Jet Propulsion Laboratory by R6t6zU0w


									Jet Propulsion Laboratory
California Institute of Technology

                                       Acknowledgment – CREI Subcontract
                                                     (RFP Attachment A-5)
                                (This completed acknowledgement must accompany your offer)

                                                    Offeror Information

1. Offeror Name:
      (Note: Include the full name of the subcontracting entity, not just the operating division. Such full name
      is the name that would go in the subcontract if awarded to your organization)

2. Name and telephone number of the person authorized to conduct negotiations:
      Name:                                                       Phone Number:

3. Business Classification (please check all that apply):
           Educational Institution            Non-profit Organization       HBCU/OMI Business

                                                  Terms and Conditions

4. The Offeror acknowledges that the General Provisions, titled “Cost-Reimbursement without Fee with an
   Educational Institution (College or University) Subcontract,” dated_______, are acceptable in case of
   subcontract award. The General Provisions can be found at the following website:    Yes      No

      Note: The General Provisions cannot be altered without NASA approval. If you answer “No”
      attach a detailed explanation of the exceptions, including a thorough rationale for each

5. The submittal of a proposal/quotation certifies your organization’s compliance with the requirements
   specified in form JPL 2892, “Certifications,” attached to the General Provisions (or which may be found

                                                     Audit Information

6. a. Audit Reports. Your Institution agrees that all Government audit reports directly related to its offer(s)
      and subcontract, if any, are authorized to be released to JPL.     Yes      No
      b. Is your organization a State or Local Government or Nonprofit Organization subject to Office of
         Management and Budget Circular No. A-133?           Yes     No (If yes, the “year ending” date of the
         most recent report is:        (Attach a copy of the most recent report, unless previously submitted to
                                        Offeror Certification
I, the undersigned, hereby declare that I am a duly authorized representative of the organization
below, and I can certify and commit the organization regarding the information on this form,
including the total offer amount submitted in response to RFQ/RFP No.          .

Authorized Signature:                                                              Date:

Type/Print Name:

                                                         1 of 1                             JPL 2384-3, R 4/12

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