MISC TO DELETED FROM SHARON LEVY RE ATTACHED PLEASE FIND THE FOLLOWING: ELECTRONIC FUNDS TRANSFER INFORMATION SHEET - COMPLETED REPS AND CERTS - UPDATE TO K-12, REGARDING 52.223-13

• Document Type: FOIA
• Keywords: CONTRACTS
• Keywords: GOOGLE INC
• Collection: FOIA Collection
• Document Number (FOIA) /ESDN (CREST): 0001487892
• Release Decision: RIPPUB
• Original Classification: U
• Document Page Count: 16
• Document Creation Date: June 22, 2015
• Document Release Date: September 29, 2008
• Case Number: F-2007-00886
• Publication Date: September 1, 2004

'19/01/2004 14:13 FAX [phone] 0006LE
Google
FACSIMILE TRANSMITTAL SHEET
FROM:
Sharon Levy
September 1, 2004
TOTAL NO. OF PAGES INCLUDING COVER:
16
^ FOR REVIEW ^ PLEASE COMMENT El PLEASE REPLY
Thanks for your patience. Attached please find the following.
? Electronic Funds Transfer Infonnation Sheet
(b) (3)
(b) (6)
^ PLEASE RECYCLE
? Completed Reps and Cents (note that no response was provided for K-17, as it should be
inapplicable for the products we're providing).
? Update to K-12, regarding 52223-13 (Certification of Toxic Chemical Release Reporting)
Please let me know if you have any questions.
Regards,
Sharon
THIS TRANSMISSION MAY BE PRiVilEGFD AND MAY CONf.AE1 CONFIDENiTAL JNPORMATION MENDED ONLY FOR THE
PERSON(S) NAMED ABOVE. ANY OTHER DIS17tIDUfION, RE-TRANsM SS1QN, COF 1NG OR DLSCL091RE LS SIRtCILY PROHIBITED,
IF YOU HAVE RECEIVED THIS TRANSMISSION IN ERROR PLEASE NOTIFY ME iM MPDIATELY BY TELEPHONE OR FACSIMI B, AND
RETURN THIS BY U.S. NQJL
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Pb, 40S P.?Ji5
ILBCTRONIC FUNDS TAAE4SFER (IRE)
NOT!: ALL PAYMENTS ARA MADE VIA !LBOTRONIC FUNDS TRANSFER (EP) -
FAILURE TO PROVIDE GFT INFORMATION MAY RG8ULT IN SERE D!LAY8 IN
INVOICE PAYMENT. '
NAME OF THE FINANCIAL INSTITUTION TO RNCEIVE PAYMENT FOR YOUR
COMPANY:
COMPLETE ADORES$.OF THE FINANCIAL, INQTITuTIQN,
FINANCIAL INSTITUTIONS NIN!-DIGIT ABA ROUTING NUMBER:
C6NTRACTOR9,ACCOUNT NUMBER TO BE CR! t !D WITH FUNDS;
TYPE OF ACCOUNT AT THE FINANCIAL INSTITUTION;
CHECKING
SAVIN?3
NAME, TITLE AND T$LEPHCNE NUMBER OF COMPANY CONTRACT PERSON;
(fie .r=~i3cal
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AUG.30.2004 111142AM NU. 4105 r.gr1D
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Section K - Rips d?. Caste.
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(d) Taxpayer Ider0cation Number (TIN),
TIN bas been plied flir.
TDQ is not reauimd because;
Oipaor is a nonresident alias, foreign eorporedM or fereida prsblp that does not have Ineame
effectively connected with the conduct of a redo or busiaws iatbe United States and does not have gn
affix or place of busine9a or a flaoal paying agent in the United States!
[ ] O Fcror is an agony or Wm ity of a fbreiga govran MM;
] 00M is eat agency or inatrumentalty of the Federal Gov nmmt.
(e) Type of organization.
[ W o propriatonship;
[ ] Pet= hip;
[ Corporate etidty (not tax-exen s);
Corporate entity (tax-Oq empt);
[ ] ovaroment entity (Pedoanl, State, or local);
[ a Pooeign govmrDme*
[] Iato?naecnal orgw ixetion per 26 CPR 1.6O49.4;
[]0dw
(t) Common parent.
/` ("Iftor is not owned or controlled by a common parent as defined is paragraph (a) of thin provision.
[ ] Name and TIN of common pates
Name
TIN
KA $.20" Cectibeatlon Regarding Debarment, Suspension!
Proposed Debarment; and Other Responsibthty Matters MAR 1996
(a)(1) The Oflrerer certifies, m the best of its lonow1edgo and belief that -
(1) The Of[bror and/or arty of Us Princjpab -
(A) Are L ] are not ?,/ ently debarred, rnepaided, proposed for debermeat, or
doolsred inaligiblezu the awoO of coutraoe by any Fod%4 Wncy
(9) Have ( ] have not within is thanayear period preceding this offer, been ooavlc ed
of or bad a evil jud t rendered Against t m for. commission of Saud or It criminal
o se in oamaeetion with obtsb*'g, aetemptlag to obtain, or performing a public
(Federal, state, or loos]) conlte t or subontracM violption of Federal or state ao*uat
statutes relating to the submission of ors or coin UsIon of ember, tires,
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Beotioa K - Reps & C.
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fwgwy, bnbery} +a1si$cgdiou or deeovcbon of nawrdm. tRldag iii1se ststeaatmts taut
evasion, or receiving stolen property; and
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AUG. 313.8Cee4 11:45AM NO.405 P.12/15
Googia
sootion K - Reps & Came.
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(b) The Con=tor abaA is any case m which it behaves that %roign afteooe satiate or Is being saugl * 1*
be obtelaed over its al tiia, or the afaauv of a Suboontraow, psvuptly- not* the C,ontactiag OMcor of sU
the QWfinenc ?ots, even if euoh Influence is not esertod to the degree speclfed is the NISPOM,
(o) The C u*o'tor shill promptly disclose to the OontictIn OflSoer aW btft :ta ion pertaining to any
iaweet of a FOCI nature in the Contractor or Suboont actor that bas dcvo1opod at nay situ dortq the
coaAaot'e duration er h99 subaequmtty come to the Cantraet0a atta3goL
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52.223-13 Certification of Toxic Chemical Release
Reporting.
As prescribed in 23.906(a), insert the following provision:
Certification of Toxic Chemical Release Reporting (Aug 2003)
(a) Executive Order 13148, of April 21, 2000, Greening the Government through
Leadership in Environmental Management, requires submission of this certification as a
prerequisite for contract award.
(b) By signing this offer, the offeror certifies that-
(1) As the owner or operator of facilities that will be used in the performance of
this contract that are subject to the filing and reporting requirements described in
section 313 of the Emergency Planning and Community Right-to-Know Act of
1986 (EPCRA) (42 U.S.C. 11023) and section 6607 of the Pollution Prevention
Act of 1990 (PPA) (42 U.S.C. 13106), the offeror will file and continue to file for
such facilities for the life of the contract the Toxic Chemical Release Inventory
Form (Form R) as described in sections 313(a) and (g) of EPCRA and section
6607 ofPPA; or
(2) None of its owned or operated facilities to be used in the performance of this
contract is subject to the Form R filing and reporting requirements because each
such facility is exempt for at least one of the following reasons: [Check each block
that is appl~able.]
i) The facility does not manufacture, process, or otherwise use any
toxic chemicals listed in 40 CFR 372.65;
[ ] (ii) The facility does not have 10 or more full-time employees as
specified in section 313(b)(1)(A) of EPCRA, 42 U.S.C. 11023(b)(1)(A);
[ ] (iii) The facility does not meet the reporting thresholds of toxic
chemicals established under section 313(f) of EPCRA, 42 U.S.C. 11023(f)
(including the alternate thresholds at 40 CFR 372.27, provided an
appropriate certification form has been filed with EPA);
iv) The facility does not fall within the following Standard Industrial
Classification (SIC) codes or their corresponding North American Industry
Classification System sectors;
(A) Major group code 10 (except 1011, 1081, and 1094.
(B) Major group code 12 (except 1241).
(C) Major group codes 20 through 39.
(D) Industry code 4911, 4931, or 4939 (limited to facilities that
combust coal and/or oil for the purpose of generating power for
distribution in commerce),,
(E) Industry code 4953 (limited to facilities regulated under the
Resource Conservation and Recovery Act, Subtitle C (42 U.S.C.
6921, et seq.), or 5169, or 5171, or 7389 (limited to facilities
primarily engaged in solvent recovery services on a contract or fee
basis); or
[ ] (v) The facility is not located in the United States or its outlying areas..
(End of provision)
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