ANNUAL REPRESENTATIONS AND CERTIFICATIONS
Offeror will complete all of this Representations and Certifications form. Failure to furnish the following representations
and certifications may be cause for the rejection of Offeror's bid(s) or proposal(s) as non-responsive, resulting in no
contract award. U.S. Government regulations prohibit CSC from awarding a seller a procurement funded under a U.S.
Government contract unless the seller certifies that it complies with certain U.S. policies. Your company is a potential
supplier of goods and services to CSC whose purchase by CSC may be funded under a U.S. Government contract.
Accordingly, to be eligible for award you are required to complete the Representations and Certifications contained
Upon completion, please have the Representations and Certifications signed by an authorized representative of your
company, date them and return them to CSC as instructed. If there has been a change in ownership during the past
year, a separate Representations and Certifications package is required for the new company and please provide the
former name of company. All applicable pages must be signed.
The seller by completion and submission of this form certifies that the information contained herein is true, complete,
and accurate as of the date written below. The executed Representations and Certifications shall be valid for 1 year.
Should the information contained herein change; the Seller agrees to notify CSC within a reasonable period subsequent
to the change.
By signing below, the Offeror agrees to the foregoing and attests that the Representations and Certifications set forth
herein are current, accurate, and complete. Further, if Offeror's status certified herein should change prior to any award
based on this certification, the Offeror shall immediately notify, in writing, the person/office to whom this original
certification was sent and submit an amended certification with any related data that may be required as a result of the
I hereby acknowledge an understanding of the U.S. Government contracting and subcontracting programs and confirm
the accuracy of the statements made in this document.
For CSC Use Only
Completion of this section is required
F225-1 (08/18/2009) 1 of 15
Business Size Representation
It is the policy of CSC that small businesses, small disadvantaged business concerns, woman-owned small businesses and HUB Zone, veteran and service
disabled veterans small businesses concerns have the maximum practicable opportunity to participate in the performance of contracts awarded to CSC. In
order to comply with this policy, please provide the following information.
Vendor Number: _ _
NOTE: Blocks 1, 2 are not required if the Company resides and is conducting business outside the US; however, a Form W-8 BEN or W-8ECI is required
Seller’s Name Phone Number
Street Address Fax Number
City State Zip No. Of Employees Email Address
Remittance Street Address (if different from Above) D&B Number Cage Code URL:
City State Zip DUNS # Payment Terms Taxpayer ID No. (EID or SSN)
This company is (check the ones that apply)
A Division of: A Subsidiary of: An Affiliate of:
Distributor Manufacturer Retailer Other
Consultant 1099 Required Yes or No Independently Owned and Operated
U.S. companies are required to complete a form W-9; all foreign companies & foreign exempt entities are required to complete the appropriate form W-8
(i.e. W-8BEN, W-8ECI or other IRS designated form); and U.S. and foreign tax exempt entities are required to provide documents which establish the tax
exemption. These documents should be submitted along with this signed Business Size Representation Form.
Identify Major Supplies/Services Primary North American Industry Classification System (NAICS) Codes NAICS: (if applicable)
Business Size/Type (select one only)
Foreign Owned (non US) Small Business Large Business
U.S. Owned Small Business Large Business Non-Profit
(Block 1) Business Ownership (select all that apply)
Minority SBA Disadvantaged Woman-Owned Business
Historically Black College/Minority Institute Service Disabled Veteran Owned
HUB Zone (certified by SBA) Veteran Owned
(Block 2) If Minority/Disadvantaged is selected above, please check the appropriate category in which business ownership falls:
African American Asian Pacific American Hispanic American Other than those listed
Native American Subcontinent Asian American Alaska Native Corp (ANC)
Provide the former name of company if there has been a change in ownership during the past year Date of ownership change if applicable
Authorized Signature Title
Name Printed Date
CSC may award procurement to the seller where the costs will be charged to a U.S. Government prime or subcontract. If so, the seller is advised that the U.S.
Government may impose a penalty against a firm misrepresenting its business size and/or disadvantaged status for the purpose of obtaining a procurement that is
To be included as part, or all of a goal contained in CSC’s Subcontracting plan. Eligibility as a small business is based on the regulations issued by the Small Business
Administration in CFR 13, Part 121 of the SBA Rules and Regulations.
FOR SDB Suppliers: Confirmation seller meets the criteria in 13CFR Part 124 to be qualified as a SDB
Visit CSC’s Supplier Diversity Web Page www.csc.com/supplierdiversity and add your company to the Supplier Profile.
F225-1 (08/18/2009) 2 of 15
(Rev. October 2007)
Request for Taxpayer
Give form to the
requester. Do not send to
Department of the Treasury
Internal Revenue Service Identification Number and Certification
Print or type
See Specific Instructions on page 2.
Name (as shown on your income tax return)
Business name, if different from above
Check appropriate box: Individual/Sole proprietor Corporation Partnership Exempt payee
Limited liability company. Enter the tax classification (D=disregarded entity, C=Corporation, P=Partnership
Other (see instructions)
Address (number, street, and apt. or suite no.) Requester’s name and address optional
City, state, and ZIP code
List account number(s) here (optional)
Part I Taxpayer Identification Number (TIN) Social Security No.
Enter your TIN in the appropriate box. The TIN provided must match the name - -
given on Line 1 to avoid backup withholding. For individuals, this is your social
security number (SSN). However, for a resident alien, sole proprietor, or
disregarded entity, see the Part I instructions on page 3. For other entities, it is your
Employer ID No.
employer identification number (EIN). If you do not have a number, see How to get -
a TIN on page 3.
Note. If the account is in more than one name, see the chart on page 4 for guidelines on whose number to enter.
Part II Certification
Under penalties of perjury, I certify that:
1. The number shown on this form is my correct taxpayer identification number (or I am waiting for a number to be issued to me), and
2. I am not subject to backup withholding because: (a) I am exempt from backup withholding, or (b) I have not been notified by the Internal Revenue
Service (IRS) that I am subject to backup withholding as a result of a failure to report all interest or dividends, or (c) the IRS has notified me that I
am no longer subject to backup withholding, and
3. I am a U.S. person (including a U.S. resident alien).
Certification instructions. You must cross out item 2 above if you have been notified by the IRS that you are currently subject to backup withholding
because you have failed to report all interest and dividends on your tax return. For real estate transactions, item 2 does not apply. For mortgage
interest paid, acquisition or abandonment of secured property, cancellation of debt, contributions to an individual retirement arrangement (IRA), and
generally, payments other than interest and dividends, you are not required to sign the Certification, but you must provide your correct TIN. (See the
instructions on page 4.)
