INFORMATION REQUIRED TO ESTABLISH CONTRACTUAL RELATIONSHIP

• Document Type: FOIA
• Keywords: CONTRACTS
• Keywords: GOOGLE INC
• Collection: FOIA Collection
• Document Number (FOIA) /ESDN (CREST): 0001487886
• Release Decision: RIPPUB
• Original Classification: U
• Document Page Count: 14
• Document Creation Date: June 22, 2015
• Document Release Date: September 29, 2008
• Case Number: F-2007-00886
• Publication Date: May 27, 2004

FOR INFORMATION, CALL:
FAX NUMBER:
(b) (3)
(b) (6)
? 1990 by John Caldwell. Used with permission from FAX THlS BOOK, Workman Publishing.
 Washington, bC 20505
27 May 2004
Google Inc.
1600 Amphithratre Way
Mountain View, CA
ATTN: Andrew McLaughlin
SUBJECT: Information Required to Establish Contractual Relationship
Dear Mr. McLaughlin:
As you are aware, our organization wishes to do business with your
company. We are currently in receipt of your Certificate Pertaining to Foreign
Interests. However, we need some additional information to "set" your company
up as a vendor within our organization. Please complete the attached forms
which included: Request for New Vendor, Electronic and finally information, Key Management Personnel
List
Offeror Representations and Certifications - Commercial Items. If you have any
questions, please email me at You may fax the information
back to me at . Thank you in a vance for your cooperation.
Sincerely,
Contracting Officer
 REQUEST FOR NEW VENDOR (COMMERCIAL)
WITH ALL ASPECTS UNCLASSIFIED
1. DUNN AND BRADSTREET NUMBER:
TAX I.D. NUMBER:
2. NAME OF FIRM:
3. FACILITY ADDRESS:
4. CITY: STATE ZIP
(CHECK ONE)
5. COMPANY TYPE:
C. = US Corporation
S = US Sole Proprietorship
P = US Partnership
X = Foreign Owned Corporation
Y = Foreign Owned Sole Proprietorship
Z = Foreign Owned Partnership
U = University/Foundation
O = Other Government Agency
I = Independent Contractor
N = Non-Profit
6. BUSINESS SIZE: (CHECK ONE).
S = Small Business
L = Large Business
7. BUSINE`SSaCATEGORY: (CHECK ONE IF APPLICABLE)
D Disadvantage/Minority
W Women-owned
8a
8. NAME OF PARENT:
9. ADDRESS OF PARENT:
REMITTANCE ADDRESS
(If Different From Vendor Facility Address)
1. NAME OF PAYEE:
2. .. ADDRESS FOR PAYMENT:
3. CITY STATE ZIP____
 ELECTRONIC FUNDS TRANSFER (EFT)
INFORMATION
NOTE: ALL PAYMENTS ARE MADE VIA ELECTRONIC FUNDS TRANSFER (EFT) -
FAILURE TO PROVIDE EFT INFORMATION MAY RESULT IN SEVERE DELAYS IN
INVOICE PAYMENT.
NAME OF THE FINANCIAL INSTITUTION TO RECEIVE PAYMENT FOR YOUR
COMPANY:
COMPLETE ADDRESS OF THE FINANCIAL INSTITUTION:
FINANCIAL INSTITUTIONS NINE-DIGIT ABA ROUTING NUMBER:
CONTRACTORS. ACCOUNT NUMBER TO BE CREDITED WITH FUNDS:
TYPE OF ACCOUNT AT THE FINANCIAL INSTITUTION:
CHECKING SAVINGS
NAME, TITLE AND TELEPHONE NUMBER OF COMPANY CONTRACT PERSON:
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 52.212-3 Offeror Representations and Certifications-Commercial items .
(JUL 2002)
(a) Definitions. As used in this provision:
"Emerging small business" means a small business concern whose size is no greater
than 50 percent of the numerical size standard for the NAICS code designated.
"Forced or indentured child labor" means all work or service-
(1) Exacted from any person under the age of 18 under the menace of
any penalty for its nonperformance and for which the worker does not
offer himself voluntarily; or
(2) Performed by any person under the age of 18 pursuant to a contract
the enforcement of which can be accomplished by process or penalties.
