REPRESENTATIONS AND CERTIFICATIONS (Short Form)
(For Leases At or Below the Simplified Lease Acquisition Threshold)
Complete appropriate boxes, sign the form, and attach to offer.
Solicitation Number Dated
The Offeror makes the following Representations and Certifications. NO TE: The "Offeror," as used on this form, is the owner of the property offered, not an individual or agent representing the owner.
1. 52.219-1 -SMALL BUSINESS PROGRAM REPRESENTATIONS (APR 2011) (a) (1) The North American Industry Classification System (NAICS) code for this acquisition is 531190.
(2) The small business size standard is $20.5 Million in annual average gross revenue of the concern for the last 3 fiscal years.
(3) The small business size standard for a concern which submits an offer in its own name, other than on a construction or service contract, but which proposes to furnish a product which it did not itself manufacture, is 500 employees. (b) Representations.
(1) The offeror represents as part of its offer that it [ ] is, [X] is not a small business concern.
(2) [Complete only if the offeror represented itself as a small business concern in paragraph (b)(1) of this provision.] The offerer represents, for general statistical purposes, that it [ ] is, [ fis not, a small disadvantaged business concern as defined in 13 CFR 124.1002.
(3) [Complete only if the offeror represented itself as a small business concern in paragraph (b)(1) of this provision.] The offeror represents as part of its offer that it [ ] is, [ ] is not a women-owned small business concern.
(4) Women-owned small business (WOSB) concern eligible under the WOSB Program. [Complete only if the offeror represented itself as a women-owned small business concem in paragraph (b)(3) of this provision.] The offerer represents as part of its offer that-
(i) It [ ] is, [ ] is not a WOSB concern eligible under the WOSB Program, has provided all the required documents to the WOSB Repository, and no change in circumstances or adverse decisions have been issued that affects its eligibility; and
(ii) It [ ] is, [ ] is not a joint venture that complies with the requirements of 13 CFR part 127, and the representation in paragraph (b)(4)(i) of this provision is accurate in reference to the WOSB concern or concerns that are participating in the joint venture. [The offeror shall enter the name or names of the WOSB concern or concerns that are participating in the joint venture:
Each WOSB concern participating in the joint venture shall submit a separate signed copy of the WOSB representation.
(5) Economically disadvantaged women-owned small business (EDWOSB) concern. [Complete only if the offeror represented itself as a women-owned small business INITIALS: ______ & _____ _
LESSOR GOVERNMENT
GENERAL SERVICES ADMINISTRATION GSA 3518A (REV. 512013) EXHIBIT 3