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U.S. Firm's Representations
U.S. Firm shall certify the following (or provide any explanation as to why any representation cannot be made):
U.S. Firm is a
Corporation LLC Partnership Sole Proprietor Other:
duly organized, validly existing and in good standing under the laws of the State of:
The U.S. Firm has all the requisite corporate power and authority to conduct its business as presently conducted, to submit this
proposal, and if selected, to execute and deliver a contract to the Grantee for the performance of the USTDA Activity. The U.S. Firm is not
debarred, suspended, or to the best of its knowledge or belief, proposed for debarment or ineligible for the award of contracts by any federal or
state governmental agency or authority.
The U.S. Firm has included herewith, a copy of its Articles of Incorporation (or equivalent charter or document issued by a designated authority in
accordance with applicable laws that provides information and authentication regarding the legal status of an entity) and a Certificate of Good
Standing (or equivalent document) issued within one (1) month of the date of signature
by the State of: 19.
The U.S. Firm commits to notify USTDA and the Grantee if it becomes aware of any change in its status in the state in which it is incorporated.
USTDA retains the right to request an updated certificate of good standing at any time. (U.S. publicly traded companies need not include Articles
of Incorporation or Certificate of Good Standing.)
Neither the U.S. Firm nor any of its directors and principal officers have, within the ten-year period preceding the submission of
these representations, been convicted of or had a civil judgment rendered against them for: commission of fraud or a criminal offen
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, forgery, bribery, falsificatio
n or destruction of records,
making false statements, tax evasion, violating state or federal criminal tax laws, or receiving stolen property.
Neither the U.S. Firm, nor any of its directors and principal officers, is presently indicted for, or otherwise criminally or civilly charged with,
commission of any of the offenses enumerated in paragraph C above.
There are no federal or state tax liens pending against the assets, property, or business of the U.S. Firm. The U.S. Firm has not, within the three-
year period preceding the submission of these representations, been notified of any delinquent federal or state taxes in an amount that exceeds
US$3,000 for which the liability remains unsatisfied. Taxes are considered delinquent if (a) the tax liability has been fully determined, with no
pending administrative or judicial appeals; and (b) a taxpayer has failed to pay the tax liability when full payment is due and required.
The U.S. Firm has not commenced a voluntary case or other proceeding seeking liquidation, reorganization, or other relief with respect to itself of
its debts under any bankruptcy, insolvency, or other similar law. The U.S. Firm has not had filed against it an involuntary petition under any
bankruptcy, insolvency, or any similar law.
The U.S. Firm certifies that it complies with the USTDA Nationality, Source, and Origin Requirements and shall continue to comply with such
requirements throughout the duration of the USTDA-funded activity. The U.S. Firm acknowledges that the USTDA Nationality, Source, and Origin
Requirements apply to the delivery of goods and professional services funded by USTDA, including, but not limited to the use of subcontractors.
The U.S. Firm commits to notify USTDA and the Grantee if it becomes aware of any change which might affect the U.S. Firm’s ability to meet the
USTDA Nationality, Source, and Origin Requirements.
Check to certify:
The U.S. Firm shall notify USTDA if any of the representations are no longer true, correct, and complete.
U.S. Firm certifies that the information provided in this form is true, correct, and complete. U.S. Firm understands and agrees that the U.S. Government may
rely on the accuracy of this information in processing a request to participate in a USTDA-funded activity. If at any time USTDA has reason to believe that any
person or entity has willfully and knowingly provided incorrect information or made false statements, USTDA may take action under applicable law. The
undersigned represents and warrants that he/she has the requisite power and authority to sign on behalf of the U.S. Firm.
22. Full Legal Name of U.S. Firm 24. Date
If U.S. Firm is Private or Other, please attach a copy of the U.S. Firm's Articles of Incorporation (or equivalent document) and
Certificate of Good Standing (or equivalent document).