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Provision of Hotel, Conference, and Restauration Services to the Soma Umenye project (All Provinces)

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Request for Quotations (RFQ)

RFQ Number:                                       SU 3072

Issuance Date:                                     July 21, 2020

Deadline for Expressions of

Interest and Questions:                      July 27, 2020

Deadline for Offers:                            August 7, 2020

Description:                                          Provision of Hotel, Conference, and Restauration Services to the Soma Umenye project (All Provinces)

For:                                                         Rwanda Soma Umenye Project/Chemonics Soma Umenye

Funded By:                                           United States Agency for International Development (USAID), Contract No. IDIQ Contract No. AID-OAA-I-14-00055, Task Order AID-696-TO-16-00001

Point of Contact:                                 SUProcurement@soma-umenye.org

Online Submissions:                            https://chemonics-soma-umenye.formstack.com/forms/soma_umenye_hotel_bpa

***** ETHICAL AND BUSINESS CONDUCT REQUIREMENTS *****

Chemonics is committed to integrity in procurement, and only selects suppliers based on objective business criteria such as price and technical merit. Chemonics expects suppliers to comply with our Standards of Business Conduct, available at https://www.chemonics.com/our-approach/standards-business-conduct/

Chemonics does not tolerate fraud, collusion among offerors, falsified proposals/bids, bribery, or kickbacks. Any firm or individual violating these standards will be disqualified from this procurement, barred from future procurement opportunities, and may be reported to both USAID and the Office of the Inspector General.

Employees and agents of Chemonics are strictly prohibited from asking for or accepting any money, fee, commission, credit, gift, gratuity, object of value or compensation from current or potential vendors or suppliers in exchange for or as a reward for a business. Employees and agents engaging in this conduct are subject to termination and will be reported to USAID and the Office of the Inspector General. In addition, Chemonics will inform USAID and the Office of the Inspector General of any supplier offers of money, fee, commission, credit, gift, gratuity, object of value, or compensation to obtain business.

Offerors responding to this RFQ must include the following as part of the proposal submission:

  • Disclose any close, familial, or financial relationships with Chemonics or project staff. For example, if an offeror’s cousin is employed by the project, the offeror must state this.
  • Disclose any family or financial relationship with other offerors submitting proposals. For example, if the offeror’s father owns a company that is submitting another proposal, the offeror must state this.
  • Certify that the prices in the offer have been arrived at independently, without any consultation, communication, or agreement with any other offeror or competitor for the purpose of restricting competition.
  • Certify that all information in the proposal and all supporting documentation are authentic and accurate.
  • Certify understanding and agreement to Chemonics’ prohibitions against fraud, bribery and kickbacks.

Please contact sblunden@soma-umenye.org with any questions or concerns regarding the above information or to report any potential violations. Potential violations may also be reported directly to Chemonics’ Washington office through the contact information listed on the website found at the hyperlink above.

Section 1:  Instructions to Offerors

  1. Introduction: The Rwanda Soma Umenye Project is a USAID program implemented by Chemonics International in Rwanda. The goal of the Soma Umenye is to improve reading outcomes in Kinyarwanda for at least 1 million children in public and government-aided schools in Rwanda. Specifically, Soma Umenye will target all children in Grades P1-P3 attending public and government-aided schools nationwide and ensure that at least 70 percent of students are able to read grade-level text with fluency and comprehension. As part of project activities, the Soma Umenye project requires a hotel, conference, and restoration services in all Rwandan Provinces.

The purpose of this RFQ is to solicit quotations from eligible suppliers for as-needed, ad hoc purchases of hotel, conference, and restoration services.  As a result of this RFQ, the Chemonics Soma Umenye Project anticipates issuing a blanket purchase agreement (BPA)—or possibly multiple BPAs—to establish specific pricing levels and parameters for ordering these commodities/services.  This will allow the Soma Umenye Project to issue specific purchase orders, on an as-needed basis, for the procurement of these supplies/services over the next 11 months.  The Supplier shall furnish the supplies/services described in any purchase orders issued by Chemonics under this BPA.  Chemonics is only obligated to pay for supplies/services ordered through purchase orders issued under this BPA and delivered by the Supplier in accordance with the terms/conditions of this BPA.

Offerors are responsible for ensuring that their offers are received by Chemonics in accordance with the instructions, terms, and conditions described in this RFQ. Failure to adhere with instructions described in this RFQ may lead to the disqualification of an offer from consideration.

