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<br />STANDARD FORM 19-8
<br />DECEMBER 1<165 EDITlQN
<br />GENERAL SERVICES ADMINISTR....TlON
<br />FED PROC REG. W erR} 1-16401
<br />
<br />REPRESENTATIONS
<br />
<br />AND CERTIFICATIONS
<br />
<br />I Constractlon Contract)
<br />(For III. with SF ,. Gad 21 J
<br />
<br />REFERENCE (E"krJ."" N".(s) liS on SF lY!1n
<br />
<br />NAME AND ADORuS OF BlODER (No.. Strut., (;". S/"",.,", ZIP Cod,)
<br />
<br />DATE OF SID
<br />
<br />In negol;~led procurements, "bid" and "bUldern shall bt construed to mean "oDer" and uoDeror.1J
<br />
<br />The bidder makes the 'ollowing fCpreSeQtaEion! and cercilicalions as a part of the bid identified above. (Cbuk ilPpropriale
<br />boxes.)
<br />1. SMALL BlISINESS
<br />
<br />Hr 0 is, 0 is not, a .m311 businrsl concern. (For ,bis pur/Jost, ., ,,,,IIIJ bIlS;,,,,1 co"u,,, is" busi",SJ ,,,'un_, i,.,I"Jin, its 4ffi/illJrJ, IIIb;(b
<br />(.) iJ jl'tlJrpfJsdnlJI, OWl'll14 "",d opn41rd, (b) jJ ;'0' domi8dIil' in ,br firld of op"Alion j,. 'Ulbid~ j, iJ biddi", 0" GOllwnnl""U rOl'lj7..rls, 4:11'.1 (r) bMl
<br />""tr4" .."flU41 7"tipt~ lor Ib, ",tudi", 3 fiH4J 7'''r~ 1'101 n:rt,ain, $7,'500.000. For .,dd;tio".J i"lorm.tio" lit '01l,rni1l, 't,UI41io"l 01 th, Small
<br />BusilJtU Admj"iUr4t;Oll.)
<br />
<br />2. CONTINGENT fEE
<br />
<br />{4l He 0 hu. 0 hill not, employed or retillined any com~ny or pt'rJon (otber rhan a full-lime bona fide employee workin(l: solely fat the
<br />bidder) to solicic or secure Ihis conltact, and (6) he 0 has. 0 has not. paid or agreed ro pay any company or person (Other than .t lull-lime
<br />bona fide emplo)"ee ..orkinJ solely lor the bidder) any lee, commission. perccnta8c or broken!e fee. conlinsefH upon or resuhins from the award
<br />of this COnlu.ct; and ;!Ignes to lurnish inforourion reluins to (,,) ilnd (6) above as requcsted by the Concrutin. Officer. (For i,tltrprtt4tio" 01
<br />Ih, r,p"st"lalio", i..rllItJi", Ib, It,,,, "bo..a /iJ, ,,,,plo,u," Sit Cod, of F,J"d R,,"l41iolU. Tin, 41, $lIb"." 1-1.5.)
<br />
<br />3. TYPE OF ORG^NIZ^TION
<br />He oper:uu as an 0 individual. 0 partnership. 0 joint venture. 0 corpota.tion, im;:otponted in State of _______~h_._________h______._.
<br />
<br />4. INDEPENDENT PRICE DETERMINATION
<br />
<br />(4) By submission of tbi. bid. each bidder certifies, and in che clle of a joint bid each puty thereto certili,. as ro bis own orsanizuion. thu in
<br />conneclion ...ilh this procuremenl:
<br />OJ The prieu in lhis bid h1:ve been arrived at independently, ...irhour cOflSultation, communication. or .tsreement. for [he purpou 01
<br />nostricdnl competition. .. to any macter relatinJl to such pricn ....irh any other bidder or ....itb .ny competitQr;
<br />(2) Unlus otherwise required by 1...... tbe prices whicb have been quoted in this bid have nOI been knowinsly di.c1osed by Ihe- bidder and
<br />will nOI knowin,ly be dlsdOled by Ihe bidder priot to opt:ninl. in tb. case of a bid. or prior to award, in the esse of a proposal. ditecrly
<br />or indirectly to any ocher bidder or to Ii'll' cOlJ1pelitor. and
<br />C 3) No alted'lpl bas been mlde or will be made by tbe bidder 10 induce a.ny other person or 6rm co IUbmir or nOt to submit a bid for tbr
<br />purpose of rescrictinl competition.
<br />
<br />(b) Each person si,nin, chi. bid certifies th.t:
<br />01 He is lhe person in the bidder's orlaniution responsible within that otpni.uti(Jn (Ot the decisiO(l. a.s to the prices being bid herein and
<br />thai he has not participate-d. and will not puricipare, in Iny action contrary ro (..) (I) throuJh (..) (3) .bovei or
<br />(2) Ci) He is not the penon in rbe bidder'. orJaniution responsible witbin that orpniP,tion for the deci.ion IllS to tbe prices be-inR bid
<br />berein but that be bas been lutboriaed in writinl 10 Ict as I,ent for tbe penons responsible for .ucb decision in certifyinl th.1 such ~ersons
<br />have not particiraltd. and will nOI particip.te. in .ny action contrary fO (..)(J) throulh (...)(3) above. and as their asent does hereby so
<br />ctrtii'Y; and (iil be has nO\. \'..ni.ci.p..t...<J.....M ~m nOL pa.nicip:ue. in .n'Y action. conu-at} to (lIlIU) thrOUIb. (.s){3) above.
