RESTRICTED ACCESS REQUEST.pdf

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US Mission Japan Local Guard Services
Solicitation number
19AQMM26R0314
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This is a Restricted Access Request form for the Local Guard Program at the U.S. Mission Japan, issued under solicitation number 19AQMM26R0314. The form serves as a pre-solicitation notice and Request for Information (RFI) designed to identify potential contractors interested in providing local guard services for the mission.

Interested firms must complete the form in its entirety, providing company name, address, UEID number, point of contact information, telephone number, and email address. Requesters must indicate their intended role as either a prime contractor, joint venture participant, or other specified capacity. All completed forms must be submitted to Berel Dorfman at DorfmanBB@state.gov for government approval. Firms are required to register with SAM.GOV prior to submitting this form. The documents are subject to strict distribution restrictions and are authorized only for legitimate bidders. Recipients must safeguard all materials by maintaining them in locked storage when not in use and must destroy all hardcopy prints through shredding and format all electronic media upon termination of use. Copying, scanning, or posting any portion of these documents on the internet is prohibited. This form does not contain specific pricing terms, response deadlines, or award information, as it functions as an initial qualification and information-gathering mechanism prior to formal solicitation.

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US Mission Japan– Local Guard Program Restricted Access Request

RESTRICTED ACCESS REQUEST –

LOCAL GUARD PROGRAM U.S. MISSION JAPAN

REQUEST FOR INFORMATION/PRE-SOLICITATION NOTICE

19AQMM26R0314

THIS FORM MUST BE FILLED OUT IN ITS ENTIRETY*. ANY INFORMATION NOT SUPPLIED WILL RENDER THIS

REQUEST INVALID.

1. Requester Information

a. Company Name

b. Company Address:

c. UEID No:

d. Point of Contact:

e. Telephone No:

f. E-mail Address:

2. My interest in this project is as a (please check one):

a. a. [ ] Prime Contractor

b. b. [ ] Joint Venture Participant

c. c. [ ] Other (please specify) ___________________________________________

3. I, the undersigned, agree that I will safeguard this information in accordance with the following distribution restriction statement:

RESTRICTED DISTRIBUTION AGREEMENT

Distribution authorized to legitimate bidders only, contains technical or operation information.

THESE RESTRICTED ACCESS DOCUMENTS MAY NOT BE DUPLICATED NOR IS ANY SECONDARY DISTRIBUTION OF DOCUMENTS AUTHORIZED. ANY AND ALL FIRMS WISHING TO VIEW ANY PART OF THESE DOCUMENTS MUST REGISTER WITH SAM.GOV, COMPLETE AND SIGN THIS FORM, AND HAVE THEIR REQUEST APPROVED BY THE GOVERNMENT. DATA SHALL BE KEPT IN A LOCKED DESK, LOCKED FILING CABINET, OR LOCKED ROOM WHEN NOT IN USE. UPON TERMINATION OF USE, THE HARDCOPY PRINTS AND ANY ELECTRONIC MEDIA SHALL BE DESTROYED BY SHREDDING THE PRINTS AND FORMATTING THE ELECTRONIC MEDIA. UPON TERMINATION

OF USE, ALL MEDIA SHALL BE REMOVED FROM ANY COMPUTERS.

DO NOT COPY, SCAN OR POST ANY PART OF THESE DOCUMENTS ON THE INTERNET.

Printed Name:_________________________ Signature:

*Completed form may be e-mailed to Berel Dorfman at DorfmanBB@state.gov Restricted Access Request Page 1

SBU - CONTRACTING AND ACQUISITIONS

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