I: INSTRUCTIONS
General Dynamics Land Systems (GDLS) must gather and maintain certain registration data from all offerors. GDLS must also gather additional representations and certifications from offerors who do (or want to) provide goods or services in support of a U.S. Government ("USG") contract. This form is designed to efficiently and effectively gather both the required registration information and, when applicable, the additional representations and certifications.
These representations and certifications are incorporated into the Standard Purchase Order, Contract Purchasing Agreement, or Blanket Purchase Agreement (“contract”) by and between GDLS and the offeror identified below (the "Seller"). Seller will complete this entire Supplier Compliance Form, including the representations and certifications, except where directions indicate otherwise. Seller's failure to complete the representations and certifications may be cause for rejecting Seller’s proposal(s) as non-responsive, resulting in no contract award. Seller agrees to notify GDLS immediately should Seller’s circumstances change with respect to these representations and certifications during any resulting contract. The executed representations and certifications shall be updated at least annually during the period that Seller is an approved GDLS Supplier.
Note: Some of the certifications and representations herein are similar to those required by the USG’s representations and certifications database, www.SAM.gov). Those representations and certifications may not substitute for completion of the representations and certifications in this form. Additionally, certain other solicitation ­specific and procurement ­specific policies and procedures may require additional representations and certifications from Seller beyond those in this document.
GDLS will rely on this executed Representation & Certification when considering Seller for award of a purchase order/subcontract, and will require Seller to certify as to its continued accuracy, or submit an amended certification prior to award. Failure to provide an up-to-date certification prior to award, or as otherwise may be required by GDLS, may result in a default termination of any purchase order/subcontract awarded on the basis of Seller's outdated representations and certifications.
Certification of Seller, or Seller’s Authorized Representative: By submitting this information, I am attesting that the information contained in this document is current, accurate, and complete as of the date written below. I understand that 18 U.S.C. § 1001 makes it a crime to knowingly or willfully make false statements in any matter within the jurisdiction of the executive, legislative, or judicial branch of the Government of the United States. On behalf of Seller, I acknowledge that GDLS will rely on the information provided by the Seller in this document in determining whether to issue contracts to Seller and that if any of Seller’s representations and certifications herein change during the period of performance of any contract issued by GDLS or while Seller remains an approved GDLS Supplier, Seller agrees to provide immediate written notice to GDLS.

II: GENERAL INFORMATION

* 1. SUPPLIER SITE (Name/Address to Appear on PO)

* 2. ORACLE NUMBER WITH GDLS (6 digits)

* 3. PAY SITE / REMIT TO: (if different from SUPPLIER SITE)

* 4. BUSINESS INFORMATION: DUNS NUMBER and CAGE CODE

Please provide the following information:
(please enter n/a if not available)

* 5. FEDERAL EMPLOYER IDENTIFICATION NUMBER (EIN) / TAX IDENTIFICATION NUMBER (Tax ID or Taxpayer ID)
(FAR 52.204-3 TAXPAYER IDENTIFICATION (Oct. 1998))
Note: This is necessary if US based company (example format xx-xxxxxxx)

* 6. SYSTEM FOR AWARD MANAGEMENT (SAM) REGISTRATION
Offerors may obtain information on registration in SAM at https://www.acquisition.gov.

Is your company registered in U.S. Government System for Award Management (SAM) (Refer to FAR 52.204-7 SYSTEM FOR AWARD MANAGEMENT)(Oct. 2016))

* 7. NAICS CODE: Primary 6 Digit Major Group
(refer to North American Industry Classification System website: http://www.census.gov/eos/www/naics/)

* 8. BUSINESS TYPE (select all which apply)

* 9. TYPE OF BUSINESS ORGANIZATION (select one)

* 12. COMPANY LINKAGE

Is your company a subsidiary of a Parent Company?

* 13. PARENT COMPANY INFORMATION (if applicable)

III: REPRESENTATIONS, CERTIFICATIONS AND DISCLOSURES

* 14. FOREIGN BUSINESS STATUS

Seller represents, pursuant to government law or regulation, that it:

* 15. BUSINESS SIZE CERTIFICATION

The Seller represents and certifies that it is (check all that apply):

Note: Information provided on this form is used in selection of suppliers and for reporting to the federal government. The United States may impose criminal and civil penalties and remedies for misrepresentations for the purpose of obtaining a subcontract including misrepresentation of a firm's status as a small business concern. Where applicable, the terms in this certification are defined in FAR 52.204-5 (Oct. 2014) and FAR 52.219-1 (Oct. 2014).  For further information regarding Small Business classifications see the SBA website at www.sba.gov.

* 16. BUSINESS SYSTEMS

Note: If Seller represents it has any systems indicated below have been reviewed and deemed acceptable, please provide certification or documentation verifying as such to GDLS.

Does Seller have the following:

  Yes No
Cost Estimating System?
Earned Value Management System?
Material Management and Accounting System?
Accounting System?
Contractor Purchasing System?
Contractor Property Management System?