Sign Signature of
Here U.S. person Date
General Instructions Definition of a U.S. person. For federal tax purposes, you are
Section references are to the Internal Revenue Code unless otherwise considered a U.S. person if you are:
noted. An individual who is a U.S. citizen or U.S. resident alien,
A partnership, corporation, company, or association created or
Purpose of Form organized in the United States or under the laws of the United
A person who is required to file an information return with the IRS States,
must obtain your correct taxpayer identification number (TIN)to report, An estate (other than a foreign estate), or
for example, income paid to you, real estate transactions, mortgage A domestic trust (as defined in Regulations section 301.7701-7).
interest you paid, acquisition or abandonment of secured property,
Special rules for partnerships. Partnerships that conduct a trade
cancellation of debt, or contributions you made to an IRA.
or business in the United States are generally required to pay a
Use Form W-9 only if you are a U.S. person (including a resident
withholding tax on any foreign partners’ share of income from such
alien), to provide your correct TIN to the person requesting it (the
business. Further, in certain cases where a Form W-9 has not been
requester) and, when applicable, to:
received, a partnership is required to presume that a partner is a
1. Certify that the TIN you are giving is correct (or you are waiting
foreign person, and pay the withholding tax. Therefore, if you are a
for a number to be issued),
U.S. person that is a partner in a partnership conducting a trade or
2. Certify that you are not subject to backup withholding, or
business in the United States, provide Form W-9 to the partnership
3. Claim exemption from backup withholding if you are a U.S.
to establish your U.S. status and avoid withholding on your share of
exempt payee. If applicable, you are also certifying that as a U.S.
person, your allocable share of any partnership income from a U.S.
trade or business is not subject to the withholding tax on foreign
The person who gives Form W-9 to the partnership for purposes of
partners’ share of effectively connected income. establishing its U.S. status and avoiding withholding on its allocable
Note. If a requester gives you a form other than Form W-9 to request share of net income from the partnership conducting a trade or
your TIN, you must use the requester’s form if it is substantially similar business in the United States is in the following cases:
to this Form W-9. The U.S. owner of a disregarded entity and not the entity,
F225-1 (08/18/2009) 3 of 15
The U.S. grantor or other owner of a grantor trust and not the trust, 4. The IRS tells you that you are subject to backup withholding
and because you did not report all your interest and dividends on your
The U.S. trust (other than a grantor trust) and not the beneficiaries tax return (for reportable interest and dividends only), or dividends
of the trust. only), or
5. You do not certify to the requester that you are not subject to
Foreign person. If you are a foreign person, do not use Form backup withholding under 4 above (for reportable interest and
W-9. Instead, use the appropriate Form W-8 (see Publication dividend accounts opened after 1983 only).
515, Withholding of Tax on Nonresident Aliens and Foreign
Entities). Certain payees and payments are exempt from backup
withholding. See the instructions below and the separate Instructions
Nonresident alien who becomes a resident alien. Generally, only a for the Requester of Form W-9.
nonresident alien individual may use the terms of a tax treaty to Also see Special rules for partnerships on page 1.
reduce or eliminate U.S. tax on certain types of income. However,
most tax treaties contain a provision known as a ―saving clause.‖ Penalties
Exceptions specified in the saving clause may permit an exemption
Failure to furnish TIN. If you fail to furnish your correct TIN to a
from tax to continue for certain types of income even after the payee
requester, you are subject to a penalty of $50 for each such failure
has otherwise become a U.S. resident alien for tax purposes.
unless your failure is due to reasonable cause and not to willful
If you are a U.S. resident alien who is relying on an exception
contained in the saving clause of a tax treaty to claim an Civil penalty for false information with respect to withholding. If
exemption from U.S. tax on certain types of income, you must you make a false statement with no reasonable basis that results in
attach a statement to Form W-9 that specifies the following five no backup withholding, you are subject to a $500 penalty.
1. The treaty country. Generally, this must be the same treaty under Criminal penalty for falsifying information. Willfully falsifying
which you claimed exemption from tax as a nonresident alien. certifications or affirmations may subject you to criminal penalties
2. The treaty article addressing the income. including fines and/or imprisonment.
3. The article number (or location) in the tax treaty that contains the
saving clause and its exceptions. Misuse of TINs. If the requester discloses or uses TINs in violation
4. The type and amount of income that qualifies for the exemption of federal law, the requester may be subject to civil and criminal
from tax. penalties.
5. Sufficient facts to justify the exemption from tax under the terms
of the treaty article. Specific Instructions
Example. Article 20 of the U.S.-China income tax treaty allows Name
an exemption from tax for scholarship income received by a
Chinese student temporarily present in the United States. Under If you are an individual, you must generally enter the name shown
U.S. law, this student will become a resident alien for tax purposes if on your income tax return. However, if you have changed your last
his or her stay in the United States exceeds 5 calendar years. name, for instance, due to marriage without informing the Social
However, paragraph 2 of the first Protocol to the U.S.-China treaty Security Administration of the name change, enter your first name,
(dated April 30, 1984) allows the provisions of Article 20 to continue to the last name shown on your social security card, and your new last
apply even after the Chinese student becomes a resident alien of the name.
United States. A Chinese student who qualifies for this exception
(under paragraph 2 of the first protocol) and is relying on this If the account is in joint names, list first, and then circle, the name
exception to claim an exemption from tax on his or her scholarship or of the person or entity whose number you entered in Part I of the
fellowship income would attach to Form W-9 a statement that includes form.
the information described above to support that exemption.
Sole proprietor. Enter your individual name as shown on your
If you are a nonresident alien or a foreign entity not subject to income tax return on the ―Name‖ line. You may enter your business,
backup withholding, give the requester the appropriate completed trade, or ―doing business as (DBA)‖ name on the ―Business name‖
Form W-8. line.
Limited liability company (LLC). Check the ―Limited liability
What is backup withholding? Persons making certain payments company‖ box only and enter the appropriate code for the tax
to you must under certain conditions withhold and pay to the classification (―D‖ for disregarded entity, ―C‖ for corporation, ―P‖ for
IRS 28% of such payments. This is called ―backup withholding.‖ partnership) in the space provided.
Payments that may be subject to backup withholding include interest, For a single-member LLC (including a foreign LLC with a domestic
tax-exempt interest, dividends, broker and barter exchange owner) that is disregarded as an entity separate from its owner
transactions, rents, royalties, nonemployee pay, and certain payments under Regulations section 301.7701-3, enter the owner’s name on
from fishing boat operators. Real estate transactions are not subject the ―Name‖ line. Enter the LLC’s name on the ―Business name‖ line.
to backup withholding.
For an LLC classified as a partnership or a corporation, enter the
You will not be subject to backup withholding on payments you LLC’s name on the ―Name‖ line and any business, trade, or DBA
receive if you give the requester your correct TIN, make the proper name on the ―Business name‖ line.
certifications, and report all your taxable interest and dividends on
your tax return. Other entities. Enter your business name as shown on required
federal tax documents on the ―Name‖ line. This name should match
Payments you receive will be subject to backup withholding the name shown on the charter or other legal document creating the
if: entity. You may enter any business, trade, or DBA name on the
―Business name‖ line.
1. You do not furnish your TIN to the requester, Note. You are requested to check the appropriate box for your
2. You do not certify your TIN when required (see the Part II status (individual/sole proprietor, corporation, etc.).
instructions on page 3 for details),
3. 3. The IRS tells the requester that you furnished an incorrect Exempt Payee
TIN, If you are exempt from backup withholding, enter your name as
F225-1 (08/18/2009) 4 of 15
described above and check the appropriate box for your status, then Part I. Taxpayer Identification Number (TIN)
check the ―Exempt payee‖ box in the line following the business
name, sign and date the form. Enter your TIN in the appropriate box. If you are a resident alien
and you do not have and are not eligible to get an SSN, your TIN is
Generally, individuals (including sole proprietors) are not exempt from your IRS individual taxpayer identification number (ITIN). Enter it in
backup withholding. Corporations are exempt from backup the social security number box. If you do not have an ITIN, see How
withholding for certain payments, such as interest and dividends. to get a TIN below.
If you are a sole proprietor and you have an EIN, you may enter
Note. If you are exempt from backup withholding, you should still either your SSN or EIN. However, the IRS prefers that you use your
complete this form to avoid possible erroneous backup withholding. SSN.
If you are a single-member LLC that is disregarded as an entity
The following payees are exempt from backup withholding: separate from its owner (see Limited liability company (LLC) on page
1. An organization exempt from tax under section 501(a), any IRA, 2), enter the owner’s SSN (or EIN, if the owner has one). Do not
or a custodial account under section 403(b)(7) if the account enter the disregarded entity’s EIN. If the LLC is classified as a
satisfies the requirements of section 401(f)(2), corporation or partnership, enter the entity’s EIN.
2. The United States or any of its agencies or instrumentalities,
3. A state, the District of Columbia, a possession of the United Note. See the chart on page 4 for further clarification of name and
States, or any of their political subdivisions or instrumentalities, TIN combinations.
4. A foreign government or any of its political subdivisions,
agencies, or instrumentalities, or How to get a TIN. If you do not have a TIN, apply for one
5. An international organization or any of its agencies or immediately. To apply for an SSN, get Form SS-5, Application for a
instrumentalities. Social Security Card, from your local Social Security Administration
Other payees that may be exempt from backup withholding include: office or get this form online at www.ssa.gov. You may also get this
6. A corporation, form by calling 1-800-772-1213. Use Form W-7, Application for IRS
7. A foreign central bank of issue, Individual Taxpayer Identification Number, to apply for an ITIN, or
8. A dealer in securities or commodities required to register in the Form SS-4, Application for Employer Identification Number, to apply
United States, the District of Columbia, or a possession of the United for an EIN. You can apply for an EIN online by accessing the IRS
States, website at www.irs.gov/businesses and clicking on Employer
9. A futures commission merchant registered with the Commodity Identification Number (EIN) under Starting a Business. You can get
Futures Trading Commission, Forms W-7 and SS-4 from the IRS by visiting www.irs.gov or by
10. A real estate investment trust, calling 1-800-TAX-FORM (1-800-829-3676).
11. An entity registered at all times during the tax year under the If you are asked to complete Form W-9 but do not have a TIN, write
Investment Company Act of 1940, ―Applied For‖ in the space for the TIN, sign and date the form, and
12. A common trust fund operated by a bank under section 584(a), give it to the requester. For interest and dividend payments, and
13. A financial institution, certain payments made with respect to readily tradable instruments,
14. A middleman known in the investment community as a nominee generally you will have 60 days to get a TIN and give it to the
or custodian, or requester before you are subject to backup withholding on
15. A trust exempt from tax under section 664 or described in payments. The 60-day rule does not apply to other types of
section 4947. payments. You will be subject to backup withholding on all such
payments until you provide your TIN to the requester. If you are a
The chart below shows types of payments that may be exempt from sole proprietor and you have an EIN, you may enter either your SSN
backup withholding. The chart applies to the exempt payees listed or EIN. However, the IRS prefers that you use your SSN.
above, 1 through 15.
If you are a single-member LLC that is disregarded as an entity
separate from its owner (see Limited liability company (LLC) on page
IF the payment is for . . . THEN the payment is exempt 2), enter the owner’s SSN (or EIN, if the owner has one). Do not
for . . . enter the disregarded entity’s EIN. If the LLC is classified as a
corporation or partnership, enter the entity’s EIN. Note. See the
Interest and dividend payments All exempt payees except for 9 chart on page 4 for further clarification of name and TIN
Broker transactions Exempt payees 1 through 13. Note. Entering ―Applied For‖ means that you have already applied
Also, a person registered under for a TIN or that you intend to apply for one soon.
the Investment Advisers Act of Caution: A disregarded domestic entity that has a foreign owner
1940 who regularly acts as a must use the appropriate Form W-8.
Part II. Certification
Barter exchange transactions Exempt payees 1 through 5
and patronage dividends To establish to the withholding agent that you are a U.S. person, or
resident alien, sign Form W-9. You may be requested to sign by the
withholding agent even if items 1, 4, and 5 below indicate otherwise.
Payments over $600 required Generally, exempt payees For a joint account, only the person whose TIN is shown in Part I
to be reported and direct 1 through 7 2 should sign (when required). Exempt payees, see Exempt Payee on
1See Form 1099-MISC, Miscellaneous Income, and its instructions.
2However, the following payments made to a corporation (including gross proceeds
Signature requirements. Complete the certification as indicated in
paid to an attorney under section 6045(f), even if the attorney is a corporation) and 1 through 5 below.
reportable on Form 1099-MISC are not exempt from backup withholding: medical and
health care payments, attorneys’ fees, and 1. Interest, dividend, and barter exchange accounts opened
before 1984 and broker accounts considered active during
1983. You must give your correct TIN, but you do not have to sign
F225-1 (08/18/2009) 5 of 15
2. Interest, dividend, broker, and barter exchange accounts Secure Your Tax Records from Identity Theft
opened after 1983 and broker accounts considered inactive Identity theft occurs when someone uses your personal information
during 1983. You must sign the certification or backup withholding will such as your name, social security number (SSN), or other
apply. If you are subject to backup withholding and you are merely identifying information, without your permission, to commit fraud or
providing your correct TIN to the requester, you must cross out item 2 other crimes. An identity thief may use your SSN to get a job or may
in the certification before signing the form. file a tax return using your SSN to receive a refund.
