(9)
Employer Identification Number (EIN), if registered: __________________
(10)
DUNS or DUNS+4 Number (if registered): ________________________
(11)
CAGE or NCAGE Code (if registered):
(12)
State(s) Vendor is authorized to do business in:
(b)
Conduct. The Vendor hereby certifies that the following is true information about the
Vendor and its owners, directors, and principal officers:
(1)
has been barred or suspended for an award of a federal, state or local
government contract or subcontract.
Yes No If Yes, please attach explanation.
(2)
has been listed with Exclusions in the System for Award Management
(https://www.
sam.gov).
Yes No If Yes, please attach explanation.
(3)
has been convicted of or had a civil judgment rendered against it, within a five-
year period preceding the date of this Agreement, for the:
(A)
commission of fraud or a criminal offense in connection with
obtaining, attempting to obtain or performing any contract or
subcontract;
(B) violation of a confidentiality agreement or intellectual property laws;
(C) commission of embezzlement, theft, forgery, bribery, falsification or
destruction of records, making false statements or receiving stolen
property.
Yes No If Yes, please attach explanation.
(4)
a "foreign principal" or an "agent of a foreign principal " (as defined in § 1 of the
Foreign Agents Registration Act of 1938)
2
is either (A) a principal officer
2
Section I (b)-(c) of the Foreign Agents Registration Act of 1938 provides that:
(b)
The term "foreign principal" includes -
(1)
a government of a foreign country and a foreign political party;
(2)
a person outside of the United States, unless it is established that such person is an individual and a
citizen
of and domiciled with in the United States, or that such person is not an individual and is organized under or
created by the laws of the United States or of any State or other place subject to the jurisdiction of the United States
and has its principal place of business within the United States; and
(3)
a partnership, association, corporation, organization, or other combination of persons organized
under the laws of or having its principal place of business in a foreign country.
(c)
Expect [sic.] as provided in subsection (d) of this section, the term "agent of a foreign principal
"
means -
(
1
) any person who acts as an agent, representative, employee, or servant, or any person who acts in
any
other capacity at the order, request, or under the direction or control, of a foreign principal or of a
person
any of whose activities are directly or indirectly supervised, directed, controlled, financed, or subsidized in
whole or in major part by a foreign principal
,
and who directly or through any other
person -
(i)
engages within the United States in political activities for or in the interests of such foreign
principal ;
(ii)
acts within the United States as a public relations counsel, publicity agent, information-
service employee or political consultant for or in the interests of such foreign principal ;
(iii)
within the United States solicits, collects, disburses, or dispenses contributions, loans,
money, or other things of value for or in the interest of such foreign principal; or