ANNUAL OFFEROR REPRESENTATIONS AND CERTIFICATIONS AND OTHER STATEMENTS OF OFFERORS

Certain representations and certifications must be made by all Offerors who do or want to provide goods and or services in support of U.S. Government (USG) contracts. These representations and certifications must be submitted annually. FLIR Systems, Inc., its subsidiaries or affiliates (“FLIR”) require Offerors to submit a complete updated copy of these representations and certifications when there has been any material change in its responses below or as required by a specific solicitation. The signature by an authorized agent of the Offeror on the last page of this document constitutes the execution of all applicable representations and certifications. References applicable to the document include Federal Acquisition Regulations (FAR) and Defense Federal Acquisition Regulations (DFARS).

All Offerors are requested to complete this form. Any Offerors who do or want to provide FLIR with goods or services in support of a USG contract must also complete all Items in their entirety. All Foreign Offerors must at a minimum complete Items 1, 2, 10, 12, 31, 35, 39 and 40. Small Business Owners must ensure completion of Item 13 and 14.

Business Information.

Click or tap here to enter text. Name “Offeror” Click or tap here to enter text. Address Click or tap here to enter text. Address Click or tap here to enter text. City, State, Zip Code	Click or tap here to enter text. Phone Number Click or tap here to enter text. DUNS Number Click or tap here to enter text. Tax ID Number (TIN)

Please complete the following and provide applicable the North American Industry Classification System (NAICS) Code(s).

NAICS Code	Description

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Business Status

The Offeror represents, by checking the applicable box, represents that -

Offeror ☐.is not a foreign entity and operates a ☐ corporation, registered for business in (state/territory) Click or tap here to enter text. , ☐ an individual sole-proprietor, ☐ a limited liability company, ☐ a partnership, ☐ a nonprofit organization or ☐ a joint venture.

Offeror ☐.is a foreign entity, and operates a ☐ corporation, registered for business in (country) Click or tap here to enter text., ☐ an individual sole-proprietor, ☐ a limited liability company, ☐ a partnership, ☐ a nonprofit organization or ☐ a joint venture.

FAR 52.203-2	Certificate of Independent Price Determination (Apr 1985)

The Offeror certifies that:

The prices in this offer have been arrived at independently, without, for the purpose of restricting competition, any consultation, communication, or agreement with any other Offeror or competitor relating to (1) those prices, (2) the intention to submit an offer, or (3) the methods or factors used to calculate the prices offered;

The prices in this offer have not been and will not be knowingly disclosed by the Offeror, directly or indirectly, to any other Offeror or competitor before bid opening (in the case of a sealed bid solicitation) or subcontract award (in the case of a negotiated solicitation) unless otherwise required by law; and

No attempt has been made or will be made by the Offeror to induce any other concern to submit or not to submit an offer for the purpose of restricting competition.

Each signature on the offer is considered to be certification by the signatory that the signatory:

Is the person in the Offeror's organization responsible for determining the prices being offered in this bid or proposal, and that the signatory has not participated and will not participate in any action contrary to subparagraphs (A)(1) through (A)(3) above; or

a. Has been authorized, in writing, to act as agent for the following principals in certifying that those principals have not participated, and will not participate in any action contrary to subparagraphs (A)(1) through (A)(3) above of this provision

Click here to enter text.(Insert full name of person(s) in the Offeror's organization responsible for determining the prices offered in this bid or proposal and the title of his or her position in the Offeror's organization.)

b. As an authorized agent, does certify that the principals named in paragraph B(2)(a) of this provision have not participated, and will not participate, in any action contrary to paragraphs (A)(1) through (A)(3) of this provision; and

c. As an agent, has not personally participated, and will not participate, in any action contrary to paragraphs (A) (1) through (A) (3) of this provision.

If the Offeror deletes or modifies paragraph (A) (2) above, the Offeror must furnish with its offer a signed statement setting forth in detail the circumstances of the disclosure.

(4)	FAR 52.203-18 Prohibition on Contracting with Entities that Require Certain Internal Confidentiality Agreements or Statements--Representation (Jan 2017)

By execution of this document the Offeror certifies that it is in full compliance with the provisions set forth in FAR 52.203-18.