"Service-disabled veteran-owned small business concern"-
(1) Means a small business concern-
(i) Not less than 51 percent of which is owned by one or more
service-disabled veterans or, in the case of any publicly owned
business, not less than 51 percent of the stock of which is owned
by one or more service-disabled veterans; and
(ii) The management and daily business operations of which are
controlled by one or more service-disabled veterans or, in the
case of a veteran with permanent and severe disability, the
spouse or permanent caregiver of such veteran.
;(2), Service-disabled veteran means a veteran, as defined in 38 U.SC.
101(2), with a disability that is service-connected, as defined in 38 U.S.C.
10,(16).
"Small business concern" 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 size standards in this solicitation.
"Veteran-owned small business concern" means a small business concem-
(1) Not less than 51 percent of which is owned by one or more veterans
(as defined at 38 U.S.C. 101(2)) or, in the case of any publicly owned
business, not less than 51 percent of the stock of which is owned by one
or more veterans; and
(2) The management and daily business operations of which are
controlled by one or more veterans.
"Women-owned business concern" means a concern which is at least 51 percent owned
by one or more women; or in the case of any publicly owned business, at least 51
percent of its stock is owned by one or more women; and whose management and daily
business operations are controlled by one or more women.
 "Women-owned small business concern" means a small business concern-
(1) That is at least 51 percent owned by one or more women; or, in the
case of any publicly owned business,: at least 51 percent of the stock of
which is owned by one or more women;: and
(2) Whose management and daily business operations are controlled by
one or more women.
(b) Taxpayer Identification Number (TIN) (26 U.S.C. 6109, 31 U.S.C. 7701). (Not
applicable if the offeror is required to provide this information to a central
contractor registration database to be eligible for award.)
(1) All offerors must submit the information required in paragraphs (b)(3)
through (b)(5) of this provision to comply with debt collection
requirements of 31 U.S.C. 7701(c) and 3325(d), reporting requirements
of 26 U.S.C. 6041, 6041 A, and 6050M, and implementing regulations
issued by the Internal Revenue Service (IRS).
(2) The TIN may be used by the Government to collect and report on any
delinquent amounts arising out of the offerors relationship with the
Government (31 U.S.C. 7701 (c)(3)). If the resulting contract is subject to
the payment reporting requirements described in FAR 4.904, the TIN
provided hereunder may be matched with IRS records to verify the
accuracy of the offeror's TIN.
(3) 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 United
States and does not have an office- or place of business or a fiscal paying agent in the
United States;
[ ] Offeror is an agency or instrumentality of a foreign government;
[ ] Offeror is an agency or instrumentality of the Federal Government.
(4) Type of organization.
[ ] Sole proprietorship;
[ ] Partnership;
[ J Corporate entity (not tax-exempt);
[ ] Corporate entity (tax-exempt);
[ ] Government entity (Federal, State, or local);
[ ] Foreign government;
[ ] International organization per 26 CFR 1.60494;
[ ] Other [ ].
(5) Common parent.
 [ } Offeror is not owned or controlled by a common parent,
[ ] Name and TIN of common parent:
(] Name [ ].
[ } TIN [].
(c) Offerors must complete the following representations when the resulting
the Trust United States, its territories or
contract to be performed
of the Pacific Islands, or the District
possessions, Puerto o Rico,
of Columbia. Check all that apply.
(1) Small business concern. The offeror represents as part of its offer that
it [ ] is, [ ] is not a small business concern.
(2) Veteran-owned small business concern:' [Complete only if the offeror
represented itself as a small business concern in paragraph (c)(1) of this
provision.] The offeror represents as part of its offer that it [ ] is, [ ] is not
a veteran-owned small business concern.
(3) Service-disabled veteran-owned small
small boos Hess
only if the offeror represented itself as a veteran
concern io paragraph (c)(2) of this provision.] The offeror represents as
part of its offer that it [ ] is, [ ] is not a service, disabled veteran-owned
small business concern.
(cthe offeror
(4) Small disadvantaged business concern. in [Complete,
)(1) of this
represented itself as a small business concern paragraph
provision.] The offeror represents, for general statistical'purposes, that it [
] is, [ ] is not a small disadvantaged business concern as defined in 13
CFR 124.1002.