* 17. GENERAL DYNAMICS LAND SYSTEMS' STANDARDS OF BUSINESS ETHICS AND CONDUCT

Seller confirms it has read and complies with the General Dynamics Land Systems’ Standards of Business Ethics and Conduct within the Ethnics and Conduct Blue Book located at www.gdls.com under Suppliers, Ethics and Conduct section. In the event you discover or are otherwise made aware of any attempt by a GDLS employee or business associate to solicit a kickback, gratuity, or other favor or violation of the GDLS’ Ethics and Conduct Blue Book, as a condition of doing business, please contact the GDLS’ Ethics Hotline at 1-800-433-8442.

* 18. SELLER'S RESPONSIBILITY CERTIFICATIONS
(A) PROTECTING THE GOVERNMENT'S INTEREST WHEN SUBCONTRACTING WITH CONTRACTORS DEBARRED, SUSPENDED, OR PROPOSED FOR DEBARMENT (FAR 52.209-6) (Oct. 2015))
Applicable to offers in excess of $35,000, unless for commercially available off-the-shelf items

(1) As a condition of award, Seller represents that Seller and/or any of its Principals are not presently debarred, suspended, or proposed for debarment, or declared ineligible for the award of contracts by any Federal agency;
(2)Seller agrees to provide immediate written notice to GDLS if, at any time before the award of a contract, Seller learns that its certification was erroneous when submitted or has become erroneous due to changed circumstances.

(B) As defined in CERTIFICATION REGARDING RESPONSIBILITY MATTERS (FAR 52.209-5) (Oct. 2015)):
As a condition of award, Seller certifies, to the best of its knowledge and belief, that -
Seller and/or any of its Principals -

  Agree Disagree
(1) Are not presently debarred, suspended, proposed for debarment, or declared ineligible for the award of contracts by any Federal agency
(2) Have not, within a three-year period preceding this offer, been convicted of or had a civil judgment rendered against them for: commission of fraud or a criminal offense in connection with obtaining, attempting to obtain, or performing a public (Federal, state, or local) contract or subcontract; violation of Federal or antitrust statutes relating to the submission of offers; or commission of embezzlement, theft, forgery, bribery, falsification or destruction of records, making false statements, or receiving stolen property
(3) Are not presently indicted for, of otherwise criminally or civilly charged by a government entity with, commission of any of the offenses enumerated in item (2) of this certification
(4) Have not, within a three-year period preceding this offer, been notified of any delinquent Federal taxes in an amount that exceeds $3,500 for which the liability remains unsatisfied; and
(5) Has not, within a three-year period preceding this offer, had one or more contracts terminated for default by any Federal agency

* 19. CERTIFICATION AND DISCLOSURE REGARDING PAYMENTS TO INFLUENCE CERTAIN FEDERAL TRANSACTIONS (FAR 52.203-11 (Sep. 2007))

a) The definitions and prohibitions contained in the clause at Limitation on Payments to Influence Certain Federal Transactions (FAR 52.203-12) (Oct. 2010)), are hereby incorporated by reference in paragraph (b) of this certification.
(b) Seller hereby certifies to the best of his or her knowledge and belief that—
* (1) No Federal appropriated funds have been paid or will be paid to any person for influencing or attempting to influence an officer or employee of any agency, a Member of Congress, an officer or employee of Congress, or an employee of a Member of Congress on his or her behalf in connection with the awarding of this contract;
* (2) If any registrants under the Lobbying Disclosure Act of 1995 have made a lobbying contact on behalf of Seller with respect to this contract, Seller shall complete and submit, with its offer, OMB Standard Form LLL, Disclosure of Lobbying Activities, to provide the name of the registrants. Seller need not report regularly employed officers or employees of Seller to whom payments of reasonable compensation were made; and
* (3) He or she will include the language of this certification in all subcontract awards at any tier and require that all recipients of subcontract awards in excess of $150,000 shall certify and disclose accordingly.
(c) Submission of this certification and disclosure is a prerequisite for making or entering into any resulting contract that is imposed by section 1352, Title 31, United States Code. Any person who makes an expenditure prohibited under this provision, or who fails to file or amend the disclosure form to be filed or amended by this provision, shall be subject to a civil penalty of not less than $10,000, and not more than $100,000, for each such failure.
(d) Should Seller’s circumstances change during the life of any resulting contract with respect to the above certification, Seller shall notify GDLS immediately.

* 20. REPORTING EXECUTIVE COMPENSATION AND FIRST-TIER SUBCONTRACT AWARDS (FAR 52.204-10) (Oct 2016)).

Within 30 days of signing this certification and annually thereafter, Seller shall report the names and total compensation of each of the Seller’s five most highly compensated executives for the preceding fiscal year at www.fsrs.gov if:

(a) In the Seller’s preceding fiscal year, Seller received—
(1) 80 percent or more of its annual gross revenues from Federal contracts (and subcontracts), loans, grants (and subgrants), cooperative agreements, and other forms of Federal financial assistance; and
(2) $25,000,000 or more in annual gross revenues from Federal contracts (and subcontracts), loans, grants (and subgrants), cooperative agreements and other forms of Federal financial assistance; and

(b) The public does not have access to information about the compensation of the executives through periodic reports filed under section 13(a) or 15(d) of the Securities Exchange Act of 1934 (15 U.S.C. 78m(a), 78o(d)) or section 6104 of the Internal Revenue Code of 1986. (To determine if the public has access to the compensation information, see the U.S. Security and Exchange Commission total compensation filings www.sec.gov/answers/execomp.htm.)

