Supplier is a nonresident foreign corporation, or foreign partnership that does not have income effectively connected with the conduct of a trade or business in the United States and does not have an office or place of business or a fiscal paying agent in the United States; Supplier is an agency or instrumentality of a foreign government; Supplier is an agency or instrumentality of the Federal Government. The Supplier, by checking the applicable box, represents that it operates as: a corporation incorporated under the laws of the State of , a sole proprietorship a government entity (Federal, State, or local) a foreign entity and if a corporation registered for business in (country) a partnership an International organization per 26 CFR 1.6049-4 or a venture between Supplier is not owned or controlled by a common parent as defined in paragraph (a) of this provision. Name and TIN of common parent: Name: TIN: 2. AFFILIATION IDENTIFYING A. If the Submitter is owned or controlled by a parent company, provide the following information: Name of Parent Company: Street Address: City/State/Zip: Parent Company Employer's Identification Number: B. If Submitter is not owned or controlled by a parent company, provide the following information: Submitter Employer’s Identification Number: Submitter DUNS Identification Number: NOTE: The Data Universal Numbering System (DUNS) is assigned by Dun and Bradstreet, Inc., and is contained in that company’s Data Universal Numbering System (DUNS). If the number is not known, it can be obtained from any Dun and Bradstreet branch office. The Supplier should not delay the submission of this form or its quotation/proposal pending receipt of its DUNS number. C. If the Submitter's facility has been approved to retain classified documents, provide the following information: Cognizant Government Security Office: Street Address: City/State/Zip: Submitter’s bid rates have been audited by DCAA: Yes No If yes, in accordance with FAR 32.503-3, submitter shall provide the following information:
Supplier is a nonresident foreign corporation, or foreign partnership that does not have income effectively connected with the conduct of a trade or business in the United States and does not have an office or place of business or a fiscal paying agent in the United States; Supplier is an agency or instrumentality of a foreign government; Supplier is an agency or instrumentality of the Federal Government. The Supplier, by checking the applicable box, represents that it operates as: a corporation incorporated under the laws of the State of , a sole proprietorship a government entity (Federal, State, or local) a foreign entity and if a corporation registered for business in (country) a partnership an International organization per 26 CFR 1.6049-4 or a venture between Supplier is not owned or controlled by a common parent as defined in paragraph (a) of this provision. Name and TIN of common parent: Name: TIN: 2. AFFILIATION IDENTIFYING A. If the Submitter is owned or controlled by a parent company, provide the following information: Name of Parent Company: Street Address: City/State/Zip: Parent Company Employer's Identification Number: B. If Submitter is not owned or controlled by a parent company, provide the following information: Submitter Employer’s Identification Number: Submitter DUNS Identification Number: NOTE: The Data Universal Numbering System (DUNS) is assigned by Dun and Bradstreet, Inc., and is contained in that company’s Data Universal Numbering System (DUNS). If the number is not known, it can be obtained from any Dun and Bradstreet branch office. The Supplier should not delay the submission of this form or its quotation/proposal pending receipt of its DUNS number. C. If the Submitter's facility has been approved to retain classified documents, provide the following information: Cognizant Government Security Office: Street Address: City/State/Zip: Submitter’s bid rates have been audited by DCAA: Yes No If yes, in accordance with FAR 32.503-3, submitter shall provide the following information:
ASC-SRC-01%20Rev%20F%20Annual%20Supplier%20Reps%20and%20Certs.docx