36E77618R0055-012.doc

CONFIDENTIALITY CERTIFICATE

VA Contractor

VA Project Title

VA Contract Number

The Physical Security Design Standards Data Definitions are for Official Use Only. I certify that I will not disclose the contents of these documents nor transmit electronically or in hard copy the documents to any other persons or firms. [Note to requestor: A limited number of other members of your firm, directly involved on this VA contract, can request access to these documents. Prior to receipt of these documents, they must provide justification and their signed Confidentiality Certificate to the VA Project Manager for approval].

I also certify that appropriate precautions are in place to protect these documents from theft or inadvertent disclosure, and access is limited to the person signing the Certificate Contractor’s Name

Contractor Employee Name

Signature

Title

Date

Contact information: Address/telephone/email address