Proposal Certification Form (Revised April 17, 2020)

The purpose of this checklist is to assist offerors with the completion of their proposal submissions to the National Institute of Aerospace’s (NIA) for requests for task order proposals under NASA Prime Contract No. NNL13AA08B. This checklist is also used to request additional information of the offeror, which will be needed to process the proposal. Offerors shall complete the checklist below, as an effort to ensure proposal compliance, and to submit the completed checklist along with the proposal submission to NIA.

Offeror’s Legal Name: _________________________________________________________

DUNS Number: _________________________ NIA Task Order #: ______________

Please check off each box as each proposal item is completed per the Request for Task Proposal and accompanying NIA Proposal Preparation Guidelines.

I. Technical Proposal: (reference the request for task order proposal for additional information)

Technical plan that sets forth the proposal’s approach and schedule for accomplishing the technical workas defined in the Government’s statement of work and per the NIA Proposal Preparation Guidelines.

Bio-sketches or short-form of resumes of key personnel are enclosed with the proposal’s technical plan.

Software Information – Have included applicable software information in the technical proposal as follows:

identified if non-commercial software will be required to support the proposed effort, and if so, has described the software and if the software is NASA-owned; identified if there will be any software developed to support the proposed effort; and if no software is needed, has noted it in the proposal.

Rights to Proposal Data – Please clearly identify any data or software that is being provided in the proposal with limited or restricted rights as defined by 52.227-14 Rights in Data – General. Per paragraph (g), please include the following statement in the proposal, with information completed as appropriate:

52.227-23 Rights to Proposal Data (Technical) (June 1987) Except for data contained on pages ______, it is agreed that as a condition of award of this task order, and notwithstanding the conditions of any notice appearing thereon, the Government shall have unlimited rights (as defined in the “Rights in Data-General” clause contained in this contract) in and to the technical data contained in the proposal dated __________________, upon which this contract/task order is based. (If applicable to this task order proposal, please fill in blanks as appropriate.)

Please note that if it is not specified that any data or software, per FAR Clause 52.227-23, then NIA will assume that the information is being provided with unlimited or unrestricted rights, per those definitions contained in FAR Clause 52.227-14.

II. Cost Proposal: (reference the request for task order proposal for additional information)

Cost proposal, based on a cost reimbursement type award, conforms to the NIA Proposal PreparationGuidelines, and includes both a:

line-item budget; and budget justification narrative.

Cost proposal is within the task order’s period of performance, estimated budget profile (if applicable), and if task performance crosses the Government’s fiscal years (October 1 – September 30), has separated the budget in accordance with fiscal years.

If cost proposal is over $750,000, a completed Certified Cost and Pricing Data is included with the cost proposal.

III. Organizational and Personal Conflict of Interest: (reference the requestfor task order proposal for additional information)

Completed and enclosed the NIA Organization Conflict of Interest Checklist form; completed form has been returned to NIA within 48 hours after receipt of the request for task order proposal

Completed and enclosed the NIA Subcontractor OCI/PCI Review and Certification form; completed form has been returned to NIA within 48 hours after receipt of the request for task order proposal

IV. Export Controls:

Addressed in the technical proposal if any element of what is being proposed is export controlled. Offerorunderstands that a subcontract will not be issued for the proposed effort until it has been determined ifthe work involves export controls (EAR or ITAR).

V. Personnel and Access Identification:

Offeror has fully completed the required four-page NIA Personnel and Access Identification form to identify all persons who will or may contribute to the technical execution of the identified project at any time andidentify if they will requirement access to non-public data, information, and/or assets in performance ofthe task order work. Any person requiring access to non-public information must include a documentedjustification for specific access.

Offeror certifies, by signing this document, that they understand they must conform with NASA ProceduralRequirements 1600.4 (NPR 1600.4 found at: https://nodis3.gsfc.nasa.gov/displayDir.cfm?Internal_ID=N_PR_1600_004A_&page_name=main andhttps://nodis3.gsfc.nasa.gov/NPR_attachments/N_AII_1600_004A.pdf).

Foreign nationals will require to be vetted and approved per NASA NPR 1600.4 before they are authorized to perform the proposed effort. Offeror understands that NASA’s vetting process can take as long as two weeks; however, if the foreign national is from a designated country, the vetting process may take longer than two weeks.

Offeror certifies they understand they are required to contact NIA if there is a change or the addition of personnel, including foreign national personnel, on all awarded task orders.

VI. Certifications and Other Information Provided as a Conditionof Award: (reference the request for task order proposal for additional information)

Registration in ‘SAM’ – or System for Award Management. SAM can be accessed athttps://sam.gov/SAM/. Registration in SAM requires a DUNS Number (Dunn and Bradstreet UniversalNumbering System). Please be aware NIA cannot issue a Subcontract without confirming SAM registration.

Insurance - Offeror certifies that they have obtained and maintain insurance coverage as per NASA FARClause 1852.228-75 “Minimum Insurance Coverage”.

NASA’s IT Security Awareness Training – Offeror understands that all subcontractor personnel requiringphysical or logical access to NASA IT resources are required to complete NASA’s annual IT SecurityAwareness training.

NASA Langley’s Travel Policies Required Prior Approval – Offeror understands that they are aware of allNASA Langley’s current travel policies, which will apply to all subcontracted work, as referenced at NPR9770.1 with regards to conference travel(https://nodis3.gsfc.nasa.gov/displayDir.cfm?t=NPR&c=9770&s=1) and NPR 9710.1, with regards to NASAgeneral travel policy, especially training requirements of chapter 7, entitled Foreign Travel(https://nodis3.gsfc.nasa.gov/displayDir.cfm?t=NPR&c=9710&s=1).

Protecting Government Interests Certification – I, ____________________ DO HEREBY CERTIFY ANDDECLARE that neither I nor the principals of the organization I represent are presently debarred, suspended or proposed for debarment, declared ineligible, or voluntarily excluded from participation in thistransaction by any Federal department or agency. (Please fill in name of person certifying and sign bottomof this form.)

By signing this Proposal Certification Form, I agree and certify that all the information provided within this document is true and accurate. In addition, Certifications and Other Information Provided as a “Condition of Award” is true and accurate.

Organization’s Authorized Representative:

__________________________________________________ Signature Date

__________________________________________________ Name and Title