(5)	FAR 52.203-11 Certification and Disclosure Regarding Payments to Influence Certain Federal Transactions (Sep 2007) (Applies to orders over $150,000)

The definitions and prohibitions contained in the clause at FAR 52.203-12, Limitation on Payments to Influence Certain Federal Transactions, included in this solicitation, are hereby incorporated by reference in paragraph (b) of this certification.

The Offeror, by signing its offer, hereby certifies to its knowledge and belief that:

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 its behalf in connection with the awarding of any Federal contract;

If any funds other than Federal appropriated funds (including profit or fee received under a covered Federal transaction) 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 this solicitation, the Offeror shall complete and submit with its offer, OMB standard form LLL, Disclosure of Lobbying Activities, to FLIR Systems, Inc.; and

Offeror 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.

Submission of this certification and disclosure is a prerequisite for making or entering into a contract imposed by section 1352, title 31, United States Code. Any person who makes 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.

(6)	FAR 52.204-5	Women-Owned Business (Other than Small Business) (Oct. 2014)

Complete only if the Offeror is a women-owned business concern and has not represented itself as a small business concern in paragraph (c)(1) of FAR.

The Offeror represents that it ☐ is a women-owned business concern.

(7)	FAR 52.204-10 Reporting Executive Compensation and First-Tier Subcontract Awards (Oct 2018) (TAILORED)

If a subcontract or Purchase Order award to Offeror has an expected value of $30,000 or more in support of a prime contract, FLIR must, subject to certain exceptions, gather and publicly report information regarding the award in accordance with FAR 52.204-10.

The Offeror certifies that-

Has Offeror had gross income from its business or organization’s preceding completed fiscal year, from all sources under $300,000? Yes ☐ No ☐.

If Yes, Offeror is not required to complete the balance of this FAR 52.204-10 section and may proceed directly to the next certification (#5 FAR 52.204-20) in this document.

If No, Offeror must proceed to section 4(B)(2) below.

2. In your business or organization’s preceding completed fiscal year, did your business or organization receive (1) 80 percent or more of your annual gross revenues in U.S. federal contracts, subcontracts, loans, grants, subgrants, cooperative agreements; and/or other forms of federal financial assistance; and (2) $25,000,000 or more in annual gross revenues from U.S. federal contracts, subcontracts, loans, grants, subgrants, cooperative agreements and other forms of federal financial assistance? Yes ☐ No ☐.

If Yes, Offeror must proceed to section 4(B)(3) below.

If No, Offeror is not required to complete the balance of this FAR 52.204-10 section and may proceed to the next certification (#5 FAR 52.204-20) in this document.

3. Does the public have access to information about the compensation of executives in your business or organization 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? Yes ☐ No ☐

Note: To determine if the public has access to the compensation information, see the U.S. Security and Exchange Commission total compensation filings at http://www.sec.gov/answers/execomp.htm.

If Yes, Offeror is not required to complete the balance of this FAR 52.204-10 section and may proceed to the next certification (#5 FAR 52.204-20) in this document.

If No, Offeror must proceed to section 4(C) below and report compensation information.

C.	Refer to FAR Clause 52.204-10 for the definition of “Total compensation” and “Executive”.

Provide the information below for the five (5) most highly compensated executives in Offeror business or organization.
Name	Position Title	Total compensation Amount for the Entity’s last complete fiscal year
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(8)	FAR 52.204-20	Predecessor of Offeror (July 2016)

(a) Definitions. As used in this provision—

“Commercial and Government Entity (CAGE) code” means--

(1) An identifier assigned to entities located in the United States and its outlying areas by the Defense Logistics Agency (DLA) Contractor and Government Entity (CAGE) Branch to identify a commercial or government entity, or

(2) An identifier assigned by a member of the North Atlantic Treaty Organization (NATO) or by the NATO Support and Procurement Agency (NSPA) to entities located outside the United States and its outlying areas that DLA Commercial and Government Entity (CAGE) Branch records and maintains in the CAGE master file. This type of code is known as a NATO CAGE (NCAGE) code.

“Predecessor” means an entity that is replaced by a successor and includes any predecessors of the predecessor.

