Fillable Executive Compensation Certification (FAR 52.204-10) In accordance with (Johns Hopkins University Applied Physics Laboratory)

Fill Online, Printable, Fillable, Blank Executive Compensation Certification (FAR 52.204-10) In accordance with (Johns Hopkins University Applied Physics Laboratory) Form

Use Fill to complete blank online JOHNS HOPKINS UNIVERSITY APPLIED PHYSICS LABORATORY pdf forms for free. Once completed you can sign your fillable form or send for signing. All forms are printable and downloadable.

Executive Compensation Certification (FAR 52.204-10) In accordance with (Johns Hopkins University Applied Physics Laboratory)

On average this form takes 10 minutes to complete

The Executive Compensation Certification (FAR 52.204-10) In accordance with (Johns Hopkins University Applied Physics Laboratory) form is 2 pages long and contains:

  • 1 signature
  • 1 check-box
  • 35 other fields

Country of origin: US
File type: PDF

U.S.A. forms for Johns Hopkins University Applied Physics Laboratory

BROWSE JOHNS HOPKINS UNIVERSITY APPLIED PHYSICS LABORATORY FORMS
Fill has a huge library of thousands of forms all set up to be filled in easily and signed.
Fill in your chosen form
Sign the form using our drawing tool
Send to someone else to fill in and sign.
find another form
 
Rev. 02/2011
Executive Compensation Certification (FAR 52.204-10)
In accordance with Public Law 109-282 and FAR 52.204-10, Reporting Executive Compensation for First-Tier
Subcontract Awards (JUL 2010), you are required to provide certain information pertaining to compensation of
executives in order to be eligible for this subcontract award. Please answer the following question(s) in connection
with this requirement:
1. Did your organization in the previous tax year have gross income from all sources over $300,000?
Yes No
If you answered “No” to question 1 above, you are exempt from this reporting requirement. Please sign in the spaces
indicated below and return this certification to the cognizant APL procurement representative. If you answered “Yes,”
please complete Table I and answer the following questions:
2. Did your company receive 80% or more of its annual gross revenues from Federal contracts (and
subcontracts), loans, grants (and subgrants) and cooperative agreements in the preceding fiscal year?
Yes No
3. Did your company receive $25,000,000 or more in annual gross revenues from Federal contracts (and
subcontract), loans, grants (and subgrants) and cooperative agreements in the preceding fiscal year?
Yes No
4. Does the public NOT have access to information about the compensation of your company’s executives
through periodic reports filed under 13(a) or 15(d) of the Securities Exchange Act 0f 1934 (15 U.S.C.
78m(a), 78o(d)) or section 6104 of the Internal Revenue Code of 1986? (To determine if the public has
access to the compensation information, see the U.S. Security and Exchange Commission total
compensation filing at http://www.sec.gov/answers/execomp.htm.)
Yes No
If the answers to questions 2, 3 and 4 are all “Yes,” you are required to provide the names and total compensation of
each of the five most highly compensated executives in your organization as part of this certification, and on an annual
basis for the life of this subcontract. Provide this compensation information in Table II below. Please note that as
required by public law and FAR 52.204-10(b), APL will report this information to the government, and this
information will be made public. Further, please note your continuing obligation to immediately notify APL in writing
of any changes to previously reported data.
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.
Company: ________________________________________________________________
Signature: _________________________________________________________________
Printed Name: ____________________________________________________________
Title: ______________________________________________________________________
Date: ______________________________________________________________________
click to sign
signature
click to edit
Rev. 02/2011
Executive Compensation Certification (FAR 52.204-10)
Table I
Subcontractor DUNS Number
Subcontractor Parent Company DUNS Number
(if applicable)
Subcontractor Primary Address
Must Include nine-digit zip code and
Congressional district.
Primary Location for Performance of
Subcontract (if different from Primary
Address).
Must Include nine-digit zip code and
Congressional District.
North American Industry Classification System
(NAICS) code
Table II
Name
Total Compensation (as defined
in FAR 52.204-10(a))
Executive 1
Executive 2
Executive 3
Executive 4
Executive 5
Table III (For APL Internal Use Only)
Subcontract number
Amount of the subcontract award
Date of the subcontract award
A description of the products or services
being provided, including overall purpose
and expected results
The prime contract number
Awarding agency name and code
Funding agency name and code
Government contracting office code
Treasury Account Symbol (TAS) as
reported in FPDS
Download
Save PDF to desktop
Email
Email completed PDF
Send for Signing
Email for others to sign
Print
Print document
Choose a Field
Click on a field and
select the person that should complete it
Want to add a signature?
You can add a signature field
and assign it to someone else
to sign
Choose a Field
Click on a field and
select the person that should complete it

Executive Compensation Certification (FAR 52.204-10) In accordance with (Johns Hopkins University Applied Physics Laboratory)

This document is locked as it has been sent for signing.

You have successfully completed this document.

Other parties need to complete fields in the document. You will recieve an email notification when the document has been completed by all parties.

This document has been signed by all parties.

Completed 2 February 2021

Message

View Audit Log
Print With Audit Log
Duplicate Document