  1. Offer Deadline and Protocol: Offers must be received no later than 5:00 PM local Rwandan time on August 7, 2020, through online submissions to the following link: https://chemonics-soma-umenye.formstack.com/forms/soma_umenye_hotel_bpa

Please reference the RFQ number in any response to this RFQ.  Offers received after this time and date will be considered late and will be considered only at the discretion of Chemonics.

If there are any issues with online submission, please contact SUProcurement@soma-umenye.org and reference the RFQ number above.

  1. Expressions of Interest and Questions: Expressions of Interest and questions regarding the technical or administrative requirements of this RFQ may be submitted no later than 5:00 PM local Rwandan time on July 27, 2020, 2020 by email to SUProcurement@soma-umenye.org.  Questions and requests for clarification—and the responses thereto—that Chemonics believes may be of interest to other offerors will be circulated to all RFQ recipients who have submitted an expression of interest. 

Only the written answers issued by Chemonics will be considered official and carry weight in the RFQ process and subsequent evaluation.  Any verbal information received from employees of Chemonics or any other entity should not be considered as an official response to any questions regarding this RFQ.

  1. Specifications: Section 3 contains the technical specifications of the items that may be ordered under the BPA. 
  2. Please note that, unless otherwise indicated, stated brand names or models are for illustrative description only.  An equivalent substitute, as determined by the specifications, is acceptable.

At this time, specific quantities to be purchased under any BPA resulting from this RFQ are unknown.  Specific quantities will depend on the needs of the Soma Umenye Project.  Individual purchase orders will be issued under the BPA agreement, as the need arises for additional supplies/services. 

  1. Quotations: The per-unit pricing in quotations in response to this RFQ must be priced on a fixed-unit-price, all-inclusive basis, including delivery and all other costs.  Pricing must be presented in Rwandan Francs.   Offers must remain valid for not less than ninety (90) calendar days after the offer deadline.  Prices quoted must remain fixed for a minimum of eleven (11) months.  Offerors are requested to provide quotations on official letterhead or quotation format; in the event this is not possible, offerors may complete the table in Section 3.

In addition, offerors responding to this RFQ are requested to submit the following:

  • Cover letter, signed by an authorized representative of the offeror (see Section 4 for template)
  • Official quotation, including specifications (see Section 3 for example format)
  • Copy of offeror’s registration or business license (see Section 1.5 for more details)
  • Copy of VAT certificate or tax clearance certificate
  • Copy of offeror’s certificate of classification issued by Rwanda Development Board (RDB)
  • List detailing the number of available facilities lodging units and conference rooms
  • Cancellation policy
  • Required certifications (see Section 5 for templates)
  1. Delivery: The delivery location for the items described in this RFQ is the hotel premises or on-site at a school or government office.  As part of its response to this RFQ, each offeror is expected to provide an estimate (in calendar days) of the delivery timeframe (after receipt of order).  The delivery estimate presented in an offer in response to this RFQ must be upheld in the performance of any resulting contract.
  2. Source/Nationality/Manufacture: All goods and services offered in response to this RFQ or supplied under any resulting award must meet USAID Geographic Code 935 in accordance with the United States Code of Federal Regulations (CFR), 22 CFR §228.  The cooperating country for this RFQ is Rwanda. 

Offerors may not offer or supply any supplies or services that are manufactured or assembled in, shipped from, transported through, or otherwise involving any of the following countries: Cuba, Iran, North Korea, Syria.

  1. Taxes and VAT: In accordance with the agreement under which this procurement is financed, Chemonics will be reimbursed by the Rwandan government for taxes imposed on suppliers and subcontractors.  Therefore, offerors must include taxes, VAT, charges, tariffs, duties, and levies in accordance with the laws of the Cooperating Country.  If selected for the award, the selected supplier will cooperate in providing Chemonics with the documentation necessary to obtain tax reimbursement.
  2. Eligibility: By submitting an offer in response to this RFQ, the offeror certifies that it and its principal officers are not debarred, suspended, or otherwise considered ineligible for an award by the U.S. Government.  Chemonics will not award a contract to any firm that is debarred, suspended, or considered to be ineligible by the U.S. Government.
  3. Evaluation and Award: The award will be made to a responsible offeror whose offer follows the RFQ instructions, meets the eligibility requirements, and meets or exceeds the minimum required technical specifications, and is judged to be the best value based on a lowest-price, technically acceptable basis. Please note that if there are significant deficiencies regarding responsiveness to the requirements of this RFQ, an offer may be deemed “non-responsive” and thereby disqualified from consideration. Chemonics reserves the right to waive immaterial deficiencies at its discretion.