<br />
<br />(c) This certilication i. not Ipplicable co a fonian bidder submitrin~ a bid for a. contract wbich require. performance or delivery ounide che
<br />United Sutes. in posselflons. Ind Puerto Rico.
<br />
<br />(d) ^ bid will not be con.idered for award when e..) (u. (4'){3). or (b) above. has bftn del~led or modified. Where (_) (2) above. has been
<br />del~ted or modified. the bid 'WitI nor be con.idered lor award unless Ibe bidder furnishes with tbe bid . silned Jtllement which sets forth in
<br />detail tbe circumslance. of the diKlo.ure and tbe bead of tbe alency. or bit dnisnee. detcrminn tbat sucb ditclosure was not made {or rbe purpose
<br />of resuictinJl competition.
<br />
<br />THE FOllOWING NEED BE CHECKED O"-LY IF BID I!X.CEED$ 'fO,ooo IN AMOUNT.
<br />5. EQUAL OPPORTUNITY
<br />He 0 hOlI. 0 hOl. nOl. panicipated in I prey Iou. cemlract or .ubcontf'lCf. .uhject 10 Ihe Equal Opponunit)l Chule herein. the c1awe
<br />ori,inally contained in Section 301 of Eucutive Order No. 100:Z" ot tb. claUIe contained in Section 201 of ltxeauiYtl Order No. lInf; he 0 hu.
<br />D has not, liled all required compli.nce report'i and reprtoUnration. indicaljn. lUhmiuion of required compliance repon.. .isned by propoted sub.
<br />contractors. will be obtained ptiOl to lubconll'act awuds. (T", .-boll, ,.p"",""';O'l ""il Mol ", 1""",ill,4 ;11 (0....'(';0,. wilh ro"',,,,,, 0' lub(o".
<br />Ir""1 wbifb "'~ "u",PI /'0'" ,b, rl.MII.)
<br />6. PARENT COMPANY AND EMPLOYER IDENTifiCATION NUMBER
<br />E.1Ch bidde, Sh41/ IlIrnish the lol/owl", ;"lorm4tiD" hy /illi", iN th~ tZppropri4t~ blocks:
<br />e", Is the bidder o.".ncd or coacrolted by I parmi company al de.cribed below? 0 Yea 0 No. (fo, Ib~ p."POII of tbis bid. . p4r,,,t
<br />01111{',#lJ iJ d~"",d 4J Q'" ",hieh ,itbn 011'''' Qr '"0""0/1 ,h, .uli,,;,;,, ""J 10..,;,. hm;,''', ""Iid" /JI Ih, bjdd,r. To IlUlrS ""/Jlb,, (Ilm"a",
<br />""4m Ib, I",r"" (Ortl""", ""nl 01Vll 011 J,illl " ",.;o,il, (".or, ,b.." '0 pnt,,,n oj II" lIo,i., r1,blS i" ,b.., (0"''''''',_ To (ontrol .."olbrr (01'1-
<br />p..",. IJI,b o",,,,,,blp ;s no' "quir,il; ;1 dolhl7 ro",p..", is .bl, 10 lo,,,,ul..u, d',I_d..., 0' 11,,0 6<111Si& illd;"", poUt1 d"i,;olJJ 01 tb, bidd",
<br />Jllth o,hn (0"'P""1 is (o"lid.t"J Ib, p""", (0./1"'1 01 Ib, .idJ,r. Tbi, (otllrol .., ", ,Jl:ft'&;,M ',",ouIII &I" ..n 01 40",i""", ",ino,il, ~o,j",
<br />,i,blJ, uu 0/ P,oxy 1I01in,. &o"t,.Clutf/ .",,,,,,.,.11. rn olbnwin.)
<br />(b) If Ihe ans'Wer to (,,) above. i. ..Ye.... bidder .ball inlert in the .pace bel(nli the name Ind main office addns. of tbe parent company.
<br />
<br />NAME OF PARENT COMPANY
<br />
<br />"'''IN OFFICE "ODRESS (No., SI,,,I. Cit,. SI4I" ""il ZfP Codd
<br />
<br />(() Biddet .hall in.en in Ihe applicable space below. if he has no patent company. hiJ own Employer'S Identilicalion Number {E.!. No,}
<br />(F,J,r.u Soci," S~(.,it, Nu",b,r !Iud 0,. employ,,', Q....,II,I, Fwdn.1 TIP" R.,u,,,, U.S. TrIlUl,r, D~p""mtrrt Fo,,,, 941). or. if he has ;II parent
<br />company. the E.I. No_ of his puent company.
<br />
<br />EMPLOYER I~..!I PARENT COMPANY I BIDDER
<br />IDENTIFICATION NUMBER OF .",
<br />
<br />NOTE.-Bids mUJI sel fO'lh ful/, a('(u'all', 4nd comp/ele info,mation ar requi,ed by lhir il11';lalio1l 10, bidr (indudinll
<br />al/m:hmolfs). The pt'"aJly fo, making false slalemenlJ in bids is p,esc,ibed in 18 U.s.c. /001.
<br />1i-301
<br />
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