* 21. CERTIFICATION REGARDING KNOWLEDGE OF CHILD LABOR FOR LISTED END PRODUCTS (FAR 52.222-18) (Feb. 2001))

By checking the appropriate box, Seller hereby certifies to one, and only one, of the paragraphs below:

* 22. PROHIBITION OF SEGREGATED FACILITIES (FAR 52.222-21) (Apr. 2015))

a) The definitions contained in FAR 52.222-21 (Apr. 2015) are incorporated by reference into paragraph (b) of this certification.

(b) Seller hereby certifies that it does not and will not maintain or provide for its employees any segregated facilities at any of its establishments, and that it does not and will not permit its employees to perform their services at any location under its control where segregated facilities are maintained. Seller agrees that a breach of this clause is a violation of the Equal Opportunity clause at FAR 52.222-26 (Sep. 2016).

* 23. PREVIOUS CONTRACTS AND COMPLIANCE REPORTS (FAR 52.222-22) (Feb. 1999))

By checking the appropriate box below, Seller makes the following representations concerning its prior and future activities:

  Agree Disagree
(a) Has participated in a previous contract or subcontract subject to the Equal Opportunity clause of this solicitation;
(b) Has filed all required compliance reports; and representation indicating submission of previously required compliance reports will be obtained before any future purchase order is awarded.

* 24. AFFIRMATIVE ACTION COMPLIANCE (FAR 52.222-25) (Apr. 1984))

Seller represents that:

  Agree Disagree
(a) Has developed and has on file at each establishment, affirmative action programs required by the rules and regulations of the Secretary of Labor (41 CFR 60-1 and 60-2) - OR -
(b) Has not previously had contracts subject to the written affirmative action programs requirement of the rules and regulations of the Secretary of Labor.

* 25. BUY AMERICAN ACT—BALANCE OF PAYMENTS PROGRAM CERTIFICATE (DFARS 252.225-7000) (Nov. 2014)

a) The definitions contained in DFARS 252.225-7001 (Nov. 2014) are incorporated by reference into paragraph (b) of this certification.
(b) The Seller hereby certifies that each end product to be furnished to GDLS is a domestic end product and that the Seller has considered components of unknown origin to have been mined, produced, or manufactured outside of the United States or a qualifying country.

* 26. REPRESENTATION AND CERTIFICATION CONCERNING RESTRICTION ON ACQUISITION OF SPECIALTY METALS (DFAR 252.225-7008) (Mar. 2013) AND (DFAR 252.225-7009) (Oct. 2014)

(a) The definitions contained in DFARS 252.225-7008 (Mar. 2013) and 252.225-7009 (Oct. 2014) are incorporated by reference in paragraphs (b) and (c) of this certification.
(b) The Seller hereby certifies that any specialty metals delivered under this contract is melted or produced in the United States or its outlying areas, or a qualifying country.
(c) The Seller hereby certifies that any specialty metals incorporated in items delivered under this contract are melted or produced in the United States, its outlying areas, or a qualifying country.

* 27. SAFEGUARDING COVERED DEFENSE INFORMATION AND CYBER INCIDENT REPORT (DFARS 252.204-7012) (Oct. 2016)

(a) The definitions contained in DFARS 252.204-7012 (Oct. 2016) are incorporated by reference in this certification.
(b) Seller represents that the Seller has implemented, or shall implement the security requirements in the National Institute of Standards and Technology (NIST) Special Publication (SP) 800-171, “Protecting Controlled Unclassified Info (NIST SP 800-171), but not later than December 31, 2017.

ANTI-CORRUPTION COMPLIANCE DISCLOSURE:

* 28. Anti-Corruption Program:

Does the Seller's organzation have an anti-corruption program in place?

* 29. Is Seller's organization wholly or partially government owned?

* 30. Reporting Political Exposure

Have any key personnel in Seller's company held a position in political office over the previous 12 months?

* 31. If responded Yes to above question, please indicate the name(s) and title(s) of key personnel :

* 32. Reporting Government Interaction:

Do any personnel in Seller's company interact directly with Foreign (Non-U.S.) government officials in support of Seller's business with General Dynamics Land Systems (GDLS)?

* 33. If responsed Yes to above question, please indicate type(s) of interactions (customs, visas, immigration officials, etc.)

* 34. Indicate the location (countries) of active operations for seller's company or any of its affiliates.

* 35. AUTHORIZED SIGNATURE
(Seller’s signature applies to all of representations, certifications, and other provisions provided as part of this document):

* 36. DATE COMPLETED

Date format (mm/dd/yyyy)
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SCM 072 01-18-2017, Rev. 2
S. Francuck

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