09 FCL Verification Certification Template_Final.docx
DOCX document 24 KB Posted
- Attached to
- DCSA Background Investigation Fieldwork Services Federal contract opportunity
- Solicitation number
- HS0021-22-R-0002
About this file
This solicitation requests proposals for background investigation fieldwork services. The Defense Counterintelligence and Security Agency is seeking these services to support personnel security investigations. Offerors must hold the required facility security clearance level and meet all terms specified in the performance work statement and DD Form 254. Proposals are due by the date and time indicated in this solicitation posting. The North American Industry Classification code for this opportunity is 561611.
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Text version
| DCSA BI Fieldwork | CUI | 09 FCL Verification |
| Certification Template | ||
| [This form should be submitted on company letterhead.] |
Date:
Contract or Solicitation Number:
Offeror Company Legal Name:
Offeror Company Physical Address:
Offeror Company CAGE Code:
Offeror Company DUNS:
Offeror Company Facility Security Officer Name:
Offeror Company Facility Security Officer Phone Number:
Offeror Company Facility Security Officer Email:
| |_| Yes |_| No | The Offeror Company is currently a member of the National Industrial Security Program (NISP), has a valid CAGE code, and currently holds a Facility Clearance Level (FCL) granted by the Defense Counterintelligence and Security Agency (DCSA). |
| |_| Yes |_| No | The Offeror Company currently holds the FCL specified in the performance work statement (PWS) at the time of proposal and will maintain it throughout the award process and for the life of the ensuing contract if awarded to the Offeror. |
Current Facility Clearance Level: Granted By: Date Granted:
Current Approved Safeguarding Level: Date Granted:
Current DCSA Cognizant Security Office and address:
Name of DCSA Industrial Security Representative:
Date and assigned Rating from the last two (2) Security Vulnerability Assessments (SVAs) conducted by DCSA:
Date: Rating:
Date: Rating:
The Offeror Company has reviewed the PWS and DD Form 254 contained in the solicitation and meets the security requirements. The signature below indicates Offeror Company’s understanding and certifies that all information provided on this form is current and accurate.
______________________________________________________ Date: _________________ Name of Offeror Company Signatory:
Title of Offeror Company Signatory:
CUI // Source Selection Information. See FAR 2.101 and 3.104.
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