Residency_Requirement_Form.pdf

Attachment II

DEPARTMENT OF JUSTICE

RESIDENCY REQUIREMENT CERTIFICATION FORM (JUNE 2004)

This certification is required to be completed for all purchase card transactions for services that are subject to the DOJ Residency Requirement.

If the service is to be provided by an individual, that individual must sign the certification and return it to the cardholder for filing with the purchase card acquisition form. If the service is to be provided by a company, one certification may be submitted by an authorized company representative. By submitting this certification, the company is agreeing to provide the BOP with contract employees that meet the DOJ Residency Requirement.

Individuals

By signing this certification I certify that for three of the five years immediately prior to responding to this solicitation, I have: 1) legally resided in the United States (U.S.); 2) worked for the U.S. overseas in a Federal or military capacity; or 3) have been a dependent of a Federal or military employee serving overseas.

Companies

By signing this certification I certify that for three of the five years immediately prior to responding to this solicitation, the contract employees providing services to the BOP have: 1) legally resided in the United States (U.S.); 2) worked for the U.S. overseas in a Federal or military capacity; or 3) have been a dependent of a Federal or military employee serving overseas.

Name of Individual/Vendor Date

Signature of Individual or Vendor Representative