“Successor” means an entity that has replaced a predecessor by acquiring the assets and carrying out the affairs of the predecessor under a new name (often through acquisition or merger). The term “successor” does not include new offices/divisions of the same company that only changes its name. The extent of the responsibility of the successor for the liabilities of the predecessor may vary, depending on State law and specific circumstances.

(b) The Offeror represents that it is ☐, (or is not ☐ ), a successor to a predecessor that held a Federal contract or grant within the last three years.

(c) If the Offeror has indicated “is” in paragraph (b) of this provision, enter the following information for all predecessors that held a Federal contract or grant within the last three years (if more than one predecessor, list in reverse chronological order):

Predecessor CAGE code: Click or tap here to enter text. (or mark “Unknown”).

Predecessor legal name: Click or tap here to enter text.. (Do not use a “doing business as” name)

(9) FAR 52.204-23 Prohibition on Contracting for Hardware, Software, and Services Developed or Provided by Kaspersky Lab and Other Covered Entities (Jul 2018)

By execution of this document the Offeror certifies that it is in full compliance with the provisions set forth in FAR 52.204-23.

(10) FAR 52.209-5	Certification Regarding Responsibility Matters (Oct 2015) (TAILORED)

A. The Offeror certifies, to the best of its knowledge and belief, that:

1. The Offeror and/or any of its Principals-

a.	Are ☐, (are not ☐) presently debarred, suspended, proposed for debarment, or declared ineligible for the award of contracts by any Federal agency;

b.	Have ☐, (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 State antitrust statutes relating to the submission of offers; or commission of embezzlement, theft, forgery, bribery, falsification or destruction of records, making false statements, tax evasion, or receiving stolen property; (if Offeror checks “have”, the Offeror shall also see 52.209-7, if included in the solicitation); and

c.	Are ☐, (are not ☐) presently indicted for or otherwise criminally or civilly charged by a governmental entity with, commission of any of the offenses enumerated in paragraph (A)(1)(b) of this provision; and

d.	Have ☐, (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.

(1) Federal taxes are considered delinquent if both of the following criteria apply:

The tax liability is finally determined. The liability is finally determined if it has been assessed. A liability is not finally determined if there is a pending administrative or judicial challenge. In the case of a judicial challenge to the liability, the liability is not finally determined until all judicial appeal rights have been exhausted.

(ii) The taxpayer is delinquent in making payment. A taxpayer is delinquent if the taxpayer has failed to pay the tax liability when full payment was due and required. A taxpayer is not delinquent in cases where enforced collection action is precluded.

2.	The Offeror has ☐, (has not ☐), within a three-year period preceding this offer, had one or more contracts terminated for default by any Federal agency.

3. "Principal," for the purpose of this certification, means officer; director; owner; partner; or person having primary management or supervisory responsibilities within a business entity (e.g., general manager; plant manager; head of a division, or business segment, and similar positions).

This Certification Concerns a Matter Within the Jurisdiction of an Agency of the United States and the Making of a False, Fictitious, or Fraudulent Certification May Render the Maker Subject to Prosecution Under Section 1001, Title 18, United States Code.

B. The Offeror shall provide immediate written notice to FLIR Systems, Inc. if, at any time prior to subcontract award, the Offeror learns that its certification was erroneous when submitted or has become erroneous by reasons of changed circumstances.

C. A certification that any of the items in paragraph (A) of this provision exists will not necessarily result in withholding of an award under this solicitation. However, the certification will be considered in connection with a determination of the Offeror's responsibility. Failure of the Offeror to furnish a certification or provide such additional information as requested by FLIR Systems, Inc. may render the Offeror non-responsible.

D. Nothing contained in the foregoing shall be construed to require establishment of a system of records in order to render, in good faith, the certification required by paragraph (A) of this provision. The knowledge and information of an Offeror is not required to exceed that which is normally possessed by a prudent person in the ordinary course of business dealings.

E. The certification in paragraph (A) of this provision is a material representation of fact upon which reliance was placed when making award. If it is later determined that the Offeror knowingly rendered an erroneous certification, in addition to other remedies available to the Government, FLIR Systems, Inc., may terminate the subcontract resulting from this solicitation for default.

(11) FAR 52.209-11	Representation by Corporations Regarding Delinquent Tax Liability or a Felony Conviction under any Federal Law (Feb 2016)

The Offeror represents that—

(1) It is ☐, (is not ☐) a corporation that has any unpaid Federal tax liability that has been assessed, for which all judicial and administrative remedies have been exhausted or have lapsed, and that is not being paid in a timely manner pursuant to an agreement with the authority responsible for collecting the tax liability; and

(2) It is ☐, (is not ☐) a corporation that was convicted of a felony criminal violation under a Federal law within the preceding 24 months.

(12)	FAR 52.215-6	Place of Performance (Oct 1997)

The Offeror, during the performance of any subcontract resulting from this solicitation, intends ☐, (does not intend ☐), to use one or more plants or facilities located at a different address from the address of the Offeror as indicated in this proposal, quotation or response to request for information.

If the Offeror checked "intends" in paragraph (A) above, it shall complete the following required information:

Place of Performance (Street Address, City. County, State, Zip)	Name and Address of Owner and Operator of the Plant or Facility if Other than Offeror
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(13)	In addition to the annual representations required by FAR 52.219-1, below:

☐ Offeror hereby acknowledges and agrees that it shall certify its business size and, if appropriate, its small business status, by means of a confirming entry in the System for Award Management (SAM) at https://www.sam.gov/portal/public/SAM/. If Offeror fails to check this box, FLIR will not consider Offeror to be a small business concern for any potential subcontract, agreement or Purchase Order that FLIR may solicit.

FAR 52.219-1	Small Business Program Representations (Oct 2014) (TAILORED)

Offeror hereby acknowledges and agrees to provide for each specific proposal Offeror submits to FLIR, in order to be considered a small business concern:

☐ Offeror must provide the NAICS code(s) for each specific proposal, and

☐ Offeror must acknowledge the NAICS code(s) by written authorized signature.

The small business size standard that applies to the representations of Offeror below are as defined by 13 CFR Part 121.

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:

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The Offeror represents that it is ☐, (is not ☐) a small business concern. If not a small business then do not fill out the NAICS codes.

NAICS Code	Description	Small Business Concern (Yes or No)

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If Offeror represented itself as a small business concern in paragraph (B)(1) of this provision. The Offeror represents that it is ☐, (is not ☐) a small disadvantaged business concern as defined in 13 CFR 124.1002.

If Offeror represents itself as a small business concern in paragraph (B)(1) of this provision. The Offeror represents that it is ☐, (is not ☐) a women-owned small business concern.

NAICS Code	Description	Women-Owned Small Business

Concern (Yes or No)

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The Offeror represents that it is a woman-owned small business concern in paragraph (B)(3) —

It ☐ is, (is not ☐) a WOSB concern eligible under the WOSB Program, has provided all the required documents to the WOSB Repository, and no change in circumstances or adverse decisions have been issued that affects its eligibility; and

It ☐ is, (is not ☐) a joint venture that complies with the requirements of 13 CFR part 127, and the representation in paragraph (B)(4)(i) of this provision is accurate for each WOSB concern eligible under the WOSB Program participating in the joint venture. [The Offeror shall enter the name or names of the WOSB concern eligible under the WOSB Program and other small businesses that are participating in the joint venture: Click or tap here to enter text. . Each WOSB concern eligible under the WOSB Program participating in the joint venture shall submit a separate signed copy of the WOSB representation.

If Offeror represented itself as a women-owned small business concern eligible under the WOSB program in (B)(4) of this provision, then the Offeror represents that—

It ☐ is, (is not ☐) an economically disadvantaged women-owned small business concern (EDWOSB) eligible under the WOSB Program, has provided all the required documents to the WOSB Repository, and no change in circumstances or adverse decisions have been issued that affects its eligibility; and

It ☐ is, (is not ☐) a joint venture that complies with the requirements of 13 CFR part 127, and the representation in paragraph (c)(5)(i) of this provision is accurate for each EDWOSB concern participating in the joint venture. [The Offeror shall enter the name or names of the EDWOSB concern and other small businesses that are participating in the joint venture: Click or tap here to enter text.. Each EDWOSB concern participating in the joint venture shall submit a separate signed copy of the EDWOSB representation.

If the Offeror represented itself as a small business concern in paragraph (B)(1) of this provision. The Offeror represents that it is ☐, (is not ☐) a veteran-owned small business concern. If not a small business then do not fill out the NAICS codes.

NAICS Code	Description	Veteran-Owned

Small Business Concern (Yes or No)

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If the Offeror represented itself as a veteran-owned small business concern in paragraph (B)(6) of this provision. The Offeror represents that it is ☐, (is not ☐) a service-disabled veteran-owned small business concern.

NAICS Code	Description	Service-Disabled Veteran-Owned

Small Business Concern (Yes or No)

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If Offeror represented itself as small business concern in paragraph (B)(1) of this provision. The Offeror represents that—

(i) It 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 Business Administration, and no material changes in ownership and control, principal office, or HUBZone employee percentage have occurred since it was certified in accordance with 13 CFR part 126; and

(ii) It is ☐, (is not ☐) a HUBZone joint venture that complies with the requirements of 13 CFR part 126, and the representation in paragraph (c)(8)(i) of this provision is accurate for each HUBZone small business concern participating in the HUBZone joint venture. [The Offeror shall enter the names of each of the HUBZone small business concerns participating in the HUBZone joint venture: Click here to enter text.. Each HUBZone small business concern participating in the HUBZone joint venture shall submit a separate signed copy of the HUBZone representation.

Definitions

"Service-disabled veteran-owned small business concern"-

Means a small business concern-

(i) Not less than 51 percent of which is owned by one or more service-disabled veterans or, in the case of any publicly owned business, not less than 51 percent of the stock of which is owned by one or more service-disabled veterans; and

(ii) The management and daily business operations of which are controlled by one or more service-disabled veterans or, in the case of a service-disabled veteran with permanent and severe disability, the spouse or permanent caregiver of such veteran.

Service-disabled veteran means a veteran, as defined in 38 U.S.C. 101(2), with a disability that is service-connected, as defined in 38 U.S.C. 101(16).

"Small business concern," 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.

"Veteran-owned small business concern" means a small business concern-

Not less than 51 percent of which is owned by one or more veterans (as defined at 38 U.S.C. 101(2)) or, in the case of any publicly owned business, not less than 51 percent of the stock of which is owned by one or more veterans; and

The management and daily business operations of which are controlled by one or more veterans.

"Women-owned small business concern." as used in this provision, means a small business concern -

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 or more women; and

Whose management and daily business operations are controlled by one or more women.

Women-owned small business (WOSB) concern eligible under the WOSB Program (in accordance with 13 CFR part 127), means a small business concern that is at least 51 percent directly and unconditionally owned by, and the management and daily business operations of which are controlled by, one or more women who are citizens of the United States.

Notice.

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.

Under 15 U.S.C. 645(d), any person who misrepresents a firm’s status as a business concern that is small, HUBZone small, small disadvantaged, service-disabled veteran-owned small, economically disadvantaged women-owned small, or women-owned small eligible under the WOSB Program in order to obtain a contract to be awarded under the preference programs established pursuant to section 8, 9, 15, 31, and 36 of the Small Business Act or any other provision of Federal law that specifically references section 8(d) for a definition of program eligibility, shall --

(i)	Be punished by imposition of fine, imprisonment, or both;
(ii)	Be subject to administrative remedies, including suspension and debarment; and
(iii) Be ineligible for participation in programs conducted under the authority of the Act.

If Offeror represented itself as disadvantaged in paragraph (B)(2) of this provision. 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, 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

(15)	FAR 52.219-9	Small Business Subcontracting Plan (Aug 2018) (DEVIATION 2018-O018)

For all subcontracts (except small business concerns) in excess of $700,000 ($1,500,000 for construction of any public facility) in value, the Offeror shall submit and negotiate a Small Business Subcontracting Plan which addresses, separately, subcontracting with small business concerns, small disadvantaged business concerns, HUBZone small business concerns, veteran-owned small business, service-disabled veteran-owned small business, and women-owned small business concerns and which shall be included and made a material part of any resulting subcontract. As a minimum, the Subcontracting Plan shall include all of the elements specified in FAR 52.219-9.

