IBWC_Form_358A_Nondisclosure_Agreement_Release.pdf

PDF 88 KB Posted

Attached to
South Bay International Wastewater Treatment Plant Expansion
Solicitation number
191BWC24R0001
Issued by

About this file

This document is a nondisclosure agreement release form used by the International Boundary and Water Commission. The form certifies the destruction of controlled unclassified information related to Contract Number 191BWC24R0001 for the expansion of the South Bay International Wastewater Treatment Plant. Upon signature, the form releases the prime contractor and any subcontractors or suppliers from nondisclosure agreements governing the treatment of confidential project data. Signatories assert that all controlled unclassified information has been destroyed in an irrecoverable manner according to government standards. The form collects information about the contracting parties and individuals completing the certification for recordkeeping purposes.

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Text version

IBWC Form 358A(COND) Updated 10/16/2023 Page 1 of 1 www.ibwc.gov

INTERNATIONAL BOUNDARY & WATER COMMISSION

NONDISCLOSURE AGREEMENT RELEASE

Certification of Destruction of Controlled Unclassified Information (CUI)

Project: Contract Number:

Prime Contractor:

NOTE: All references to "Contract" also apply to the associated RFP/Solicitation or Task Order, as appropriate.

Agreements signed during the RFP/Solicitation period do not need to be re-signed once Contract is awarded.

Release of Nondisclosure Agreement The company noted below is released from their Nondisclosure Agreement (IBWC Form 359) in relation to this Contract.

Signature of Releasing Representative Date Signed

Printed Name of Releasing Representative Representative's Title

Only the USIBWC may release the Prime Contractor from their Nondisclosure Agreement.

The Prime Contractor shall release their subcontractors and suppliers/vendors from flow-down Nondisclosure Agreements.

Certification of Destruction of CUI Data

1. Prior to signing this form, note if either of the following apply to this Contract.

Written permission has been granted allowing retention of CUI data per IBWC Form 358 15.a.

USIBWC has been provided CUI data to store per IBWC Form 358 15.b.

2. With my signature below, I certify that my company and all subcontractors and suppliers/vendors to whom the data was issued have destroyed all CUI data in a manner that makes it unreadable, indecipherable, and irrecoverable. See Guidance for destruction in NIST SP 800-53, NIST SP 800-88, or 32 CFR 2001.47.

Signature Date Signed

Information of Person Completing Form

Printed Name:

Title:

Company Name:

Company Address:

Phone Number: Email:

The person completing this form is completing it as a representative of the company stated whether that company is an individual, partnership, joint venture, LLC, or corporation.

Project:
Contract Number:
Prime Contractor:
Printed Name 1:
Printed Name 2:
Company Name:
Company Address:
Phone Number:
Email:
Button:
Data: Off
Permission: Off
Signature:
Click here to add signature image to form: Click below to add signature image to form
Check: No
Date:
Button2:
Print:
Note: Form must be "printed" to pdf prior to submittal to USIBWC.
buttonClear:
Printed Name of Accepting Representative:
Representatives Title:
Signature2:
Click2 here to add signature image to form: Click below to add signature image to form
Date2:
Note2: Use signature image
Check2: No
Note1: Use digital signature
Button3:

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