3. Real estate transactions. You must sign the certification. You
may cross out item 2 of the certification. To reduce your risk:
4. Other payments. You must give your correct TIN, but you do not
Protect your SSN,
have to sign the certification unless you have been notified that you
Ensure your employer is protecting your SSN, and
have previously given an incorrect TIN. ―Other payments‖ include
payments made in the course of the requester’s trade or business for Be careful when choosing a tax preparer.
rents, royalties, goods (other than bills for merchandise), medical and Call the IRS at 1-800-829-1040 if you think your identity has been
health care services (including payments to corporations), payments used inappropriately for tax purposes.
to a nonemployee for services, payments to certain fishing boat crew
Victims of identity theft who are experiencing economic harm or a
members and fishermen, and gross proceeds paid to attorneys
system problem, or are seeking help in resolving tax problems that
(including payments to corporations).
have not been resolved through normal channels, may be eligible for
5. Mortgage interest paid by you, acquisition or abandonment
Taxpayer Advocate Service (TAS) assistance. You can reach TAS
of secured property, cancellation of debt, qualified tuition
by calling the TAS toll-free case intake line at 1-877-777-4778 or
program payments (under section 529), IRA, Coverdell ESA,
Archer MSA or HSA contributions or distributions, and pension
distributions. You must give your correct TIN, but you do not have to
Protect yourself from suspicious emails or phishing schemes.
sign the certification.
Phishing is the creation and use of email and websites designed to
mimic legitimate business emails and websites. The most common
What Name and Number To Give the Requester act is sending an email to a user falsely claiming to be an
established legitimate enterprise in an attempt to scam the user into
For this type of account: Give name and SSN of:
surrendering private information that will be used for identity theft.
1. Individual The Individual
2. Two or more individuals (joint account) The actual owner of the account or, The IRS does not initiate contacts with taxpayers via emails. Also,
If combined funds, the first individual the IRS does not request personal detailed information through
on the account 1 email or ask taxpayers for the PIN numbers, passwords, or similar
3. Custodian account of a minor The minor 2
(Uniform Gift to Minors Act)
secret access information for their credit card, bank, or other
4. a. The usual revocable savings The grantor-trustee 1 financial accounts.
trust (grantor is also trustee)
b. So-called trust account that is The actual owner 1 If you receive an unsolicited email claiming to be from the IRS,
not a legal or valid trust under forward this message to email@example.com. You may also report
5. Sole proprietorship or disregarded The owner 3
misuse of the IRS name, logo, or other IRS personal property to
the Treasury Inspector General for Tax Administration at
For this type of account: Give name and EIN of:
1-800-366-4484. You can forward suspicious emails to the Federal
6. Disregarded entity not owned by an The owner Trade Commission at: firstname.lastname@example.org or contact them at
Individual www.consumer.gov/idtheft or 1-877-IDTHEFT(438-4338).
7. A valid trust, estate, or pension trust Legal entity 4
8. Corporate or LLC electing corporate The corporation Visit the IRS website at w ww.irs.gov to learn more about identity
Status on Form 8832
9. Association, club, religious, charitable, The organization theft and how to reduce your risk.
Educational, or other tax-exempt
10. Partnerships or multi-member LLC The partnership
11. A broker or registered nominee The broker or nominee
12. Account with the department of The public entity
Agriculture in the name of a public
Entity (such as a state or local
Government, school district, or
Prison) that receives agriculture
1 List first and circle the name of the person whose number you furnish. If only one person on a
joint account has an SSN, that person’s number must be furnished.
2 Circle the minor’s name and furnish the minor’s SSN.
3 You must show your individual name and you may also enter your business or ―DBA‖ name on
the second name line. You may use either your SSN or EIN (if you have one), but the IRS
encourages you to use your SSN.
4 List first and circle the name of the trust, estate, or pension trust. (Do not furnish the TIN
of the personal representative or trustee unless the legal entity itself is not designated in
the account title.) Also see Special rules for partnerships on page 1.
Note. If no name is circled when more than one name is listed, the
number will be considered to be that of the first name listed.
Privacy Act Notice
Section 6109 of the Internal Revenue Code requires you to provide your correct TIN to persons who must file information returns with the IRS to report interest, dividends, and
certain other income paid to you, mortgage interest you paid, the acquisition or abandonment of secured property, cancellation of debt, or contributions you made to an IRA, or
Archer MSA or HSA. The IRS uses the numbers for identification purposes and to help verify the accuracy of your tax return. The IRS may also provide this information to the
Department of Justice for civil and criminal litigation, and to cities, states, the District of Columbia, and U.S. possessions to carry out their tax laws. We may also disclose this
information to other countries under a tax treaty, to federal and state agencies to enforce federal nontax criminal laws, or to federal law enforcement and intelligence agencies to
You must provide your TIN whether or not you are required to file a tax return. Payers must generally withhold 28% of taxable interest, dividend, and certain other payments to a
payee who does not give a TIN to a payer. Certain penalties may also apply.
F225-1 (08/18/2009) 6 of 15
A US Taxpayer EIN is required in Box 6 in order to claim a US withholding tax exemption or to claim a reduced withholding tax rate from a tax treaty;
otherwise a 30% IRS withholding rate will apply. You can obtain a US EIN from the IRS on Form SS-4.
Form W-8BEN Certificate of Foreign Status of Beneficial Owner
(Rev. February 2006) for United States Tax Withholding OMB No. 1545-1621
Department of the Treasury Section references are to the Internal Revenue Code. See separate instructions.
Internal Revenue Service Give this form to the withholding agent or payer. Do not send to the IRS.
Do not use this form for: Instead, use Form:
● A U.S. citizen or other U.S. person, including a resident alien individual . . . . . . . . . . . . . . . . . . . . . . W-9
● A person claiming that income is effectively connected with the conduct
of a trade or business in the United States . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . W-8ECI
● A foreign partnership, a foreign simple trust, or a foreign grantor trust (see instructions for exceptions) . . . . . . . . W-8ECI or W-8IMY
● A foreign government, international organization, foreign central bank of issue, foreign tax-exempt organization,
foreign private foundation, or government of a U.S. possession that received effectively connected income or that is
claiming the applicability of section(s) 115(2), 501(c), 892, 895, or 1443(b) (see instructions) . . . . . . . . . . . . W-8ECI or W-8EXP
Note: These entities should use Form W-8BEN if they are claiming treaty benefits or are providing the form only to
claim they are a foreign person exempt from backup withholding.
● A person acting as an intermediary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . W-8IMY
Note: See instructions for additional exceptions.
Part I Identification of Beneficial Owner (See instructions.)
