2C. Company Letterhead Template.pdf
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- Solicitation number
- N6274224R1312
About this file
This document is a contractor company letterhead template for certifying personnel details on a federal contract. It requires contractors to list the full legal names, middle initials if applicable, and National Crime Check Act holder numbers for up to 30 personnel working on an unspecified federal contract. The contractor point of contact must sign and date the certification that all personnel details are true before a government sponsor acknowledges the certification by providing their printed name, title, and date. No other contract details are specified in the template.
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Text version
CONTRACTOR COMPANY LETTERHEAD
DATE:
CONTRACT NUMBER & TITLE:
Name & Address of Sub-Contractor: (If applicable)
Full Legal Name (Last, First, MI)
NCAC Holder
CERTIFICATION:
"I hereby certify that all personnel listed above are either born U.S. citizens, naturalized U.S. citizens with the naturalization number shown, or legal aliens with the alien registration number indicated and declare under penalty and perjury that all of the information provided on this form is true, complete and correct”.
Contractor POC Printed Name & Title Date
GOVERNMENT SPONSOR ACKNOWLEDGEMENT
Printed Name & Title Date
| Full Legal Name Last First MI1: |
| NCAC Holder1: |
| Full Legal Name Last First MI2: |
| NCAC Holder2: |
| Full Legal Name Last First MI3: |
| NCAC Holder3: |
| Full Legal Name Last First MI4: |
| NCAC Holder4: |
| Full Legal Name Last First MI5: |
| NCAC Holder5: |
| Full Legal Name Last First MI6: |
| NCAC Holder6: |
| Full Legal Name Last First MI7: |
| NCAC Holder7: |
| Full Legal Name Last First MI8: |
| NCAC Holder8: |
| Full Legal Name Last First MI9: |
| NCAC Holder9: |
| Full Legal Name Last First MI10: |
| NCAC Holder10: |
| Full Legal Name Last First MI11: |
| NCAC Holder11: |
| Full Legal Name Last First MI12: |
| NCAC Holder12: |
| Full Legal Name Last First MI13: |
| NCAC Holder13: |
| Full Legal Name Last First MI14: |
| NCAC Holder14: |
| Full Legal Name Last First MI15: |
| NCAC Holder15: |
| Full Legal Name Last First MI16: |
| NCAC Holder16: |
| Full Legal Name Last First MI17: |
| NCAC Holder17: |
| Full Legal Name Last First MI18: |
| NCAC Holder18: |
| Full Legal Name Last First MI19: |
| NCAC Holder19: |
| Full Legal Name Last First MI20: |
| NCAC Holder20: |
| Full Legal Name Last First MI21: |
| NCAC Holder21: |
| Full Legal Name Last First MI22: |
| NCAC Holder22: |
| Full Legal Name Last First MI23: |
| NCAC Holder23: |
| Full Legal Name Last First MI24: |
| NCAC Holder24: |
| Full Legal Name Last First MI25: |
| NCAC Holder25: |
| Full Legal Name Last First MI26: |
| NCAC Holder26: |
| Full Legal Name Last First MI27: |
| NCAC Holder27: |
| Full Legal Name Last First MI28: |
| NCAC Holder28: |
| Full Legal Name Last First MI29: |
| NCAC Holder29: |
| Full Legal Name Last First MI30: |
| NCAC Holder30: |
| Contractor POC Printed Name Title: |
| Date777: |
| Printed Name Title: |
| Date_2: |
File details come from the government source that posted it. Updated .