This is to certify that the Offeror has ☐, (has not ☐) established a Small Business Subcontracting Plan for any resultant subcontract(s) over $700,000 in value in compliance with the requirements of FAR 52.219-9 and will adhere to that plan. Compliance to the plan can be monitored by resident government agencies at the Offeror's facility. If the Offeror is now a small business and its status changes prior to any subcontract award, it agrees to submit a plan to FLIR Systems, Inc.’s Procurement Point of Contact.

(16)	FAR *52.222-21	Prohibition of Segregated Facilities (Apr 2015)

By execution of this document the Offeror certifies that it is in full compliance with the provisions set forth in FAR 52.222-21.

(17)	FAR *52.222-22	Previous Contracts and Compliance Reports (Feb 1999)

The Offeror represents that

(1) It has ☐, (has not ☐) participated in a previous contract or subcontract subject to the Equal Opportunity clause of this solicitation;

(2) It has ☐, (has not ☐) filed all required compliance reports; and

(3) Representations indicating submission of required compliance reports, signed by proposed subcontractors, will be obtained before subcontract awards and will be forwarded to FLIR Systems, Inc.’s procurement point of contact.

(18)	FAR *52.222-25	Affirmative Action Compliance (Apr 1984)

The Offeror represents that

(1) it has ☐ developed and has on file, (has not ☐ developed and does not have 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

(2) it has not ☐ previously had contracts/subcontracts subject to the written affirmative action programs requirement of the rules and regulations of the Secretary of Labor.

(19)	FAR *52.222-35	Equal Opportunity for Veterans (Oct 2015)

By execution of this document the Offeror certifies that it is in full compliance with the provisions set forth in FAR 52.222-35.

(20)	FAR *52.222-36	Equal Opportunity for Workers With Disabilities (Jul 2014)

By execution of this document the Offeror certifies that it is in full compliance with the provisions set forth in FAR 52.222-36.

(21)	FAR 52.222-37	Employment Reports Veterans (Feb 2016)

By execution of this document the Offeror certifies that it is in full compliance with the provisions
set forth in FAR 52.222-37.

(22)	FAR 52.222-38	Compliance with Veterans’ Employment Reporting Requirements (Feb 2016)

By submission of its offer, the Offeror represents that, if it is subject to the reporting requirements of 38 U.S.C. 4212(d) (i.e., if it has any contract containing Federal Acquisition Regulation clause 52.222-37, Employment Reports on Veterans), it has filed the most recent VETS-4212 Report required by that clause.

(23)	FAR 52.222-50 Combatting Trafficking in Persons (Jan 2019)

By submission of its offer, the Offeror represents that it is in full compliance with the provisions set forth in FAR 222-50 paragraph (h) of the clause as it applies to any portion of a subsequent award.

(24)	FAR 52.223-1	Biobased Product Certification (May 2012)

By execution of this document the Offeror certifies that it is in full compliance with the provisions

set forth in FAR 52.223-1.

(25)	FAR 52.223-6	Drug-Free Workplace (May 2001)

By execution of this document the Offeror certifies that it is in full compliance with the provisions set forth in FAR 52.223-6.

(26)	FAR 52.225-2	Buy American Certificate (May 2014) (TAILORED)

The terms “commercially available off-the-shelf (COTS) item,” “component,” “domestic end product,” “end product,” “foreign end product,” and “United States” are defined in the FAR clause 52.225-1 “Buy American—Supplies.”

☐ The Offeror hereby acknowledges and agrees that by submission of its offer or delivery of goods to FLIR that (1) Offeror certifies that each end product is a domestic end product ( for other than COTS items, the Offeror has considered components of unknown origin to have been mined, produced, or manufactured outside the United States) or (2) Offeror shall list by country of origin the foreign end products in each future proposal (Offeror shall list as foreign end product those end products manufactured in the United States that do not qualify as a domestic end product, i.e., and end product that is not a COTS item and does not meet the component test in the definition of “domestic end product”).”