Best-offer quotations are requested. It is anticipated that award will be made solely on the basis of these original quotations. However, Chemonics reserves the right to conduct any of the following:

  • Chemonics may conduct negotiations with and/or request clarifications from any offeror prior to award.
  • While preference will be given to offerors who can address the full technical requirements of this RFQ, Chemonics may issue a partial award or split the award among various suppliers, if in the best interest of the Soma Umenye Project.
  • Chemonics may cancel this RFQ at any time.
  • Chemonics may reject any and all offers, if such action is considered to be in the best interest of Chemonics.

In order for an entity to be considered technically acceptable, they must fulfil the following conditions:

Please note that in submitting a response to this RFQ, the offeror understands that USAID is not a party to this solicitation and the offeror agrees that any protest hereunder must be presented—in writing with full explanations—to the Soma Umenye Project for consideration, as USAID will not consider protests regarding procurements carried out by implementing partners.  Chemonics, at its sole discretion, will make a final decision on the protest for this procurement.

  1. Terms and Conditions: This is a Request for Quotations only.  Issuance of this RFQ does not in any way obligate Chemonics, the Soma Umenye Project, or USAID to make an award or pay for costs incurred by potential offerors in the preparation and submission of an offer. 

This solicitation is subject to Chemonics’ standard terms and conditions.  Any resulting award will be governed by these terms and conditions; a copy of the full terms and conditions is available upon request.  Please note the following terms and conditions will apply:

  • Chemonics’ standard payment terms are net 30 days after receipt and acceptance of any commodities or deliverables. Payment for purchase orders issued under any BPA resulting from this RFQ will only be issued to the entity submitting the offer in response to this RFQ and identified in the corresponding BPA award; payment will not be issued to a third party.
  • Any award resulting from this RFQ will be in the form of a Blanket Purchase Agreement (BPA). The Soma Umenye Project anticipates issuing a BPA (or multiple BPAs) under which specific purchase orders can be issued—on an as-needed basis—at the pricing levels established in the BPA.  When the need arises for the commodities/services described in the BPA, the Soma Umenye Project will issue a purchase order to the BPA-holder.  If there are multiple BPA-holders as a result of this RFQ, the purchase order will be issued to the BPA-holder that presents the best value for that specific order, based on price and delivery time. Any BPA issued as a result of this RFQ will have a minimum duration of at least 11 months.  The Supplier shall furnish the supplies/services described in any purchase orders issued by the Soma Umenye Project under the BPA.  The Soma Umenye Project is only obligated to pay for supplies/services to the extent purchase orders are issued under any BPA resulting from this RFQ.
  • No commodities or services may be supplied that are manufactured or assembled in, shipped from, transported through, or otherwise involving any of the following countries: Cuba, Iran, North Korea, Syria.
  • Any international air or ocean transportation or shipping carried out under any award resulting from this RFQ must take place on U.S.-flag carriers/vessels.
  • United States law prohibits transactions with, and the provision of resources and support to, individuals and organizations associated with terrorism. The supplier under any award resulting from this RFQ must ensure compliance with these laws.
  • The title to any goods supplied under any award resulting from this RFQ shall pass to Chemonics following delivery and acceptance of the goods by Chemonics. Risk of loss, injury, or destruction of the goods shall be borne by the offeror until title passes to Chemonics.

Section 2:  Offer Checklist

To assist offerors in preparation of proposals, the following checklist summarizes the documentation to include an offer in response to this RFQ:

  • Cover letter, signed by an authorized representative of the offeror (see Section 4 for template)
  • Official quotation, including specifications of offered equipment (see Section 3 for example format)
  • Copy of offeror’s registration or business license (see Section 1.5 for more details)
  • Copy of VAT certificate or tax clearance certificate
  • Copy of offeror’s certificate of classification issued by Rwanda Development Board (RDB)
  • List detailing the number of available facilities lodging units and conference rooms
  • Cancellation policy
  • Required certifications (see Section 5 for template)

 Section 3:  Specifications Technical Requirements and Pricing Schedule

The table below contains the list of supplies/services that may be ordered under the BPA mechanism.  Offerors are requested to provide per-unit quotations containing the information below on the official letterhead or official quotation format.  In the event this is not possible, offerors may complete this Section 3 and submit a signed/stamped version to Chemonics.