1 Name of individual or organization that is the beneficial owner 2 Country of incorporation or organization
3 Type of beneficial owner: Individual Corporation Disregarded entity Partnership Simple trust
Grantor trust Complex trust Estate Government International organization
Central bank of issue Tax-exempt organization Private foundation
4 Permanent residence address (street, apt. or suite no., or rural route). Do not use a P.O. box or in-care-of address.
City or town, state or province. Include postal code where appropriate. Country (do not abbreviate)
5 Mailing address (if different from above)
City or town, state or province. Include postal code where appropriate. Country (do not abbreviate)
6 U.S. taxpayer identification number, if required (see instructions) 7 Foreign tax identifying number, if any (optional)
SSN or ITIN EIN
8 Reference number(s) (see instructions)
Part II Claim of Tax Treaty Benefits (if applicable)
9 I certify that (check all that apply):
a The beneficial owner is a resident of within the meaning of the income tax treaty between the United States and that country.
b If required, the U.S. taxpayer identification number is stated on line 6 (see instructions).
c The beneficial owner is not an individual, derives the item (or items) of income for which the treaty benefits are claimed, and, if applicable,
meets the requirements of the treaty provision dealing with limitation on benefits (see instructions).
d The beneficial owner is not an individual, is claiming treaty benefits for dividends received from a foreign corporation or interest from a
U.S. trade or business of a foreign corporation, and meets qualified resident status (see instructions).
e The beneficial owner is related to the person obligated to pay the income within the meaning of section 267(b) or 707(b), and will file
Form 8833 if the amount subject to withholding received during a calendar year exceeds, in the aggregate, $500,000.
10 Special rates and conditions (if applicable—see instructions): The beneficial owner is claiming the provisions of Article of the
treaty identified on line 9a above to claim a % rate of withholding on (specify type of income): Explain the reasons the beneficial owner
meets the terms of the treaty article:
Part III Notional Principal Contracts
11 I have provided or will provide a statement that identifies those notional principal contracts from which the income is not effectively
connected with the conduct of a trade or business in the United States. I agree to update this statement as required.
Part IV Certification
Under penalties of perjury, I declare that I have examined the information on this form and to the best of my knowledge and belief it is true, correct, and complete. I
further certify under penalties of perjury that:
1 I am the beneficial owner (or am authorized to sign for the beneficial owner) of all the income to which this form relates,
2 The beneficial owner is not a U.S. person,
3 The income to which this form relates is (a) not effectively connected with the conduct of a trade or business in the United States, (b) effectively connected but is
not subject to tax under an income tax treaty, or (c) the partner’s share of a partnership’s effectively connected income, and
4 For broker transactions or barter exchanges, the beneficial owner is an exempt foreign person as defined in the instructions.
Furthermore, I authorize this form to be provided to any withholding agent that has control, receipt, or custody of the income of which I am the beneficial owner or
any withholding agent that can disburse or make payments of the income of which I am the beneficial owner.
Sign Here ..………………………………………………………………………………………………
Signature of beneficial owner (or individual authorized to sign for beneficial owner) Date (MM-DD-YYYY) Capacity in which acting
F225-1 (08/18/2009) 7 of 15
IMPORTANT: To protect the privacy of your information, please send this EFT Authorization Agreement Form SEPARATELY from the
other documents in this packet. Please send to our dedicated fax at 703.736.5017 or e-mail to email@example.com. Thank you.
For CSC Use Only
EFT AUTHORIZATION AGREEMENT FORM
(Electronic Funds Transfer)
Check appropriate box below only typed responses please
Decline Initial Cancel Change of Change of Change of
Participation Participation Participation Financial Account Remittance
Institution * Number * Address
I hereby authorize Computer Sciences Corporation, hereinafter referred to as ―the Company,‖ to initiate Electronic Funds Transfer (EFT)
for the purposes contemplated, herein also referred to as ACH, credit entries, or debit corrections, of all amounts payable to me through
the Company’s EFT program(s), and to the depository institution and account, identified below.
VENDOR LEGAL NAME: DBA:
VENDOR REMITTANCE ADDRESS:
(Address on vendor invoice) TIN / SSN:
CITY: STATE: ZIP:
**WE ARE ONLY ABLE TO ACCEPT U.S. BANKING INFORMATION AT THIS TIME**
FINANCIAL INSTITUTION NAME:
NAME ON ACCOUNT:
BRANCH LOCATION: CITY: STATE: ZIP: PHONE:
BANK ABA: ACCT. NUMBER:
TYPE OF ACCOUNT: Checking Savings Lock Box
METHOD REQUIRED FOR ACH TRANSMISSION:
CTX - 9,999 lines of invoice data will transmit, so paper remittances are not necessary
Please note that we are only offering CTX ACH transmission at this time as it is the preferred banking method.
**REQUIRED: ATTACH A VOIDED CHECK TO THIS FORM**
This authorization is to remain in full force and effect until the Company has received proper written notification
Voided from me of its change or termination, or the Company terminates its EFT program or my participation therein.
Here The undersigned is duly authorized to sign this Agreement.
AGREED AND ACCEPTED:
Name Printed Clearly Phone #
Email address for Remittance Advices:
1. Complete and sign the CSC EFT Authorization Agreement Form (above form).
2. Authorized Approver must be Director, VP, CFO, President or CEO, if delegated to other than listed, please provide a letter of delegation on your
company’s letterhead and submit along with the completed EFT form, signed by one of the above.
3. Include a copy of a voided check and verify with your bank that the ABA NUMBER (usually the first 9 digits at the bottom of your check) and YOUR
ACCOUNT NUMBER are appropriate for direct deposit purposes.
4. Forms not accompanied by voided checks will not be processed. Illegible forms may be rejected.
5. Business accounts require all bank signatures necessary to be on this form. If extra lines are needed, please attach an additional sheet.
6. Should your banking or remittance address information change, promptly send updates to our dedicated fax line: (703) 736-5017 to ensure
7. If you have any questions, please call CSC Accounts Payable Department at (703) 318-2555.
F225-1 (08/18/2009) 8 of 15
1. ROYALTY INFORMATION CERTIFICATION (FAR 52.227-6)
Offeror certifies royalty or license fee costs ARE ARE NOT contemplated to be included in ANY Offer
submitted. When Offeror indicates royalty of license fees "ARE NOT" contemplated above, Offeror agrees to notify
Buyer when any solicitation response contains such costs.
2. EQUAL OPPORTUNITY (FAR 52.222-26)
The Offeror represents that it is in agreement with the subject clause and the Executive Order 11246, as amended,
and the rules, regulations, and Orders of the Secretary of Labor pertaining to Equal Opportunity.