(5) Women-owned small business concern. [Complete only if the offeror of this
represented itself as a small business concern in paragraph (c)(1)
provision.] The offeror represents that it [ ] is, [ ] is not a women-owrtd
small business concern.
Note: Complete paragraphs (c)(6) and (c)(7) only if this solicitation is expected to
exceed the simplified acquisition threshold.
(6) Women-owned business concern (other than small business
concern). [Complete only if the offeror is a women-owned business
concern and did not represent itself as a small business concern in
paragraph (c)(1) of this provision.] The offeror represents that it [ ] is a
women-owned business concern.
(7) Tie bid priority for labor surplus area concerns. If this is an invitation
for bid, small business offerors may identify the labor surplus areas in
which costs to be incurred ractorso~to moret than 50 percent tof the
offeror or first-tier subcontractors) amount
contract price: [ ]
(8) Small Business Size for the Small Businesk Competitiveness
Demonstration Program and for the Targeted Industry Categories under
the Small Business Competitiveness Demonstration Program. [Complete
only if the offeror has represented itself to be a small business concern
under the size standards. for this solicitation.]
 (i) [Complete only for solicitations indicated in an addendum as
being set-aside for emerging small businesses in one of the four
designated industry groups' (DIGs).] The offeror represents as
part of its offer that it [I is, [ ] is not an emerging small business.
(ii) [Complete only for solicitations indicated in an addendum as
being for one of the targeted industry categories (TICs) or four
designated industry groups (DIGS).] Offeror represents as follows:
(A) Offeror's number of employees for the past 12 months
(check the Employees column if size standard stated in the
solicitation is expressed in terms of number of employees);
(B) Offerors average annual gross revenue for the last 3
fiscal years (check the Average Annual Gross Number of
Revenues column if size standard stated in the solicitations
is expressed in terms of annual receipts).
(Check one of the following):
Average Annual Gross Revenues
Number of Employees
50 or fewer
51-100\.
L] 101-250
L] 251-500
L] 501-750
L] 751-1,000
[_] Over 1,000
$1' million or less
L] $1,000,001-$2 million
$2,000,001-$3.5 million
$3,500,001-$5 million
$5,000,001-$10 million
L] $1Q,000,001-$17 million
L] Over $17 million
(9) [Complete only if the solicitation contains the clause at FAR 52.2-19-
23; Notice of Price Evaluation Adjustment for Small Disadvantaged
Business Concerns, or FAR 52.219-25, Small Disadvantaged Business
Participation Program-Disadvantaged Status and Reporting, and the
offeror desires a benefit based on its disadvantaged status.]
(i) General. The offeror represents that either-
(A) It [ ] is, [ ] is not certified by the. Small Business
Administration as a small disadvantaged business concern
and identified, on the date of this representation, as a
certified small disadvantaged business concern in the
database maintained by the Small Business Administration
(PRO-Net), and that no material change in disadvantaged
ownership and control has occurred since its certification,
and, where the concern is owned by one or more
individuals claiming disadvantaged status, the net worth of
each individual upon whom the certification is based does
not exceed $750,000 after taking into account the
applicable exclusions set forth at 13 CFR 124.104(c)(2); or
(B) It [ ] has, [ ] has not submitted a completed application
to the Small Business Administration or a Private Certifier
to be certified as a small disadvantaged business concern
 in accordance with 13 CFR 124, Subpart B, and a decision
on that application is pending, and that no material change
in disadvantaged ownership and control has occurred
since its application was submitted.
(ii). [ ] Joint Ventures under the Price Evaluation Adjustment for
Small Disadvantaged Business Concerns. The offeror represents,
as part of its offer, that it is a joint venture that complies with the
requirements in 13 CFR 124.1002(f) and that the representation in
paragraph (c)(9)(i) of this provision is accurate for the small
disadvantaged business concern that is participating in the joint
venture. [The offeror shall enter the name of the small
disadvantaged business concern that is participating in the joint
venture: [ ]
(10) HUBZone small business concern. [Complete only if the offeror
represented itself as a small business concern in paragraph (c)(1) of this
provision.] The offeror represents, as part of its offer, that-
(i) It [ ] is, [ ] is not a HUBZone small business concern listed, on
th(p date of this representation, on the List of Qualified HUBZone
Small Business Concerns maintained by the Small Business
Administration, and no material change in ownership and control,
principal office, or HUBZone employee percentage has occurred
since it was certified by the Small Business Administration in
accordance with 13 CFR part 126;. and
(ii) It [ ] is, [ ]. is not 4 -Joint venture that complies with the
requirements of 13 CFR part 126, and the representation in
paragraph (c)(1 0)(i) of this provision is accurate for the HUBZone
small business concern or concerns that are participating in the
joint venture. [The offeror shall enter the name or names of the
HUBZone small business concern or concerns that are
participating in the joint venture: .] Each HUBZone
small business concern participating in the joint venture shall
submit a separate signed copy of the HUBZone representation.