Description of services needed

Unit

Specifications

Unit Price (Rwf) inclusive of VAT

Lodging

1 -25 units**

Facilities

Mid-range room (with en suite bathroom) of adequate quality for hosting training participants and or gov’t officials with breakfast included. Must have internet connectivity with the capacity for video calls. Cost should include morning coffee/tea accompanied by light breakfast items, such as pastries or cookies

** Unit means the total number of nightly room reservations (for example, if 20 people stay for 5 nights this will mean 100 units)

 

26-50 units**

 

+51units**

 

Conference room

1-50 people per day

The capacity of up to 50 people with sound system, notebooks, pens, markers, scotch and projector/screen, internet connectivity with capacity for video calls, and flip chart stand.

 

51-100 people per day

The capacity of 51 - 100 people with sound system, notebooks, pens, markers, scotch and projector/screen, internet connectivity with capacity for video calls, and flip chart stand.

 

101-150 people per day

The capacity of 101 - 150 people with sound system, notebooks, pens, markers, scotch and projector/screen, internet connectivity with capacity for video calls, and flip chart stand.

 

151-200 people per day

The capacity of 150 - 200 people with sound system, notebooks, pens, markers, scotch and projector/screen, internet connectivity with capacity for video calls, and flip chart stand.

 

201 and above people per day

The capacity of 201 people and above with sound system, notebooks, pens, markers, scotch and projector/screen, internet connectivity with capacity for video calls, and flip chart stand.

 

Coffee/Tea/Refreshment Break

(within hotel/conference center)

Per Person

Includes coffee, tea, soda or natural juice with cookies, pastries, or other light snacks

 

Light Lunch

(within hotel/conference center)

Per Person

Small lunch, such as a sandwich, wrap, sambosa, etc. Should contain a protein (such a meat, fish, or chicken), vegetables, and a starch (bread, chapati, etc.), with a bottle of water.

 

Lunch

(within hotel/conference center)

Per Person

Buffet complete with varieties of a protein (such as meat, fish, or chicken), vegetables, and a starch (rice, potato, etc.), with a bottled soft drink

Non-alcoholic beverages at all meals

 

Dinner

(within hotel/conference center)

Per person

Buffet complete with varieties of a protein (such as meat, fish, or chicken), vegetables, and a starch (rice, potato, etc), with a bottled soft drink

Non-alcoholic beverages at all meals

 

Water

(within hotel/conference center)

Per bottle

500 ml bottle to be placed in the conference room

 

 

1

 

NA

 

1

 

NA

The hotel must not be a COVID-19 confinement center

1

The hotel must not be a COVID-19 confinement center

NA

 

Outside catering, within district capital

Coffee/Tea/Refreshment Break

(outside catering, within district capital)

Per Person

Includes coffee, tea, soda or natural juice with cookies, pastries, or other light snacks

(inclusive of travel and transport costs)

 

Light Lunch

(outside catering, within district capital)

Per Person

Small lunch, such as a sandwich, wrap, sambosa, etc. Should contain a protein (such a meat, fish, or chicken), vegetables, and a starch (bread, chapati, etc.), with a bottle of water.

(inclusive of travel and transport costs)

 

Lunch

(outside catering, within district capital)

Per Person

Buffet complete with varieties of a protein (such as meat, fish, or chicken), vegetables, and a starch (rice, potato, etc.), with a bottled soft drink

Non-alcoholic beverages at all meals

(inclusive of travel and transport costs)

 

Water

(outside catering, within district capital)

Per bottle

500 ml bottle to be placed in the conference room

 

(inclusive of travel and transport costs)

 

 

Outside catering, within the district

Coffee/Tea/Refreshment Break

(outside catering, within the district)

Per Person

Includes coffee, tea, soda or natural juice with cookies, pastries, or other light snacks

(inclusive of travel and transport costs)

 

Light Lunch

(outside catering, within the district)

Per Person

Small lunch, such as a sandwich, wrap, sambosa, etc. Should contain a protein (such a meat, fish, or chicken), vegetables, and a starch (bread, chapati, etc.), with a bottle of water.

