Form Representations And Certifications

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REPRESENTATIONS AND CERTIFICATIONS
Solicitation Number
Dated
(Acquisition of Leasehold Interests in Real Property)
Complete appropriate boxes, sign the form, and attach to offer.
The Offeror makes the following Representations and Certifications. NOTE: The "Offeror," as used on this form, is the owner of the
property offered, not an individual or agent representing the owner.
1.
52.219-1 - SMALL BUSINESS PROGRAM REPRESENTATIONS (NOV 1999)
(a)
(1)
The standard industrial classification (SIC) code for this acquisition is 6515.
(2)
The small business size standard applicable to this acquisition is average annual gross revenues of $15 million
or less for the preceding three fiscal years.
(3)
The small business size standard for a concern which submits an offer in its own name, other than on a
construction or service contract, but which proposes to furnish a product which it did not itself manufacture, is
500 employees.
(b)
Representations.
(1)
The Offeror represents as part of its offer that it [ ] is, [ ] is not a small business concern.
(2)
(Complete only if offeror represented itself as a small business concern in paragraph (b)(1) of this provision.) The
Offeror represents, for general statistical purposes, that it [ ] is, [ ] is not a small disadvantaged business
concern as defined in 13 CFR 124.1002.
(3)
(Complete only if offeror represented itself as a small business concern in paragraph (b)(1) of this section.) The
Offeror represents as part of its offer that it [ ] is, [ ] is not a women-owned small business concern.
(4)
[Complete only if offeror represented itself as a small business concern in paragraph (b)(1) of this provision.] The
offeror represents, as part of its offer, that it—
(i) [ ] is, [ ] is not a HUBZone small business concern listed, on the date of this representation, on the List of
Qualified HUBZone Small Business Concerns maintained by the Small BusinessAdministration, and no material
change in ownership and control, principal office of ownership, or HUBZone employee percentage has occurred
since it was certified by the Small Business Administration in accordance with 13 CFR Part 126; and
(ii) It [ ] is, [ ] is not a joint venture that complies with the requirements of 13 CFR Part 126, and the
representation in paragraph (b)(4)(i) of this provision is accurate for the HUBZone small business concern or
concerns that are participating in the joint venture. [The offeror shall enter the name or names of the HUBZone
small business concern or concerns that are participating in the joint venture: __________________________.]
Each HUBZone small business concern participating in the joint venture shall submit a separate signed copy of
the HUBZone representation.
(5)
[Complete if offeror represented itself as disadvantaged in paragraph (b)(2) of this provision]. The offeror shall
check the category in which its ownership falls:
____ Black American.
____ Hispanic American.
____ Native American (American Indians, Eskimos, Aleuts, or Native Hawaiians).
____ Asian-Pacific American (persons with origins from Burma, Thailand, Malaysia, Indonesia, Singapore,
Brunei, Japan, China, Taiwan, Laos, Cambodia (Kampuchea), Vietnam, Korea, The Philippines, U.S.
Trust Territory of the Pacific Islands (Republic of Palau), Republic of the Marshall Islands, Federated
States of Micronesia, the Commonwealth of the Northern Mariana Islands, Guam, Samoa, Macao, Hong
Kong, Fiji, Tonga, Kiribati, Tuvalu, or Nauru).
____ Subcontinent Asian (Asian-Indian) American (persons with origins from India, Pakistan, Bangladesh, Sri
Lanka, Bhutan, the Maldives Islands, or Nepal).
____ Individual/concern, other than one of the preceding.
(c)
Definitions. Small business concern, as use in this provision, means a concern, including its affiliates, that is
independently owned and operated, not dominant in the field of operation in which it is bidding on Government
contracts, and qualified as a small business under the criteria in 13 CFR Part 121 and the size standard in paragraph (a)
of this provision.
Women-owned small business concern, as use in this provision, means a small business concern--
(1)
Which is at least 51 percent owned by one or more women or, in the case of any publicly owned business, at
least 51 percent of the stock of which is owned by one ore more women; and
(2)
Whose management and daily business operations are controlled by one or more women.
(d)
Notice.
(1)
If this solicitation is for supplies and has been set aside, in whole or in part, for small business concerns, then the
clause in this solicitation providing notice of the set-aside contains restrictions on the source of the end items to
be furnished.
INITIALS:
&
LESSOR
GOVERNMENT
GSA FORM 3518 PAGE 1 (REV 12/99)

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