3. AFFIRMATIVE ACTION COMPLIANCE (FAR 52.222-25)
The Offeror represents that it HAS HAS NOT developed an affirmative action program as required by the rules
and regulations of the Secretary of Labor (41 CFR 60-1 and 60-2), or it HAS NOT previously held contracts
subject to the written affirmative action programs requirement of the rules and regulations of the Secretary of Labor.
4. PREVIOUS CONTRACTS AND COMPLIANCE REPORTS (FAR 52.222-22)
The Offeror represents that:
A. It HAS HAS NOT participated in a previous contract or subcontract subject to the Equal Employment
Opportunity clause of any solicitation/procurement (FAR 52.222-26).
B. It HAS HAS NOT filed all required compliance reports.
5. BUY AMERICAN ACT- CERTIFICATE (FAR 52.225-2)
(Applicable only if the CSC Solicitation contains the clause at FAR 52.225-1, "Buy American Act-
Balance of Payments Program-Supplies")
The Offeror certifies that each end product, except those listed below, is a domestic end product (as defined in the
clause of the CSC solicitation entitled "Buy American Act-Balance of Payments Program-Supplies"), and that the
Offeror has considered components of unknown origin to have been mined, produced, or manufactured outside the
United States. The Offeror shall list as foreign end products those end products manufactured in the United States
that do not qualify as domestic end products.
Foreign End Products Country of Origin
6. CERTIFICATION REGARDING DEBARMENT, SUSPENSION, PROPOSED DEBARMENT, AND
OTHER RESPONSIBILITY MATTERS (FAR 52.209-5)
The Offeror certifies, to the best of its knowledge and belief, that the Offeror and/or any of its
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 the 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;
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 this provision; and
The Offeror, aside from the offenses enumerated in this provision, HAS HAS NOT, within the past three years,
relative to tax, labor and employment, environmental, antitrust, or consumer protection laws, been convicted of a
Federal or state felony (or has any Federal or state felony indictments currently pending against them); or had a
Federal court judgment in a civil case brought by the United States rendered against them; or had an adverse
decision by a Federal administrative law judge, board, or commission indicating a willful violation of law. If the
Offeror has responded affirmatively, the Offeror shall provide additional information if requested by CSC; and
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.
F225-1 (08/18/2009) 9 of 15
"Principals," for the purposes of this certification, means officers; directors; owners; partners; and, persons having
primary management or supervisory responsibilities within a business entity (e.g., general manager; plant manager;
head of a subsidiary, division, or business segment, and similar positions).
THIS CERTIFICATION CONCERNS A MATTER WITHIN THE JURSIDICTION 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.
The Offeror shall provide immediate written notice to CSC if, at any time prior to contract award, the Offeror learns
that its certification was erroneous when submitted or has become erroneous by reason of changed circumstances.
A certification that any of the items in 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
CSC may render the Offeror nonresponsible. 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 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. The certification in 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 the other remedies available to it, CSC may terminate the contract
resulting from this solicitation for default.
7. CERTIFICATE OF INDEPENDENT PRICE DETERMINATION (FAR 52.203-2)
a. The Offeror certifies that:
The prices set forth in ALL offers have been arrived at independently without any consultation,
communication or agreement with any other Offeror or competitor relating to: (i) those prices, (ii) the
intention to submit an offer, and/or (iii) the methods or factors used to calculate the prices offered;
The prices set forth in ALL offers 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 contract award (in the case of a negotiated solicitation) unless otherwise required by
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.
b. Each signature on an offer is considered to be a 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 subparagraph (a) above; or
Has been authorized, in writing, to act as agent for the principals involved in certifying that those
principals have not participated, and will not participate in any action contrary to this provision; and
further agrees to include the name and title of person(s) in the Offeror's organization responsible for
determining the prices offered in bids or proposals on ALL responses to CSC solicitations.
8. CERTIFICATION AND DISCLOSURE REGARDING PAYMENTS TO INFLUENCE CERTAIN
FEDERAL TRANSACTIONS (FAR 52.203-11)
a. 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.
b. The Offeror hereby certifies to the best of his or her knowledge and belief that as of the date of execution of
this certification –
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 any Federal contract, the making of any Federal grant, the making of any Federal
loan, the entering into of any cooperative agreement, and the extension, continuation, renewal,
amendment or modification of any Federal contract, grant, loan, or cooperative agreement;
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 the Contracting Officer; and
F225-1 (08/18/2009) 10 of 15
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 $100,000 shall certify and disclose accordingly.
c. Submission of this certification and disclosure is a prerequisite for making or entering into this contract
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
9. CERTIFICATION OF TOXIC CHEMICAL RELEASE REPORTING (FAR 52.223-13)
(Not applicable to procurements of commercial items as defined in FAR Part 2.)
a. Submission of this certification is a prerequisite for making or entering into this contract imposed by
Executive Order 12969, August 8, 1995.
b. The Offeror certifies that –
As the owner or operator of facilities that will be used in the performance of this contract that are
subject to the filing and reporting requirements described in section 313 of the Emergency Planning
and Community Right-to-Know Act of 1986 (EPCRA) (42 U.S.C. 11023) and section 6607 of the
Pollution Prevention Act of 1990 (PPA) (42 U.S.C. 13106), the Offeror will file and continue to file for
such facilities for the life of the contract the Toxic Chemical Release Inventory Form (Form R) as
described in sections 313(a) and (g) of EPCRA and section 6607 of PPA; or
None of its owned or operated facilities to be used in the performance of this contract is subject to the
Form R filing and reporting requirements because each such facility is exempt for at least one of the
following reasons: (Check each block that is applicable.)
The facility does not manufacture, process, or otherwise use any toxic chemicals listed under
section 313(c) of EPCRA, 42 U.S.C. 11023(c);
The facility does not have 10 or more full-time employees as specified in section 313(b)(1)(A) of
EPCRA, 42 U.S.C. 11023(b)(1)(A);
The facility does not meet the reporting thresholds of toxic chemicals established under section
313(f) of EPCRA, 42 U.S.C. 11023(f) (including the alternate thresholds at 40 CFR 372.27,
provided an appropriate certification form has been filed with EPA);
The facility does not fall within Standard Industrial Classification Code (SIC) major groups 20
through 39 or their corresponding North American Industry Classification System (NAICS) sectors
31 through 33; or
The facility is not located within any state of the United States, the District of Columbia, the
Commonwealth of Puerto Rico, Guam, American Samoa, the United States Virgin Islands, the
Northern Mariana Islands, or any other territory or possession over which the United States has
10. COST ACCOUNTING STANDARDS (CAS) NOTICES AND CERTIFICATIONS (FAR 52.230-1)
Note: This notice does not apply to small businesses, foreign governments or for the procurement
of commercial items.
