MDA SPAIR Access Agreement Form.docx

SPAIR Access Agreement Form Documents to support industry’s response to SPAIR Request for Information are located on the beta.SAM.gov site with controlled access. These documents are a collection of For Official Use Only/Controlled Unclassified Information/Export Control documents to this acquisition. The Missile Defense Agency (MDA) will provide access upon approval.

Steps required to gain access:

1. Each company will provide a maximum of two (2) personnel for access to the controlled documents related to this acquisition.

2. Complete, print and sign/e-sign the application and agreement form.

3. Email the signed application and agreement in PDF format to MDASPAIR@mda.mil.

4. A confirmation receipt will be sent, which indicates that the application is under review.

5. Within 3 business days, MDA will send an e-mail approving the application or, if required, disapproving the application due to a lack of a capability to safeguard the information.

Section 1 – To be Completed by Industry

Company Name:

Company Cage Code:

Facility Clearance Level:

Facility Storage Authorization Level:

The company has the following capabilities (select as applicable):

☐ SIPRNet, if selected provide address for Facility Security Officer (FSO)

☐ CWAN, if selected provide address for FSO

☐ Capability to accept Fedex Deliveries. If selected provide physical addres, if different from below company physical address:

☐ Capability to process and store classified CDs

Need to Know Rationale (include area of technical focus and type of technical data requested):

Company’s Physical Mailing Address:

Company’s Lead/Point of Contact Name:

Phone Number:

E-mail Address:

Company’s Primary Library Custodian Name:

(if different from FSO)

Phone Number:

Company’s Alternate Library Custodian Name:

Phone Number:

Company’s Facility Security Officer (FSO) Name:

Phone Number:

FSO’s Signature:

Date:

“In submitting this request, I, on behalf of my company, agree to the following document handling procedures: Only US persons <<modify as needed>> with need to know (my team) will have access to the Missile Defense Agency (MDA) Missile Defense System (MDS) Controlled Unclassified Information (CUI) << revise as necessary depending the level of classification in the requirement>> document(s), as defined below, obtained in support of subject acquisition. My company will comply with the DFARS clause 252.204-7012 for protection of MDS FOUO/CUI on the company’s unclassified information systems.

Not later than 5 days after contract award or company’s determination not to pursue an offer, all MDA documentation, no matter what the form (hardcopy, electronic, CD/DVD, etc.), shall be destroyed. I further agree, on behalf of my company, to hold the MDA harmless from any liability or damage which may result from the failure of my company or its employees to abide by the terms and conditions of this Access Agreement.”

THIS AGREEMENT CONCERNS A MATTER WITHIN THE JURISDICTION OF AN AGENCY OF THE UNITED STATES AND THE MAKING OF A FALSE, FICTITIOUS, OR FRAUDULENT CERTIFICATION MAY RENDER THE MAKER SUBJECT TO PROSECUTION UNDER TITLE 18, UNITED STATES CODE, SECTION 1001. OTHER SANCTIONS RELATED TO CONDUCT MAY ALSO APPLY.

The following is an extract of information from MDA procedures: <<add or delete definitions as needed>> “Definitions

a. Automated Information System (AIS). An assembly of computer hardware, software, and firmware configured to automate functions of calculating, computing, sequencing, storing, retrieving, displaying, communicating, or otherwise manipulating data, information, or textual material.

b. Controlled Unclassified Information (CUI). Information the Government creates or possesses, or that an entity creates or possesses for or on behalf of the Government, that a law, regulation, or Government-wide policy requires or permits an agency to handle using safeguarding or dissemination controls. Refer to DODI 5200.48, “Controlled Unclassified Information” for additional guidance on CUI.

c. Dual Citizenship. A dual citizen is a citizen of two nations. For the purposes of this document, an individual must have taken action to obtain or retain dual citizenship. Citizenship gained as a result of birth to non-U.S. parents or by birth in a foreign country to U.S. parents thus entitling the individual to become a citizen of another nation does not meet the criteria of this document unless the individual has taken action to claim and to retain such citizenship.

d. For Official Use Only (FOUO). FOUO is a dissemination control applied by the DoD to unclassified information that may be withheld from public disclosure under one or more of the nine exemptions of the Freedom of Information Act (FOIA) (See DoD 5400.7-R). FOUO is not a form of classification to protect U.S. national security interests.

e. National of the United States. Title 8, U.S.C. Section 1101(a)(22), defines a National of the U.S. as: (1) A citizen of the United States, or, (2) A person who, but not a citizen of the U.S., owes permanent allegiance to the U.S. Note: 8 USC Section 1401, paragraphs (a) through (g), lists categories of persons born in and outside the U.S. or its possessions that may qualify as Nationals and Citizens of the U.S. This subsection should be consulted when doubt exists as to whether or not a person can qualify as a National of the U.S.

f. U. S. Person. Any form of business enterprise or entity organized, chartered, or incorporated under the laws of the United States or its possessions and trust territories and any person who is a citizen or national (see National of the United States) of the United States, or permanent resident of the United States under the Immigration and Nationality Act.”

Section 2 – FOR GOVERNMENT COMPLETION Section 2a. Contracts Verification of Corporate Cage Code and Other Provided Data

PCO or Contract Specialist Name and Signature:

Date:

Section 2b. Security/Verification

Acquisition Lead Name and Signature:

Government’s Approval/Non Approval of Access:

Date Notified Company: