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Representations and Certifications_2_ by hcj


									Fluor Enterprises Inc.


The Offeror identified below certifies to the following facts. The full text of the representations and certifications made below (and referenced to the right of each statement) is available in the Federal Acquisition Regulations (FAR) or can be supplied by Phoenix Constructors JV. Check each block that applies: 1. The Offeror certifies, to the best of its knowledge and belief, that the Offeror and/or any of its principals: ARE ARE NOT presently debarred, suspended, proposed for debarment, or declared ineligible for award of contracts by any federal agency; and HAVE HAVE NOT within a 3-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 federal, state, or local government contract or subcontract; violation of federal or state antitrust statutes relating to the submission of offers; or commission of embezzlement, theft, bribery, falsification or destruction of records, making false statements, tax evasion, or receiving stolen property, and ARE ARE NOT presently indicted for, or otherwise criminally or civilly charged by a government entity with, commission of any of these offenses. 2. 3. The Offeror represents as part of its offer that it IS IS NOT a small business concern 52.219-1 52.219-1 FAR CLAUSE 52.209-5

Complete only if the Offeror represented itself as a small business concern in item 2 above. The Offeror The Offeror The Offeror The Offeror The Offeror The Offeror IS IS IS IS IS IS IS NOT a small disadvantaged business concern as defined in 13 CFR 124.1002. IS NOT a women-owned small business concern. IS NOT a veteran-owned small business concern. IS NOT a service-disabled veteran-owned small business concern. IS NOT a HUBZone small business concern. IS NOT a joint venture that complies with the requirements of 13 CFR Part 126.


Complete only if the Offeror represented itself as a small disadvantaged business concern in item 3 above. The Offeror shall check the category in which its ownership falls: Black American Alaskan Native American Certified 8(a) contractor Hispanic American Asian Pacific American Other minority firm Native American Subcontinent Asian American


5. 6. 7. 8. 9. 10. 11.

Segregated facilities will not be used by this Offeror, and subcontractors will be notified that they shall not maintain segregated facilities. Offeror Offeror Offeror HAS HAS HAS HAS NOT participated in previous work subject to Equal Opportunity. HAS NOT filed all required Equal Opportunity compliance reports. HAS NOT developed and has on file Affirmative Action Programs. HAS NOT had previous contracts subject to written Affirmative Action Program

52.222-21 52.222-22 52.222-22 52.222-25 52.222-25 52.225-1 52.230-1

Offeror HAS requirements.

Each end product is a domestic end product unless the Offeror (or supplier) notifies Phoenix Constructors JV of the use of foreign end products. Offeror can comply with the Cost Accounting Standards (CAS). If exempt or eligible for modified coverage, list why:

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Fluor Enterprises Inc.
12. 13. 14. Offeror has an approved accounting system. Offeror has approved forward pricing rates. Offeror has an approved Disclosure Statement.

Date accounting period ends:

Date: Name: Phone Number:

Offeror’s Administrative Contracting Officer (ACO): Address: 15. 16. 17. 18. 19. 20.

Any facility to be used for this effort is not listed on EPA’s list of violating facilities. Offeror maintains a corporate quality assurance program and executes all projects/orders in accordance with this program. ISO 9001 Certified. Offeror has an approved Property Management system. Signer is authorized to represent the business making this offer (Offeror) in all matters related to pricing, terms and conditions, conduct of business, and buyer-seller relationships between Offeror and the Buyer. Prices offered have been arrived at independently, without consultation, communication, agreement, or condition that relates to the proposal by any other Offeror or competitor. The Offeror has not, and will not, disclose offered prices to any other Offeror or competitor prior to award of a resulting Contract or Purchase Order, or cancellation of this solicitation. The Offeror has not attempted to induce any other person or firm to submit, or not submit, an offer in response to this solicitation. Offeror warrants that the prices offered do not exceed those currently offered to any other customer for the same or similar quantities of the same or similar goods or services. No person or company, other than Offeror’s employee(s) or affiliate firms, has/have been paid to solicit or obtain this Contract or Purchase Order nor has any agreement been made to pay a person or company a commission, fee, or any form of compensation contingent upon award of this solicitation. Offeror’s current Experience Modification Rating (EMR) is (potential contractors only): Offeror provides Goods Services Employer/Tax I.D. No.: -


22. 23. 24.

Complete one of the following responses: Offeror is not subject to backup withholding per Sec. 3406(a)(i)(c) Internal Revenue Code. Offeror is subject to backup withholding; social security number(s) is: -


Offeror is: An Individual A Partnership U.S. Government Agency Company LEGAL Name: Dun & Bradstreet Number: Ordering Address: P.O. Box: State: Phone: Contact: City: Zip: Fax: Title: A Joint Venture A Foreign Citizen A Nonprofit Corporation A State or Local Government Agency

A Corporation Incorporated in the State of

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Fluor Enterprises Inc.
Remit To Address: P.O. Box: State: Phone: Contact:


City: Zip: Fax: Title:

Parent Company Name: Dun & Bradstreet Number: Ordering Address: P.O. Box: State: Phone: Contact: City: Zip: Fax: Title:

I certify that the information provided on this form is accurate and true to the best of my knowledge, and any changed conditions shall be reported promptly to Phoenix Constructors JV. These certification statements concern matters within the jurisdiction of an agency of the United States. Making a false, fictitious, or fraudulent certification may render Offeror subject to prosecution Section 1001, Title 18, United States Code. The Buyer may withhold an award based on any negative responses to the certifications above and/or Offerors’ failure to adequately describe the conditions of the response. Offeror agrees that the certifications and conditions provided herein are a material and binding part of, and are hereby incorporated by reference into, any resulting contract unless specifically excluded in the Contract or Purchase Order.

Printed Name




Internet Homepage and/or Email Address:

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