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Certifications and
Representations
of Offerors Housing
Non-Construction Contract
U.S. Department of Housing
and Urban Development
Office of Public and Indian
OMA Approval No: 2577-0180 (oxp. 7/3046)
Public reporting burden for this collection of information is estimated to average § minutes per response, Including the time for reviewing instructions, searching
existing data sources, gathering and maintaining the data neaded, and completing and reviewing the collection of information.
This form includes clauses required by OMB's common rule on bidding/offering procedures, implamented by HUD in 24 CFR 86.36, and those requirements
set forth in Executive Order 11625 for small, minority, women-owned businesses, and certifications for independent price determination, and conflict of interest.
‘The form is required for nonconstruction contracts awarded by Housing Agencies (HAs). The form is used by bidders/offerars to certify to the HA's Contracting
Officer for contract compliance. If the form were not used, HAs would be unable to enforce their contracts. Responses to the collection of information are
required to obtain a benefit or to retain a benefit. The information requested does not lend itself to confidentiality.
1. Contingent Fee Representation and Agreement
(a) The bidder/offeror represents and certifies as part of its bid/
offer that, except for full-time bona fide employees working
solely for the bidder/offeror, the bidder/offeror:
qd) [ ] has, [ ] has not employed or retained any person or
company to solicit or obtain this contract; and
(2) [ ] has, [ ] has not paid or agreed to pay to any person
or company employed or retained to solicit or obtain this
contract any commission, percentage, brokerage, or other
fee contingent upon or resulting from the award of this
contract.
(b) If the answer to either (a)(1) or (a) (2) above is affirmative,
the bidder/offeror shall make an immediate and full written
disclosure to the PHA Contracting Officer.
(c) Any misrepresentation by the bidder/offeror shall give the
PHA the right to (1) terminate the resultant contract; (2) at its
discretion, to deduct from contract payments the amount of any
commission, percentage, brokerage, or other contingent fee; or
(3) take other remedy pursuant to the contract.
2. Small, Minority, Women-Owned Business Concern Rep-
resentation
The bidder/offeror represents and certifies as part of its bid/ offer
that it;
(a) [ jis, [ jis not a small business concem. "Small business
concern," as used in this provision, means a concern, includ-
ing its affiliates, that is independently owned and operated,
not dominant in the field of operation in which it is bidding,
and qualified as a small business under the criteria and size
standards in 13 CFR 121.
(b) [ Jis. [ jis not a women-owned small business
concern. "Women-owned," as used in this provision,
means a small business that is at least 51 percent owned
by a woman or women who are U.S. citizens and who also
control and operate the business.
() [ jis, [ lis not a minority enterprise which, pursuant to
Executive Order 11625, is defined as a business which is at
least 51 percent owned by one or more minority group
members or, in the case of a publicly owned business, at least
51 percent of its voting stock is owned by one or more
minority group members, and whose management and daily
operations are controlled by one or more such individuals.
For the purpose of this definition, minority group members are:
(Check the block applicable to you)
[ ] Black Americans [ ] Asian Pacific Americans
[ ] Hispanic Americans [ ] Asian Indian Americans
[ ] Native Americans [ ] Hasidic Jewish Americans
3. Certificate of Independent Price Determination
(a) The bidder/offeror certifies that-
(1) The prices in this bid/offer have been arrived at indepen-
dently, without, for the purpose of restricting competi-
tion, any consultation, communication, or agreement
with any other bidder/offeror or competitor relating to ()
those prices, (ii) the intention to submit a bid/offer, or
(iii) the methods or factors used to calculate the prices
offered;
(2) The prices in this bid/offer have not been and will not be
knowingly disclosed by the bidder/offeror, directly or
indirectly, to any other bidder/offeror or competitor be-
fore bid opening (in the case of a sealed bid solicitation)
or contract award (in the case of a negotiated solicitation)
unless otherwise required by law; and
(3) No attempt has been made or will be made by the bidder/
offeror to induce any other concern to submit or not to
submit a bid/offer for the purpose of restricting competition.
(b) Each signature on the bid/offer is considered to be a certifi-
cation by the signatory that the signatory:
(1) Is the person in the bidder/offeror’s organization respon-
sible for determining the prices being offered in this bid
or proposal, and that the signatory has not participated
and will not participate in any action contrary to subpara-
graphs (a)(1) through (a)(3) above; or
(2) (i) Has been authorized, in writing, to act as agent for the
following principals in certifying that those principals
have not participated, and will not participate in any
action contrary to subparagraphs (a)(1) through (a)(3)
above (insert full name of person(s) in the bidder/offeror’s
organization responsible for determining the prices of-
fered in this bid or proposal, and the title of his or her
position in the bidder/offeror s organization);
(ii) As an authorized agent, does certify that the princi-
pals named in subdivision (b)(2)(i) above have not par-
ticipated, and will not participate, in any action contrary
to subparagraphs (a)(1) through (a)(3) above; and
Previous edition is obsolete
Financial Operations, IC & RA Review
RFP# FOICRAR-08-26
page 1 of 2
form HUD-§369-C (8/93)
ref. Handbook 7460.8
Initial:
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