CAS N/A: Small Business Foreign Govt. Providing Commercial items
This notice is in three parts, identified by Roman numerals I through III. Offerors shall examine each part and
provide the requested information in order to determine Cost Accounting Standard (CAS) requirements applicable to
any resultant contract.
I. DISCLOSURE STATEMENT - COST ACCOUNTING PRACTICES AND CERTIFICATION
Any contract in excess of $650,000 resulting from this solicitation will be subject to the requirements of the Cost
Accounting Standards board (48 CFR Chapter 99) except for those contracts which are exempt as specified in 48
CFR, Subpart 9903.201-1.
Any Offeror submitting a proposal which, if accepted, will result in a contract subject to the requirements of 48 CFR
Chapter 99 must, as a condition of contracting, submit a Disclosure Statement to the US Government as required by
48 CFR, Subpart 9903.202. The Disclosure Statement must be submitted at the time of the Offeror's proposal
submission under this solicitation unless the Offeror has already submitted a Disclosure Statement disclosing the
practices used in connection with the pricing of this proposal. If an applicable Disclosure Statement has already
been submitted, the Offeror may satisfy the requirement for submission by providing the information requested in
paragraph (c) of Part I of this provision.
F225-1 (08/18/2009) 11 of 15
CAUTION: In the absence of specific regulations or agreement, a practice disclosed in a Disclosure Statement shall
not, by virtue of such disclosure, be deemed to be a proper, approved, or agreed-to practice for pricing proposals or
accumulating and resorting contract performance cost data.
Check the appropriate box below:
a. Certificate of Concurrent Submission of Disclosure Statement.
The Offeror hereby certifies that, as a part of the offer, copies of the Disclosure Statement
have been submitted as follows:
Original and one copy to the cognizant Administrative Contracting Officer (ACO),
One copy to the cognizant contract auditor.
(Disclosure must be on Form No. CASB DS-1. Forms may be obtained from the cognizant
Date of Disclosure Statement:
Name and Address of Cognizant ACO where filed:
The Offeror further certifies that practices used in estimating costs in pricing this proposal
are consistent with the cost accounting practices disclosed in the Disclosure Statement.
b. Certificate of Previously Submitted Disclosure Statement.
The Offeror hereby certifies that Disclosure Statement was filed as follows:
Date of Disclosure Statement:
Name and Address of Cognizant ACO where filed:
The Offeror further certifies that practices used in estimating costs in pricing this proposal
are consistent with the cost accounting practices disclosed in the Disclosure Statement.
c. Certificate of Monetary Exemption.
The Offeror hereby certifies that the Offeror, together with all divisions, subsidiaries, and affiliates under
common control, did not receive net awards of negotiated prime contracts and subcontracts subject to CAS
totaling more than $50 million in the cost accounting period immediately proceeding the period in which this
proposal was submitted. The Offeror further certifies that if such status changes before an award resulting
from this proposal, the Offeror will advise CSC/the Contracting Officer immediately.
d. Certificate of Interim Exemption.
The Offeror hereby certifies that (i) the Offeror first exceeded the monetary exemption for disclosure, as
defined in (c) of this subsection, in the cost accounting period immediately preceding the period in which this
offer was submitted and (ii) in accordance with 48 CFR Subpart 9903.202-1, the Offeror is not yet required
to submit a Disclosure Statement. The Offeror further certifies that if an award resulting from this proposal
has not been made within 90 days after the end of that period, the Offeror will immediately submit a revised
certificate to CSC/the Contracting Officer, in the form specified under the statutes and regulations applying
to this provision, as appropriate, to verify submission of a completed Disclosure Statement.
CAUTION: Offerors currently required to disclose because they were awarded a CAS-covered prime
contract or subcontract of $50 million or more in the current cost accounting period may not claim this
exemption (d). Further, the exemption applies only in connection with proposals submitted before expiration
of the 90-day period following the cost accounting period in which the monetary-exemption was exceeded.
II. COST ACCOUNTING STANDARDS - ELIGIBILITY FOR MODIFIED CONTRACT COVERAGE
If the Offeror is eligible to use the modified provisions of 48 CFR, Subpart 9903.201-2(b) and elects to do so, the
Offeror shall indicate by checking the box below. Checking the box below shall mean that the resultant contract is
subject to the Disclosure and Consistency of Cost Accounting Practices clause in lieu of the Cost Accounting
The Offeror hereby claims an exemption from the Cost Accounting Standards Clause under the provisions of 48
CFR, Subpart 9903.201-2(b) and certifies that the Offeror is eligible for use of the Disclosure and Consistency of
Cost Accounting Practices clause because during the cost accounting period immediately preceding the period in
which this proposal was submitted, the Offeror received less than $50 million in awards of CAS-covered prime
contracts and subcontracts, or the Offeror did not receive a single CAS-covered award exceeding $1 million. The
Offeror further certifies that if such status changes before an award resulting from this proposal, the Offeror will
advice CSC/the Contracting Officer immediately.
F225-1 (08/18/2009) 12 of 15
CAUTION: An Offeror may not claim the above eligibility for modified contract coverage if this proposal is expected
to result in the award of a CAS-covered contract of $50 million or more or if, during its current cost accounting
period, the Offeror has been awarded a single CAS-covered prime contract or subcontract of $50 million or more.
III. ADDITIONAL COST ACCOUNTING STANDARDS APPLICABLE TO EXSITING CONTRACTS
The Offeror shall indicate below whether award of the contemplated contract would, in accordance with
subparagraph (a)(3) of the Cost Accounting Standards clause, require a change in established cost accounting
practices affecting existing contracts and subcontracts.
ADMINISTRATION OF COST ACCOUNTING STANDARDS (52.230-6)
For the purpose of administering the Cost Accounting Standards (CAS) requirements under this subcontract, the
Offeror shall take the steps outlined in (a) through (g) of this clause:
a. Submit to CSC or, at Offeror's option, to the Offeror's cognizant Administrative Contracting Officer a
description of any cost accounting practice change, the total potential impact of the change on contracts
containing a CAS clause, and, a general dollar magnitude of the change which identifies the potential shift of
costs between CAS covered contracts by contract type (i.e., firm-fixed-price, incentive, cost-plus-fixed-fee,
etc.) and other Offeror business activity. As related to CAS covered contracts, the analysis should identify
the potential impact on funds of the various Agencies/Departments (i.e., Department of Energy, National
Aeronautics and Space Administration, Army, Navy, Air Force, other Department of Defense, other
Government) as follows:
For any change in cost accounting practices required in accordance with subparagraph (a)(3) and
subdivision (a)(4)(i) of the clause at FAR 52.230-2, Cost Accounting Standards; or subparagraph
(a)(3) and subdivisions (a)(4)(i) or (a)(4)(iv) of the clause at FAR 52.230-5, Cost Accounting
Standards - Educational Institution; within 60 days (or such other date as may be mutually agreed to)
after award of a contract requiring this change.