(d) Representations required to implement provisions of Executive Order 11246-
(1) Previous contracts and compliance. The offeror represents that-
(i) It [ ] has, [ ] has not participated in arpuei previous contract or
subcontract subject to the Equal Opportunity clause
solicitation; and
(ii) It [ ] has, [ ] has not filed all required compliance reports.
(2) Affirmative Action Compliance. The offeror represents that-
(i) It [ ] has developed and has on file, (] has not developed and
does not have on file, at each establishment, affirmative action
programs required by rules and regulations of the Secretary of
Labor (41 CFR parts 60-1 and 60-2), or
 (ii) It [ ] has not previously had contracts subject to the written
affirmative action programs requirement of the rules and
regulations of the Secretary of Labor.
(e) Certification Regarding Payments to Influence Federal Transactions (31
U.S.C. 1352). (Applies only if the contract is expected to exceed $100,000.) By
submission of its offer, the offeror 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 his or her behalf in connection with the award of any
resultant contract.
(f) Buy American Act Certificate. (Applies only if the clause at Federal Acquisition
I A A
's
th
i
i
Regulation (FAR) 52.225-1, Buy American Act-Supplies, is inc u e n
solicitation.)
(1) The offeror certifies that each end product, except those listed in
paragraph (f)(2) of this provision, is a domestic end product as defined in
the clause of this solicitation entitled "Buy American Act- Supplies" and
that the offeror has considered components of unknown origin to have
been mined, produced, or manufactured outside the United States. The
offeror shall list as foreign end products those end products
manufactured in the United States that do not qualify as domestic end
products.
(2) Foreign End Products:
Line Item No. Country of Origin
[List as necessary]
(3) The Government will evaluate offers in accordance with the policies
land procedures of FAR Part 25.
(g)(1) Buy'American Act-North American Free Trade Agreement-Israeli Trade
Act- Certificate. (Applies only if the clause at FAR 52.225-3, Buy American Act-
NorttrAmerican Free Trade Agreement-Israeli Trade Act, is included in this
solicitation.)
(i) The offeror certifies that each end product, except those listed
in paragraph (g)(1)(ii) or (g)(1)(iii) of this provision, is a domestic
end product as defined in the clause of this solicitation entitled
"Buy American Act-North American Free Trade Agreement-Israeli
Trade Act" and that the offeror has considered components of
unknown origin to have been mined, produced, or manufactured
outside the United States.
(ii) The offeror certifies that the following supplies are NAFTA
country end products or Israeli end products as defined in the
clause of this solicitation entitled "Buy American Act-North
American Free Trade Agreement-Israerr Trade Act":
NAFTA Country or Israeli End Products:
Line Item No. Country of Origin
[List as necessary]
 (iii) The offeror shall list those supplies that are foreign end
products (other than those listed in paragraph (g)(1)(ii) of this
provision) as defined in the clause of this solicitation entitled "Buy
American Act-North Americarr Free Trade Agreement-Israeli
Trade Act." The offeror shall list as other foreign end products
those end products manufactured in the United States that do not
qualify as domestic end products.
Other Foreign End Products:
Line Item No. Country of Origin
[List as necessary]
(iv) The Government will evaluate offers in accordance with the
policies and procedures of FAR Part 25.
(2) Buy American Act-North American Free Trade Agreements-Israeli
Trade Act Certificate, Alternate I (May 2002). If Alternate I to the clause
at FAR 52.225-3 is included in this solicitation, substitute the following
paragraph (g)(1)(ii) for paragraph (g)(1)(ii) of the basic provision:
(9)(1)(ii) The offeror certifies that the following supplies are Canadian end
products as defined in the clause of this solicitation entitled "Buy American Act--
NortlAmerican Free Trade Agreement--Israeli Trade Act":
Canadian End Products:
Line Item No.
