Sample Unsolicited Proposal Submission Cover Letter Page 8

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(Name)
(Street)
(City,State,Zip Code)
K-10.3 Name(s) and Location(s) of the firm(s) or person(s) owning or operating the facility in Section K-10.1
above, if other than the offeror.
(Name)
(Street)
(City,State,Zip Code)
(Name)
(State)
(City,State,Zip Code)
K-11 CERTIFICATIONS: Read carefully, then complete the information requested below.
“I certify that the information provided is true and may be relied upon in determining my responsibility. If the
information is incorrect, incomplete, or misleading, I understand and agree that sufficient basis exists to
determine me non-responsible for the performance of the contract, or, if the contract has been awarded, to
terminate the contract for cause based upon fraud or misrepresentation at its inception.
I certify that the equipment described by me in the contract requirements will be provided by me without
substitution, unless the prior approval of the Contracting Officer modifying the contract requirement is
obtained.
I certify that the wages and fringe benefits specified by the current Wage Rate Determination issued by the
US Department of Labor for the service and location identified in the contract have been considered in the
preparation of my proposal. If awarded the contract, compensation to employees performing the contract will
fully comply with the current Wage Rate Determination and all other requirements of the Service Contract Act
and applicable regulations and laws.
I certify that (a) my proposal or any change to my proposal is made without consultation, communication, or
agreement for the purpose of restricting competition or manipulating awards; (b) my proposal has not been
and will not be disclosed to of Offerors or potential Offerors prior to award; and (c) I have not used another
Offeror’s proprietary information to prepare my offer.
I certify that, to the best of my knowledge and belief, all of my statements are true, correct, complete, and
made in good faith. A false statement on any part of this form may be considered a violation if US Code,
Title 18, Section 1001, which carries criminal penalties.”
COMPLETE BUSINESS NAME & ADDRESS:
My Company
_____________________________________
12345 My Street
_____________________________________
My Town, CA 922XX
_____________________________________
_____________________________________
NAME & TITLE OF OFFEROR:
I. M. Owner
____________________________________
I. M. Owner
Signature:
______________________________
29 Aug 2009
Date:
______________________________

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