NATIONAL RAILROAD PASSENGER CORPORATION (AMTRAK)
REPRESENTATIONS AND CERTIFICATIONS
As a part of its Bid/Offer, Bidder/Offeror provides the following information:
1. Bidder/Offeror Information
A. Legal Name of Bidder/Offeror: _____________________________________________________
B. Employer Identification Number of Bidder/Offeror: ____________________________________
C. Bidder/Offeror operates as a (check as applicable): Individual ______, Partnership ______, Joint
Venture _____, Corporation ______, or Limited Liability Company ______. If Bidder/Offeror operates
as a Joint Venture, a copy of the executed Joint Venture Agreement must accompany this form.
D. Bidder/Offeror is organized under the laws of: _____________________________.
2.
Parent Company Information
A. Bidder/Offeror is ____ is not ____ owned or controlled by a parent company. For purposes herein, a
parent company is one which (i) owns more than 50% of the voting rights in the Bidder/Offeror, or (ii) is able
to formulate, determine, or veto basic business policy decisions of Bidder/Offeror through the use of various
means, including, minority voting rights, proxy voting, or contractual arrangements.
B. Parent Company Name (if applicable): ____________________________________________________
C. Employer Identification Number of Parent Company (if applicable): _____________________________
3. Small Business; Socially and Economically Disadvantaged Individuals
A. Bidder/Offeror is ____ is not ____ a small business concern as defined by the United States Small
Business Administration.
B. Bidder/Offeror is ____ is not ____ owned and controlled by “socially and economically disadvantaged
individuals” as that term is defined in 49 C.F.R. Part 26.
4. Worker Safety Record
In the past three years, Bidder/Offeror has ____ has not ____ admitted or been found to have committed, any
willful or repeat violations of Federal or State worker safety laws, rules or regulations. Provide the specifics
with respect to any such violations on an attached sheet of paper.
Bidder/Offeror agrees that, if it provides false or incomplete information herein, Amtrak has the right to reject its
Bid/Offer and/or to terminate any resulting contract without liability.
I hereby certify that the information provided herein is true and complete.
_______________________________________
BIDDER/OFFEROR
By: ___________________________________
Date: _________________________________
Title: __________________________________
IFB/RFP NO. ___________________________
10/14/10