UNITED STATES
DEPARTMENT OF THE INTERIOR
ao. > RITACHMENT SHALT, BE EXECUTED BY AN OFFICIAL AUTHORIZED TO BIND TEE OFFEROR,
.itACRED AND MADE A PART OF HIS BUSINESS MANAGEMENT PROPOSAL
REPRESENTATIONS AND CERTIFICATIONS
..£ czferor makes the following representations and certifications as part of his
ui n-esal (check or complete all appropriate boxes or blanks).
SMALL BUSINESS REPRESENTATION
He Ti is, Li is not, a small business concern.
If the offeror is a small
““¢SS8 concern and is not the manufacturer of the supplies offered, he also
“nts that all supplies to be furnished hereunder || will, Li will not, be
-ivi stured or produced by a small business concern in the United States, its
..
.
.. + 7i0ns, Or Puerto Rico. A small business concern for the purpose of Government
. €ment is a concern, including its affiliates, which is independently owned
., cated,
is not dominant in the field of operation in which it is quoting on
-.'\xmrent contracts, and can further qualify under the criteria concerning number
"t e€vployees, average annual receipts, or other criteria, as prescribed by the
o°.... Fusiness Administration.
(See Code of Federal Regulations, Title 13, Part
‘24, &s amended, which contains detailed industry definitions and related
ures).
FEGULAR DEALER = MANUFACTURER REPRESENTATION
..2TéCtB exceeding $10,000)
He is a |
| regular dealer in,
ZYPE OF ORGANIZATION
|
(Applicable only to supply
| manufacturer of, the supplies offered.
.
we
He operates as | {| an INDIVIDUAL, |] | @ PARTNERSHIP,
sonsisting of
|
| a JOINT VENTURE
and
’
!_| a CORPORATION incorporated under the laws of the State of
jii an EDUCATIONAL INSTITUTION, LI a NON-PROFIT ORGANIZATION organized and
existing under the laws of the State of
, oF Ll a STATE or
LOCAL, AGENCY organized and existing under the laws of the State of
-
4.
DUNS CONTRACTOR ESTABLISHMENT NUMBER
Following is the Contractor Establishment Identification number issued to
wi.
offeror by Dun and Bradstreet,
Inc.:
'