(27)	far 52.225-4	Buy American – Free Trade Agreements – Israeli Trade Act Certificate (May 2014) (TAILORED)

The terms “Bahrainian, Moroccan, Omani, Panamanian, or Peruvian end product,” “Bahrainian, Korean, Moroccan, Omani, Panamanian, or Peruvian end product,” “Canadian end product”, “commercially available off-the-shelf item,” “component,” “domestic end product,” “end product,” “foreign end product,” “Free Trade Agreement country,” “Free Trade Agreement country end product,” “Israeli end product,” and “United States” are defined in the FAR clause 52.225-3 Buy American—Free Trade Agreements—Israeli Trade Act include Alternates.

☐ Offeror hereby acknowledges and agrees that by submission of its offer or delivery of goods to FLIR that (1) Offeror certifies that each end product is a domestic end product ( for other than COTS items, the Offeror has considered components of unknown origin to have been mined, produced, or manufactured outside the United States), or (2) Offeror certifies that each end product separately listed by country of origin is a Free Trade Agreement Country end product, Canadian end product, or Israeli end product in each future proposal or (3) Offeror shall list by country of origin other foreign end products in each future proposal (Offeror shall list a foreign end product those end products manufacturer in the United States that do not qualify as domestic end products i.e., an end product hat is not a COTS item and does not meet the component test in the definition domestic end product.” Free Trade Agreement country end products (other than Bahrainian, Moroccan, Omani, Panamanian, or Peruvian end products) or Israeli end products as defined in the clause of this solicitation entitled “Buy American--Free Trade Agreements--Israeli Trade Act”:

(28)	FAR 52.225-6	Trade Agreements Certificate (May 2014) (TAILORED)

The terms “U.S.- made end product” and “designated country end product are defined in FAR clause 5.2225-5 Trade Agreements.”

☐ Offeror hereby acknowledges and agrees that by submission of its offer or delivery of goods to FLIR that (1) Offeror certifies that each end product is a U.S. made or designated country end product or 92) Offeror shall list in each future proposal by country of origin those supplies that are not U.S. mad or designated country end products.

(29)	FAR 52.225-20 Prohibition on Conducting Restricted Business Operations in Sudan--Certification (Aug 2009)

By submission of its offer, the Offeror certifies that the Offeror does not conduct any restricted business operations in Sudan.

(30)	FAR 52.225-25 Prohibition on Contracting with Entities Engaging in Certain Activities or Transactions Relating to Iran—Representation and Certifications. (Aug 2018)

By execution of this document the Offeror certifies that it is in full compliance with the provisions set forth in FAR 52.225-25.

(31)	FAR 52.226-2	Historically Black College or University and Minority Institution Representation (Oct 2014)

The Offeror represents that it:

1. is ☐, (is not ☐) a Historically Black College or University;

2. is ☐, (is not ☐) a Minority Institution.

(32)	DFARS 252.204-7012 Representation and Certification of Compliance with Safeguarding Covered Defense Information and Cyber Incident Reporting

Unless Offeror takes exception for one of the reasons checked below, Offeror is expected to receive Covered Defense Information (CDI) subject to the requirements of DFARS 252.204-7012, Safeguarding Covered Defense Information and Cyber Incident Reporting in support of bids, proposals, subcontractors and / or purchase order activities with FLIR.

Exceptions:

☐ Offeror is a provider to FLIR of only COTS products (COTS shall be construed to mean Commercial Off the Shelf Item as defined in FAR 2.101)

☐ No CDI has been provided by FLIR as of the date of the signature of this certification. Should Offeror be notified otherwise by FLIR, Offeror shall reject all CDI until such time that Offeror becomes compliant with DFARS 252.204-7012.

By signature of its authorized representative below, Offeror certifies that unless it qualifies for one of the above exceptions, it has either implemented adequate security as required by the DFARS clause on its information systems that, complies with the requirements of the current revision of NIST Special Publication (SP) 800-171, or is in the process of and will implement adequate security through system security plans.

(33)	Nature of Work-scope

The Offeror certifies that there is ☐, (is not ☐) experimental or research work required in the performance of any resultant contract.

(34)	Use of Government Property

Complete the following statement(s) as applicable:

A. The Offeror and/or its suppliers will ☐, (will not ☐) use government property in performance of work under the proposed subcontract.

