Department of Veterans Affairs, VA Medical Center (90C), 1100 N. College Avenue, Fayetteville, AR 72703

P -- WASTE SERVICES SOL RFQ 564-1-97 DUE 061397 POC Eleanor Dalmut, Contracting Officer, 501-444-5027 WEB: VAMC Fayetteville, AR., http://www.va.gov. E-MAIL: VAMC Fayetteville, AR., vpongonis@va.gov. PART IV OF RFQ 564-1-97 REPRESENTATIONS, CERTIFICATIONS & OTHER STATEMENT- 52.204-3 TAXPAYER IDENTIFICATION (MAR 1994) (a) Definitions "Common parent," as used in this solicitation provision, means that corporate entity that owns or controls an affiliated group of corporations that files its Federal income tax returns on a consolidated basis, and of which the offeror is a member. "Corporate status," as used in this solicitation provision, means a designation as to whether the offeror is a corporate entity, an unincorporated entity (e.g., sole proprietorship or partnership), or a corporation providing medical and health care services. "Taxpayer Identification Number (TIN)," as used in this solicitation provision, means the number required by the IRS to be used by the offeror in reporting income tax and other returns. (b) The offerors are required to submit the information required in paragraphs (c) through (e) of this solicitation provision in order to comply with reporting requirementsof 26 U.S.C. 6041, 6041A, and 6050M and implementing regulations issued by the Internal Revenue Service (IRS). If the resulting contract is subject to the reporting requirements described in FAR 4.903, the failure or refusal by the offeror to furnish the information may result in a 31 percent reduction of payments otherwise due under the contract. (c) Taxpayer Identification Number (TIN). ( ) TIN: __ __ __ __ __ ___ ( ) TIN has been applied for. ( ) TIN is not required because: ( ) Offeror is a nonresident alien, foreign corporation, or foreign partnership that does not have income effectively connected with the conduct of a trade or business in the U.S. and does not have an office or place of business or a fiscal paying agent in the U.S.: ( ) Offeror is an agency or instrumentality of a foreign government; ( ) Offeror is an agency or instrumentality of a Federal, state or local government; () Other. State basis.__ __ __ __ __ __ __ __. (d) Corporate Status. ( ) Corporation providing medical and health care services, or engaged in the billing and collecting of payments for such services; ( ) Other corporate entity; ( ) Not a corporate entity; ( ) Sole proprietorship ( ) Partnership ( ) Hospital or extended care facility described in 26 CFR 501(c)(3) that is exempt from taxation under 26 CFR 501(a). (e) Common Parent. ( ) Offeror is not owned or controlled by a common parent as defined in paragraph (a) of this clause. ( ) Name and TIN of common parent: Name __ __ __ __ __ __ __ ____ TIN __ __ __ __ __ __ __ ___ (End of provision) 52.215-6 TYPE OF BUSINESS ORGANIZATION (JUL 1987) The offeror or quoter, by checking the applicable box, represents that -- (a) It operates as [] a corporation incorporated under the laws of the State of __ __ __ __ __ __ __ __ ___, [] an individual, [] a partnership, [] a nonprofit organization, or [] a joint venture; or (b) If the offeror or quoter is a foreign entity, it operates as [] an individual, [] a partnership, [] a nonprofit organization, [] a joint venture, or [] a corporation, registered for business in __ __ __ __ __ __ __ __ ___. (country) (End of provision) 52.219-1 SMALL BUSINESS PROGRAM REPRESENTATIONS (JAN 1997) (a)(1) The standard industrial classification (SIC) code for this acquisition is 4953. (2) The small business size standard is $5.0 million. (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, [] is not a small business concern. (2) (Complete only if offeror represented itself as a small business concern in block (b)(1) of this section). The offeror represents as part of its offer that it [ ] is [ ] is not a small disadvantaged business concern. (3) (Complete only if offeror represented itself as a small business concern in block (b)(1) of this section.) The offeror represents as part of its offer that it [ ] is [ ] is not a women-owned small business concern. (c) Definitions. "Joint venture", for purposes of a small disadvantaged business (SDB) set-aside or price evaluation preference (as prescribed at 13 CFR 124.321) is a concern that is owned and controlled by one or more socially and economically disadvantaged individuals entering into a joint venture agreement with one or more business concerns and is considered to be affiliated for size purposes with such other concern(s). The combined annual receipts or employees of the concerns entering into the joint venture must meet the applicable size standard corresponding to the SIC code designated for the contract. The majority of the venture's earnings must accrue directly to the socially and economically disadvantaged individuals in the SDB concern(s) in the joint venture. The percentage of the ownership involvement in a joint venture by disadvantaged individuals must be at least 51 percent. "Small business concern", as used in this provision, means a concern, including its affiliates, that is independently owned and operated, not dominant in the field of operation in which it is bidding on Government contracts, and qualified as a small business under the criteria in 13 CFR Part 121 and the size standard in paragraph (a) of this provision. (0148)

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