[List as necessary]
(3) Buy American Act-North American Free Trade Agreements-Israeli
,Trade Act Certificate, Alternate II (May 2002). If Alternate 11 to the clause
at FAR 52.225-3 is included in this solicitation, substitute the following
paragraph (g)(1)(ii) for paragraph (g)(1)(ii) of the basic provision:
(g)(1)(ii) Th'e offeror certifies that the following supplies are Canadian end
products or Israeli end products as defined in the clause of this solicitation
entitled "Buy American Act--North American Free Trade Agreement-Israeli
Trade Act":
Canadian or Israeli End Products:
Line Item No.
Country of Origin
[List as necessary]
(4) Trade Agreements Certificate. (Applies only if the clause at FAR
52.225-5, Trade Agreements, is included in this solicitation.)
(1) The offeror certifies that each end prflduct, except those listed
in paragraph (g)(4)(ii) of this provision, is a U.S.-made, designated
country, Caribbean Basin country, or NAFTA country end product,
as defined in the clause of this solicitation entitled "Trade
Agreements."
 (ii) The offeror shall list as other end products those end products
that are not U.S.-made, designated country, Caribbean Basin
country, or NAFTA country end products.
Other End Products:
Line Item No. Country of Origin
[List as necessary]
(iii) The Government will evaluate offers in accordance with the
policies and procedures of FAR Part 25. For line items subject to
the Trade Agreements Act, the Government will evaluate offers of
U.S.-made, designated country, Caribbean Basin country, or
NAFTA country end products without regard to the restrictions of
the Buy American Act. The Government will consider for award
only offers of U.S.-made, designated country, Caribbean Basin
country, or NAFTA country end products unless the Contracting
Officer determines that there are no offers for such products or
that the offers for such products are insufficient to fulfill the
requirements of the solicitation.
(h) Certification Regarding Debarment, Suspension or Ineligibility for Award
(Executive Order 12549). (Applies only if the contract value is expected to
exceed the simplified acquisition threshold.) The offeror certifies, to the best of
its'knbwledge and belief, that the offeror and/or any of its principals-
(1) [ ] Are, [ ] are not presently debarred, suspended, proposed for
debarment, or declared ineligible for the award of contracts by any
Federal agency; and
(2) [] Have, [ ] have not, within a three-year period preceding this offer,
been convicted of or had a civil judgment rendered against them for:
iCommission of fraud or a criminal offense in connection with obtainin
attempting to obtain, or performing a Federal, state or local government
contract or subcontract; violation of Federal or state antitrust statutes
relating to the submission of offers; or Commission of embezzlement,
theft, forgery, bribery, falsification or destruction of records, making false
statements, tax evasion, or receiving stolen property; and
(3) [ ] Are, [ ] are not presently indicted for, or otherwise criminally or
civilly charged by a Government entity with, commission of any of these
offenses.
(i) Certification Regarding Knowledge of Child Labor for Listed
End Products (Executive Order 13126). [The Contracting Officer
must list in paragraph (i)(1) any end products being acquired
under this solicitation that are included in the List of Products
Requiring Contractor Certification as to Forced or Indentured
Child Labor, unless excluded at 22.1503(b).]
(1) Listed end products:
Listed End Product [ ]
Listed Countries of Origin [ ]
 (2) Certification. [If the Contracting Officer has identified end products
and countries of origin in paragraph (i)(1) of this provision, then the
offeror must certify to either (i)(2)(i) or (i)(2)(ii) by checking the
appropriate block.]
[ ] (i) The offeror will not supply any end product listed in paragraph (i)(1) of this
provision that was mined, produced, or manufactured in the corresponding country as
listed for that product.
[ ] (ii) The offeror may supply an end product listed in paragraph (i)(1) of this provision
that was mined, produced, or manufactured in the corresponding country as listed for
that product. The offeror certifies that it has made a good faith effort to determine
whether forced or indentured child labor was used to mine, produce, or manufacture any
such end product furnished under this contract. On the basis of those efforts, the offeror
certifies that it is not aware of any such use of child labor.