(inclusive of travel and transport costs)

 

Lunch

(outside catering, within the district)

Per Person

Buffet complete with varieties of a protein (such as meat, fish, or chicken), vegetables, and a starch (rice, potato, etc.), with a bottled soft drink

Non-alcoholic beverages at all meals

(inclusive of travel and transport costs)

 

Water

(outside catering, within the district)

Per bottle

500 ml bottle to be placed in the conference room

(inclusive of travel and transport costs)

 

 The prices quoted above remain fixed for 11 months from the date of any resulting subcontract:

____Yes          ____No

Section 4:  Offer Cover Letter

The following cover letter must be placed on letterhead and completed/signed/stamped by a representative authorized to sign on behalf of the offeror:

To:                   Rwanda Soma Umenye Project

                        Umuyenzi Plaza, 2nd Floor

KN 5 RD

Remera, Kigali, Rwanda

Reference:       RFQ No. 3072

To Whom It May Concern:

We, the undersigned, hereby provide the attached offer to perform all work required to complete the activities and requirements as described in the above-referenced RFQ. Please find our offer attached.

We hereby acknowledge and agree to all terms, conditions, special provisions, and instructions included in the above-referenced RFQ. We further certify that the below-named firm—as well as the firm’s principal officers and all commodities and services offered in response to this RFQ—are eligible to participate in this procurement under the terms of this solicitation and under USAID regulations.

Furthermore, we hereby certify that to the best of our knowledge and belief:

  • We have no close, familial, or financial relationships with any Chemonics or Soma Umenye project staff members;
  • We have no close, familial, or financial relationships with any other offerors submitting proposals in response to the above-referenced RFQ; and
  • The prices in our offer have been arrived at independently, without any consultation, communication, or agreement with any other offeror or competitor for the purpose of restricting competition.
  • All information in our proposal and all supporting documentation is authentic and accurate.
  • We understand and agree to Chemonics’ prohibitions against fraud, bribery, and kickbacks.

We hereby certify that the enclosed representations, certifications, and other statements are accurate, current, and complete.

Authorized Signature:                                                                                                       

Name and Title of Signatory:                                                                                            

Date:                                                                                                                                 

Company Name:                                                                                                               

Company Address:                                                                                                                       

Company Telephone and Website:                                                                                               

Company Registration or Taxpayer ID Number:                                                               

Company DUNS Number:                                                                                                            

Does the company have an active bank account (Yes/No)?                                                         

Official name associated with bank account (for payment):                                                         

 Section 5:  Required Certifications                                                                                 

The following certifications must be completed and submitted in the Technical Volume:

Section 5-1:  Evidence of Responsibility Statement

Evidence of Responsibility Statement

This statement describes the offeror’s internal policies and procedures, as well as its ability to comply with the terms and conditions of a potential subcontract resulting from RFP No. SU-1923.  The offeror shall complete the information in this statement as part of its proposal.

Company Name:                                                                                                

  1. Authorized Negotiators

The offeror’s proposal in response to RFP No. SU-3059 may be discussed with any of the following individuals. These individuals are authorized to represent our company in negotiation of this proposal.

Names of authorized negotiator(s):                                                                                                                

These individuals can be reached at the following office:

Address:                                                                                                               

Telephone/Email:                                                                                               

  1. Adequate Financial Resources

We hereby certify that the above-named company maintains adequate financial resources to manage any subcontract resulting from this offer.

  1. Ability to Comply

We certify we are able to comply with the proposed schedule and period of performance, having taken into consideration all existing business commitments, commercial as well as governmental.

  1. Record of Performance, Integrity, and Business Ethics

Our record of integrity is outstanding.  We have no allegations of lack of integrity or of questionable business ethics. Our integrity can be confirmed by our Past Performance References, contained in the Technical Volume.

  1. Organization, Experience, Accounting and Operational Controls, and Technical Skills

Describe how the subcontract will be managed:                                                                                                   

  1. Equipment and Facilities

We maintain the necessary facilities and equipment to carry out the subcontract.

  1. Eligibility to Receive Award

We are qualified and eligible to receive an award under applicable laws and regulation.  In addition, we have performed similar work – describe:                                                                                                                              

  1. Acceptability of Subcontract Terms and Conditions

We have reviewed the solicitation document and attachments and agree to the terms and conditions set forth therein.

I hereby certify that the above statements are true and accurate, to the best of my knowledge.

Company Name:                                                                                                                                                                                  

                By (Signature): ___________________ Title: _____________________

Printed Name: ____________________ Date: _____________________

Section 5-2:  Certification and Disclosure Regarding Payment to Influence Certain Federal Transactions

Certification and Disclosure Regarding Payments to Influence Certain Federal Transactions (Sept 2007)

_________________________(hereinafter called the "offeror")

(Name of Offeror)

 (a) Definitions. As used in this provision—“Lobbying contact” has the meaning provided at 2 U.S.C. 1602(8).  The terms “agency,” “influencing or attempting to influence,” “officer or employee of an agency,” “person,” “reasonable compensation,” and “regularly employed” are defined in the FAR clause of this solicitation entitled “Limitation on Payments to Influence Certain Federal Transactions” (52.203-12).

(b) Prohibition. The prohibition and exceptions contained in the FAR clause of this solicitation entitled “Limitation on Payments to Influence Certain Federal Transactions” (52.203-12) are hereby incorporated by reference in this provision.

(c) Certification. The Offeror, by signing its offer, hereby certifies to the best of its knowledge and belief that no Federal appropriated funds have been paid or will be paid to any person for influencing or attempting to influence an officer or employee of any agency, a Member of Congress, an officer or employee of Congress, or an employee of a Member of Congress on its behalf in connection with the awarding of this contract.

(d) Disclosure. If any registrants under the Lobbying Disclosure Act of 1995 have made a lobbying contact on behalf of the Offeror with respect to this contract, the Offeror shall complete and submit, with its offer, OMB Standard Form LLL, Disclosure of Lobbying Activities, to provide the name of the registrants. The Offeror need not report regularly employed officers or employees of the Offeror to whom payments of reasonable compensation were made.

(e) Penalty. Submission of this certification and disclosure is a prerequisite for making or entering into this contract imposed by 31 U.S.C. 1352. Any person who makes an expenditure prohibited under this provision or who fails to file or amend the disclosure required to be filed or amended by this provision shall be subject to a civil penalty of not less than $10,000, and not more than $100,000, for each such failure.

(f) Should the Offeror’s circumstances change during the life of any resulting subcontract with respect to the above, the Offeror will notify the Buyer immediately.

 ___________________________________

Company Name:                                                                                                                

By (Signature): ___________________ Title: _____________________

Typed Name: ____________________ Date: _____________________

Section 5-3:  Subcontractor size self-certification form

Subcontractor Size Self-Certification Form

 Reference Number: [enter the funding agency's solicitation or contract number]

Project Name: [enter full name of project]

Primary NAICS Code: NA

Company Name: Full legal name                  

Address: Street address

City, State, Zip: City, State Zip

DUNS Number: [enter the Data Universal Numbering System (DUNS) here. Subcontractors must have a DUNS, unless exempted, as a part of receiving a  subcontract with Chemonics]. Contact Dun & Bradstreet through this webform to obtain a number: https://fedgov.dnb.com/webform.  

Contact Person: Name, Title

Contact Phone Number:

Type of Entity

If you have difficulty ascertaining the business size status, please refer to SBA’s website (www.sba.gov/size) or contact your local SBA office.

 Small Business  Large Business      Nonprofit/Educational    Government    Non-US

If “Small Business” is checked above, and if applicable, please identify any additional small business designations under which the company qualifies. You may wish to review the definitions for the below categories in the Federal Acquisition Regulation 19.7 or 52.219-8 (www.acquisition.gov/far/) to determine applicability.

 Small Disadvantaged Business                                                  8(a)

 HUBZone                                                                                         Woman Owned Small Business

 Veteran Owned                                                                               Service Disabled Veteran Owned

 Alaskan Native Corporation                                                         Indian Tribe

By signature below, I hereby certify that the business type and designation indicated above is true and accurate as of the date of execution of this document, and I further understand that under 15 U.S.C. 645(d), any person who misrepresents a business’ size status shall (1) be punished by a fine, imprisonment, or both; (2) be subject to administrative remedies; and (3) be ineligible for participation in programs conducted under the authority of the Small Business Act.

                                                                                                                                                                                               

Signature and Title (required)                                                                                                                           Date

Section 5-4:  FEDERAL FUNDING ACCOUNTABILITY AND TRANSPARENCY ACT (FFATA) SUBAWARD REPORTING QUESTIONNAIRE AND CERTIFICATION

In accordance with the Federal Funding Accountability and Transparency Act (FFATA), the information in this form is required to be reported by prime contractors through FAR 52.204-10 “Reporting Executive Compensation and First-Tier Subcontract Awards” for subawards valued at $30,000 and greater in the FFATA Subcontract Reporting System (FSRS.gov). As required by the referenced FAR, complete this questionnaire and certification as part of the Subcontractor Sub-Task Order with a value of $30,000 or more. Please review the Subcontractor Data included herein for accuracy and note any adjustments necessary. The Subcontractor is exempted from the FSRS.gov reporting in the case of a positive response to Section A.

Prime Contract: USAID PRIME CONTRACT NO. AID-OAA-I-14-00055

Insert Prime Contract Name: Chemonics Soma Umenye LLC

Insert Prime Contract Number/Task Order Number No. AID-696-TO-16-00001

Subcontractor Data

Insert Subcontractor Name:

Insert Subcontractor AddressLine1 :

Insert Subcontractor AddressLine2:

Insert Subcontractor City, Insert Subcontractor State in the USA, or Province/Other

Insert Subcontractor Zipcode or PostalCode Insert Subcontractor Country

Subcontract Number:

Start Date:

Subcontract Value:   

  1. In the previous tax year, was your company’s gross income from all sources under $300,000?

 Yes  No    

  1. If “No”, please provide the below information and answer the remaining questions.
  • Subcontractor DUNS Number: Insert DUNS on record
  • In your business or organization's preceding completed fiscal year, did your business or organization (the legal entity to which the DUNS number belongs) receive (1) 80 percent or more of its annual gross revenues in U.S. federal contracts, subcontracts, loans, grants, subgrants, and/or cooperative agreements; and (2) $25,000,000 or more in annual gross revenues from U.S. federal contracts, subcontracts, loans, grants, subgrants, and/or cooperative agreements?:

 Yes  No

  • Does the public have access to information about the compensation of the executives in your business or organization (the legal entity to which the DUNS number it provided belongs) through periodic reports filed under section 13(a) or 15(d) of the Securities Exchange Act of 1934 (15 U.S.C. 78m(a), 78o(d)) or section 6104 of the Internal Revenue Code of 1986?:

 Yes  No

  • Does your business or organization maintain a record in the System for Award Management (SAM.gov)?

 Yes  No     

  • If you have indicated “Yes” for paragraph (ii) and “No” for paragraph (iii) and (iv) above, provide the names and total compensation* of your five most highly compensated executives** for the preceding completed fiscal year.
  1. Name:______________________________________________________________

Amount:_____________________________________________________________

  1. Name:______________________________________________________________

Amount:_____________________________________________________________

  1. Name:______________________________________________________________

Amount:_____________________________________________________________

  1. Name:______________________________________________________________

Amount:_____________________________________________________________

  1. Name:______________________________________________________________

Amount:_____________________________________________________________

By signature below, I hereby certify that the information provided above is true and accurate as of the date of execution of this document, and I further understand that annual certification is required for information provided in paragraph (v) above.

                                                                                                                                                         

Signature and Title (required)                                                                                          Date

*“Total compensation” means the cash and noncash dollar value earned by the executive during the Subcontractor’s preceding fiscal year and includes the following (for more information see 17 CFR 229.402(c)(2)):

(1) Salary and bonus.

(2) Awards of stock, stock options, and stock appreciation rights. Use the dollar amount recognized for financial statement reporting purposes with respect to the fiscal year in accordance with the Financial Accounting Standards Board’s Accounting Standards Codification (FASB ASC) 718, Compensation-Stock Compensation.

(3) Earnings for services under non-equity incentive plans. This does not include group life, health, hospitalization or medical reimbursement plans that do not discriminate in favor of executives, and are available generally to all salaried employees.

(4) Change in pension value. This is the change in the present value of the defined benefit and actuarial pension plans.

(5) Above-market earnings on deferred compensation which is not tax-qualified.

(6) Other compensation, if the aggregate value of all such other compensation (e.g., severance, termination payments, the value of life insurance paid on behalf of the employee, perquisites or property) for the executive exceeds $10,000.

**” Executive” means officers, managing partners, or any other employees in management positions.