitation/Modification of Contract.

Modifications of existing contracts shall be accomplished by the use of change orders and/or supplemental agreements. Standard Form 30, Amendment of Solicitation/Modification of Contract, may be used for these purposes (see 1-16.901-30 of this title for illustration of form).

and substitutions to General Provisions.

(a) Contracting officers shall include additional clauses or substitute alternate clauses for those included in the four General Provisions (Forms HEW-313316) in accordance with applicable instructions in this § 3-16.5003 and the FPR. No other changes shall be made in the General Provisions without the prior approval of the Office of General Counsel, OS (BAL). Written requests shall be submitted through procurement channels directly to the Office of General Counsel (OGC-BAL), with a copy to the Director, Division of Procurement and Materiel Management (DPMM-OGS), OASA-OGS. The approval shall be transmitted by OGC-BAL through procurement channels to the contracting officer with a copy to DPMM-OGS. In the event expeditious action is required, contracting officers are authorized to request oral or written approval directly from OGCBAL. If oral approval is received from OGC-BAL, contracting officers must, however, submit a confirming letter of approval to DPMM-OGS-OASA.

(1) The "Small Business Subcontracting Program" clause set forth in § 11.710-3(b) of this title shall be included in all contracts under the circumstances set forth in that section.

(2) The "Labor Surplus Area Subcontracting Program” clause set forth in § 1-1.805-3(b) of this title shall be inIcluded in all contracts under circumstances set forth in that section.

(3) The following "Patent Indemnity" clause shall be used in contracts exceeding $5,000 which call for the delivery of supplies (or supplies with relatively minor modifications made thereto) which normally are or have been sold to the public in the commercial open market:

PATENT INDEMNITY

The Contractor agrees to indemnify the Government and its officers, agents, and employees against liability, including costs, for infringements of any United States letters patent (except letters patent issued upon an application which is now or may hereafter be kept secret or otherwise withheld from issue by order of the Government) arising out of the performance of this contract, or out of the use of or disposal by or for the account of the Government, of supplies furnished hereunder. The foregoing indemnity shall not apply unless the Contractor shall have been informed as soon as practicable by the Government of the suit or action alleging such infringement, and shall have been given such opportunity as is afforded by applicable laws, rules, or regulations to participate in the defense thereof; and further, such indemnity shall not apply if: (1) The infringement results from compliance with specific written instructions of the Contracting Officer directing a change in the supplies to be delivered or in the materials or equipment to be used; or (ii) the infringement results from addition to, or change in, such supplies or components furnished which addition or change was made subsequent to delivery or performance by the Contractor; or (ii) the claimed infringement is settled without the consent of the Contractor, unless required by final decree or a court of competent jurisdiction.

(For the purpose of excluding from patent indemnification such items as normally are not or have not been sold or offered for sale by any supplier to the public in the commercial open market, the following sentence may be added to the end of the clause:

"The foregoing shall not apply to the following items: (list the items to be excluded).")

(4) Where the primary objective of the contract is the delivery of end items other than designs, drawings, or reports, the following "Inspection" clause shall be used in lieu of the "Inspection" clause in HEW Forms 313 and 314, unless the contracting officer determines that the use of such clause is impracticable: