A10 National Security Risk Assessment Questionnaire.docx

NATIONAL SECURITY ACQUISITION RISK ASSESSMENT QUESTIONS

Solicitation #: Date:

Company Name: ______________________

1. In the aggregate, does any foreign person own, or have any type of ownership of 5 percent or more in your organization in either a direct or indirect way? (If yes, please list all parents, both foreign and domestic, by name and address, through to the ultimate parent, to include percentage of ownership. This should include any and all foreign investments in the entity. Include country of origin. Include any special right or privileges involved in the ownership. Foreign person is defined as any foreign interest and any U.S. Person effectively owned or controlled by a foreign interest. Foreign interest is defined as any foreign government, to include any agency or representatives of that government; or any form of business or legally organized entity chartered or incorporated under the laws of any country other than the U.S. or its possessions; and any person who is not a citizen of the U.S.)

2. Does your organization, either directly or indirectly, own 10 percent or more of a foreign interest? (If yes, please list all involved by name, address, and country, with percentage of ownership. Include the names of the personnel running the facilities.)

3. Are there any non-U.S. citizens holding a position at the organization as either a corporate officer, member of the Board of Directors (or other similar governing body), or any other position such as executive/senior management personnel, partners, regents, or trustees? (Please list all non-U.S. citizens listed as corporate officers (Chairman of the Board, President, Chief Executive Officer, Vice-Presidents, Secretary, Treasurer, Chief Information Officer, Chief Financial Officer, and General Counsel), executive personnel (Facility Security Officer) and all other Board of Director members by full legal name, title, date and place of birth, Social Security Number, and citizenship.)

4. Does any foreign person or entity have direct or indirect ability to influence or control the appointment or tenure of the Board of Directors (or similar governing body); any other management positions; or the direction, control, or decisions of the organization? (Identify the individuals by full legal name, title, and citizenship. Provide a full explanation of the individual's control or influence.)

5. Does the organization have any type of contractual agreement or understanding with any foreign interest? (This would include licenses, distributorships, contracts, purchase orders, sales agreements, etc. For each instance, provide the name of the foreign entity, its country, the percentage of gross income derived, and the nature of the involvement including what type of technology or product is involved, whether the product or service is either defense or nuclear related, whether classified or export controlled information is involved, and whether there is compliance with all U.S. export laws. If not defense or nuclear related, the listing of contracts can be done by listing similar equipment by country and percentage.)

6. Does the organization have any indebtedness, liabilities, obligations, or act as a guarantor to any foreign interest? (If yes, give details concerning with whom the debt or guarantee is, where they are located, the conditions or covenants regarding the debt, and what collateral, if any, was pledged. If stock or assets are pledged, provide copies of the pertinent documents. Provide details on procedures for default of the loans. This answer must be answered affirmatively even if the entity holding the loan is a U.S. entity of a foreign institution.)

7. In the last fiscal year, did the organization derive 5 percent or more of its income from one single foreign source, and/or more than 30 percent aggregately from numerous foreign sources? (If yes, give details concerning all such income.)

8. Are any hardware components, software, or other information technology equipment or goods, in whole or in part, to be provided to the Government or used by the organization in performance of any contract or order issued under this solicitation produced, manufactured or assembled by one or more entities that are owned, directed or subsidized by the People’s Republic of China? (If yes, please identify each hardware component, software, or other equipment or good produced, manufactured or assembled by one or more entities that are owned, directed or subsidized by the People’s Republic of China, and your organization’s relationship to each entity.)