Disclosure Statement (Page 2 of 4) in pdf

(Disclosure must be on Form No. CASB DS-1 or CASB DS-2, as applicable.

Forms may be obtained from the cognizant ACO or Federal official and/or

from the loose-leaf version of the Federal Acquisition Regulation.)

Date of Disclosure Statement: _______________________

Name and Address of Cognizant ACO or Federal Official where filed:

_____________ __________________________________________________

The offeror further certifies that the practices used in estimating costs in pricing

this proposal are consistent with the cost accounting practices disclosed in the

Disclosure Statement.

(2) Certificate of Previously Submitted Disclosure Statement.

The offeror hereby certifies that the required Disclosure Statement was filed as

follows:

Date of Disclosure Statement: ________________________________

Name and Address of Cognizant ACO or Federal Official where filed:

______________________________________________________________________

The offeror further certifies that the practices used in estimating costs in pricing this

proposal are consistent with the cost accounting practices disclosed in the applicable

Disclosure Statement.

(3) Certificate of Monetary Exemption.

The offeror hereby certifies that the offeror, together with all divisions, subsidiaries,

and affiliates under common control, did not receive net awards of negotiated prime

contracts and subcontracts subject to CAS totaling $50 million or more in the cost

accounting period immediately preceding the period in which this proposal was

submitted. The offeror further certifies that if such status changes before an award

resulting from this proposal, the offeror will advise the Contracting Officer

immediately.

(4) Certificate of Interim Exemption.

The offeror hereby certifies that (i) the offeror first exceeded the monetary exemption

for disclosure, as defined in (3) above, in the cost accounting period immediately

preceding the period in which this offer was submitted and (ii) in accordance with 48

CFR 9903.202-1, the offeror is not yet required to submit a Disclosure Statement. The

offeror further certifies that if an award resulting from this proposal has not been made

within 90 days after the end of that period, the offeror will immediately submit a

revised certificate to the Contracting Officer, in the form specified under

SA5243 Rev. 01/31/2013

Verify Current Revision of Form

Disclosure Statement Page 2