SBU_Information_Request_Form.pdf
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- Solicitation number
- 47PJ0019R0035
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SBU Information Request Form for Solicitation No. 47PJ0019R0035
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Revised 6/24/2015
REQUEST FOR SENSITIVE BUT UNCLASSIFIED (SBU) BUILDING INFORMATION
Solicitation No.: 47PJ0019R0035
The requester shall complete the information below and return the entire Request for Sensitive but Unclassified Building (SBU) Information document to the Contracting Officer or Contract Specialist. By signature below, the requestor of SBU building information acknowledges the requirement to maintain controls, as stated herein, to safeguard the information, and shall return or destroy the SBU building information as required by this Agreement. The undersigned acknowledges that the requester shall abide by this Agreement and shall only disseminate SBU building information to other authorized users under the conditions set forth herein.
Company Name: _____________________________________________________
Name of Individual and Title: ____________________________________________
Signature: ___________________________________________________
Date: _______________________________________________________
(The Offeror shall attach copy of business license or formation document.)
DUNS Number: _________________________________________
DUNS Number Verified by Government Representative at:
https://www.sam.gov/portal/public/SAM/#1 Yes: ___ No: ___
Employer ID Number/Federal Tax ID Number _______________________________
Offeror/bidder/contractor information and DUNS number has been verified and release of SBU building information is approved by:
Dylan White Date Contract Specialist https://www.sam.gov/portal/public/SAM/#1
Revised 6/24/2015
DISPOSAL STATEMENT FOR SENSITIVE BUT UNCLASSIFIED BUILDING
INFORMATION
Solicitation/Contract Number ________________________________________
I hereby certify that all Sensitive but Unclassified (SBU) building information relative to the referenced solicitation/contract not previously returned to the Government has been destroyed or disposed of by burning or shredding paper copies, physically destroying computer diskettes or permanently deleting/removing/erasing electronic files from computers.
I also certify the no unauthorized physical or electronic copies of such SBU building information were made or are being retained.
Company Name: ______________________________________________
Name of Individual: ____________________________________________
Signature: ___________________________________________________
Title: _______________________________________________________
Date: _________________
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