B. The Offeror certifies that to the best of its knowledge this proposed subcontract does ☐, (does not ☐) involve the acquisition of Government property, the disposal of which may be restricted by patent or other rights.

(35)	Accounting System

Has the Offeror's accounting system been reviewed and deemed adequate as to the collection of costs?

Yes ☐	No ☐

Date of review: Click here to enter text.

Reviewing agency: Click here to enter text.

(36)	Government Property System

The Offeror certifies that it’s Government Property System has ☐, (has not ☐) been approved by the Government in accordance with Part 45 of the FAR. If approved, state the approving agency's name and date of last approval. If approval has not been obtained, please explain below:

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(37)	Purchasing System

The Offeror certifies that it’s purchasing system has ☐, (has not ☐) been approved by the Government in accordance with Part 44 of the FAR. If approved, state the approving agency's name and date of last approval. If approval has not been obtained, please explain below:

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(38)	Sales Tax Collection

Please indicate, by checking the appropriate box(es), the states or districts in which your company is authorized to collect sales tax.

☐ All	☐ None
☐ Alabama	☐ Kentucky	☐ North Dakota
☐ Alaska	☐ Louisiana	☐ Ohio
☐ Arizona	☐ Maine	☐ Oklahoma
☐ Arkansas	☐ Maryland	☐ Oregon
☐ California	☐ Massachusetts	☐ Pennsylvania
☐ Colorado	☐ Michigan	☐ Rhode Island
☐ Connecticut	☐ Minnesota	☐ South Carolina
☐ Delaware	☐ Mississippi	☐ South Dakota
☐ District of Columbia	☐ Missouri	☐ Tennessee
☐ Florida	☐ Montana	☐ Texas
☐ Georgia	☐ Nebraska	☐ Utah
☐ Hawaii	☐ Nevada	☐ Vermont
☐ Idaho	☐ New Hampshire	☐ Virginia
☐ Illinois	☐ New Jersey	☐ Washington
☐ Indiana	☐ New Mexico	☐ West Virginia
☐ Iowa	☐ New York	☐ Wisconsin
☐ Kansas	☐ North Carolina	☐ Wyoming

(39)	National Defense Authorization Act 2019

☐ By execution of this document the Offeror certifies that it is in full compliance with the following terms: 1) the equipment, systems, and services delivered do not use covered telecommunications equipment or services as a substantial or essential component, or as critical technology (as those terms are defined in Section 889 of the 2019 National Defense Authorization Act (Pub. L. No: 115-232) (“Section 889”)) and 2) the equipment, systems, and services delivered are not prohibited for purchase by Section 889. See Section 889 of the 2019 NDAA at the following link https://www.congress.gov/bill/115th-congress/house-bill/5515/text

(40)	CERTIFICATION OF OFFEROR OR OFFEROR’S AUTHORIZED REPRESENTATIVE

BY SUBMITTING THIS INFORMATION, I AM ATTESTING TO THE ACCURACY OF THE INFORMATION CONTAINED WITHIN THIS DOCUMENT IS TRUE AND ACCURATE TO THE BEST OF MY KNOWLEDGE. I UNDERSTAND THAT I MAY BE SUBJECT TO PENALTIES IMPOSED BY THE US GOVERNMENT IF I MISREPRESENT ANY OF THE REPRESENTATIONS AND CERTIFICATIONS HEREIN. BY THE EXECUTION OF THIS DOCUMENT, THE UNDERSIGNED OFFEROR AGREES TO PROVIDE IMMEDIATE WRITTEN NOTICE TO FLIR SYSTEMS, INC. IF, AT ANY TIME DURING THE EFFECTIVE PERIOD OF THIS DOCUMENT, THE OFFEROR LEARNS THAT THIS DOCUMENT WAS ERRONEOUS WHEN SUBMITTED OR HAS BECOME ERRONEOUS BY REASON OF CHANGED CIRCUMSTANCES.

THE EFFECTIVE PERIOD OF THIS DOCUMENT IS ONE YEAR FROM THE DATE OF EXECUTION.

Signature
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Signer’s Name
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Signer’s Title
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Date signed

* Exempt if work is to be performed outside U.S. by employees who were not recruited within the U.S.