For any change in cost accounting practices proposed in accordance with subdivision (a)(4)(ii) or (iii)
of the clauses at FAR 52.230-2, Cost Accounting Standards, and FAR 52.230-5, Cost Accounting
Standards - Educational Institution; or with subparagraph (a)(3) of the clause at FAR 52.230-3,
Disclosure and Consistency of Cost Accounting Practices, not less than 60 days (or such other date
as may be mutually agreed to) before the effective date of the proposed change.
For any failure to comply with an applicable CAS or to follow a disclosed practice (as contemplated by
subparagraph (a)(5) at FAR 52.230-2, Cost Accounting Standards, and FAR 52.230-5, Cost
Accounting Standards - Educational Institution; or by subparagraph (a)(4) at FAR 52.230-3,
Disclosure and Consistency of Cost Accounting Practices) within 60 days (or such other date as may
be mutually agreed to) after the date of agreement with the initial finding of noncompliance, or in the
event of Offeror disagreement with the initial finding of noncompliance, within 60 days of the date the
Offeror is notified by CSC/the Contracting Officer of the determination of noncompliance.
b. After an ACO (or cognizant Federal agency official) determination of materiality, submit a cost impact
proposal in the form and manner specified by CSC/the Contracting Officer within 60 days (or such other date
as may be mutually agreed to) after the date of determination of the adequacy and compliance of a change
submitted pursuant to paragraph (a) of this clause. The cost impact proposal shall be in sufficient detail to
permit evaluation, determination, and negotiation of the cost impact upon each separate CAS-covered
contract and subcontract.
Cost impact proposals submitted for changes in cost accounting practices required in accordance with
subparagraph (a)(3) and subdivision (a)(4)(i) of the clause at FAR 52.230-2, Cost Accounting
Standards; or subparagraph (a)(3) and subdivisions (a)(4)(i) or (a)(4)(iv) of the clause at FAR 52.230-
5 Cost Accounting Standards - Educational Institution; shall identify the applicable standard or cost
principle and all contracts and subcontracts containing the clauses entitled Cost Accounting
Standards or Cost Accounting Standards - Education Institution, which have an award date before the
effective date of that standard or cost principle.
Cost impact proposals submitted for any change in cost accounting practices proposed in
accordance with subdivisions (a)(4)(ii) or (iii) of the clauses at FAR 52.230-2, Cost Accounting
Standards, and FAR 52.230-5, Cost Accounting Standards - Educational Institution; or with
subparagraph (a)(3) of the clause at FAR 52.230-3, Disclosure and Consistency of Cost Accounting
Practices; shall identify all contracts and subcontracts containing the clauses at FAR 52.230-2, Cost
Accounting Standards, FAR 52.230-5, Cost Accounting Standards - Educational Institution, and FAR
52.230-3, Disclosure and Consistency of Cost Accounting Practices.
Cost impact proposals submitted for failure to comply with an applicable CAS or to follow a disclosed
practice as contemplated by subparagraph (a)(5) of the clauses at FAR 52.230-2, Cost Accounting
F225-1 (08/18/2009) 13 of 15
Standards, and FAR 52.230-5, Cost Accounting Standards - Educational Institution; or by
subparagraph (a)(4) of the clause at FAR 52.230-3, Disclosure and Consistency of Cost Accounting
Practices, shall identify the cost impact on each separate CAS covered contract from the date of
failure to comply until the noncompliance is corrected.
Alternate I (Apr 1996). As prescribed in 30.201-3(b), add the following subparagraph (c) (5) to Part I of the
* (5) Certificate of Disclosure Statement Due Date by Educational Institution. If the offeror is an educational
institution that, under the transition provisions of 48 CFR 9903.202-1(f), is or will be required to submit a
Disclosure Statement after receipt of this award, the offeror hereby certifies that (check one and complete):
* (i) A Disclosure Statement Filing Due Date of has been established with the cognizant Federal
* (ii) The Disclosure Statement will be submitted within the 6-month period ending months after
receipt of this award.
Name and Address of Cognizant ACO or Federal Official Where Disclosure Statement is to be filed:
c. If the submissions required by paragraphs (a) and (b) of this clause are not submitted within the specified
time, or any extension granted by CSC/the Contracting Officer, an amount not to exceed 10 percent of each
subsequent amount determined payable related to the Offeror's CAS covered prime contracts, up to the
estimated general dollar magnitude of the cost impact, may be withheld until such time as the required
submission has been provided in the form and manner specified by CSC/the Contracting Officer.
d. Agree to appropriate contract and subcontract amendments to reflect adjustments established in
accordance with subparagraphs (a)(4) and (a)(5) of the clauses at FAR 52.230-2 and 52.230-5; or with
subparagraphs (a)(3) or (a)(4) of the Disclosure and Consistency of Cost Accounting Practices clause at
e. For all subcontracts subject to the clauses at FAR 52.230-2, 52.230-3 or 52.230-5 -
So state in the body of the subcontract, in the letter of award, or in both (self-deleting clauses shall not
Include the substance of this clause in all negotiated subcontracts; and
Within 30 days after award of the subcontract, submit the following information to the Offeror's
cognizant contract administration office for transmittal to the contract administration office cognizant of
the subcontractor's facility:
- Subcontractor's name and subcontract number.
- Dollar amount and date of award.
- Name of Contractor making the award.
f. Notify CSC/the Contracting Officer in writing of any adjustments required to subcontracts under this contract
and agree to an adjustment, based on them, to this contract price or estimated cost and fee. This notice is
due within 30 days after proposed subcontract adjustments are received and shall include a proposal for
adjusting the higher tier subcontract or the prime contract appropriately.
g. For subcontracts containing the clauses at FAR 52.230-2 or 52.230-5, require the subcontractor to comply
with all Standards in effect on the date of award or of final agreement on price, as shown on the
subcontractor's signed Certificate of Current Cost or Pricing Data, whichever is earlier.
11. CONTRACTOR CODE OF BUSINESS ETHICS AND CONDUCT/DISPLAY OF HOTLINE POSTERS (FAR 52.203-
3 AND 52.203-14).
NOTE: This certification only applies to orders expected to exceed $5,000,000.00 and for a performance
period of 120 days or greater.
a. The Offeror hereby claims an exemption from the above referenced clauses because:
F225-1 (08/18/2009) 14 of 15
It is providing a commercial item as defined in FAR 2.101.
The work is being performed entirely outside the United States.
b. The Offeror hereby certifies that it meets the requirements as specified in the above referenced clauses.
F225-1 (08/18/2009) 15 of 15