Amendment 3.pdf

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FOR OFFICIAL USE ONLY (FOUO)

Attachment AA

The contractor is responsible for entering and maintaining training/certification dates and artifacts for Expiring Certifications as they are renewed;

1. AED Certification

2. First Aid Certification

3. State Weapons Permit and Renewal (required)

4. State Security Officer Certification and Renewal (as required)

5. Local Permits and Renewals (as required)

6. Baton Certification

7. OC Spray Certification

8. Contractor Provided Refresher Training

9. Firearms Qualification

10. Annual Active Threat Certification

11. Other

FOR OFFICIAL USE ONLY (FOUO)

Attachment AB

Non‐Expiring Certifications requiring the contractor to begin adding the artifacts. The contractor has 365 days after contract modification/award to enter and maintain training/certifications dates and Artifacts for all non‐expiring certifications.

1. Non‐Disclosure Agreement

2. Photograph

3. National Security Information Letter

4. Copy of Driver’s License/State ID

5. Proof of Education (HS Diploma or GED Certificate)

6. Suitability Decision Letters

7. Verified Alien/Immigration Status (I9 or E‐Verify Certificate)

8. Domestic Violence Declaration Form (Lautenberg)

9. Medical Certification (SF‐78)

10. Mandatory Pre‐Employment Drug Screening

11. Post‐Employment Drug Screening

12. Initial Weapons Training

13. Contractor Provided Basic Training

14. FPS Orientation Training

15. Screener Training (16‐hour)

16. Copies of Complaints, Investigation, and Disciplinary Actions for all Infractions Committed

Under Contract

17. Copies of Commendations, Awards, and Letters for Any Work Performed Under Contract

Exhibit 1 List of Required Forms

Item Form Number Title Section

Reference

1 DD 254 DoD Contract Security Classification Specification, when applicable 5.7.1

2 DD 441 DoD Security Agreement, when applicable 5.7.5

3 DHS Form 11000-6 Non-Disclosure Agreement 7.2.5

4 DHS Form 11000-9 Disclosure and Authorization Pertaining to Consumer Reports pursuant to the Fair Credit Reporting Act

5.3.4

5 FD 258 Fingerprint Card Application 5.3.4

6 OF-306 Declaration for Federal Employment 5.3.4

7 SF 85 Questionnaire for Public Trust Positions 5.3.4

8 SF 85-P Supplemental Questionnaire for Selected Positions 5.3.4

9 SF 86 Questionnaire for National Security Positions, when applicable 5.9.1

10 USCIS Form I-9 Employment Eligibility Verification 7.2.5

11 CIWRC V2. Apr14 Contractor Information Worksheet 5.3.4

FPS CIW V4. FEB 2015

Federal Protective Service

CONTRACTOR INFORMATION WORKSHEET (CIW)

Request Type: Please select the type of request Date (MM/DD/YYYY) New Request

Periodic Re-Investigation Position Change Name Change

Contract Change Dual Contract

Separation Reason For Separation:

Section I: Requesting Official/Organization

Contracting Officer Representative (COR) (1)

Name (Last, First) Region Select Region

Phone Email

Prime Contractor POC (1)

Name (Last, First MI)

Phone Email

Prime Company (1) Company Name Contract Number

Section II: Individual to be Screened

Full Name (1) Last First Middle

Position Title (1)

Social Security Number (1) Date of Birth(MM/DD/YYYY)

Place of Birth City State Country (if not US)

E-Mail Address

Daytime Phone Number

Section III: For UNCLASSIFIED CONTRACTS, Position Designation

Low Risk Moderate Risk (5N) High Risk (6N)

Section IV: For CLASSIFIED CONTRACTS ONLY, Position Security Clearance Requirement

Secret Top Secret

*For FPS reference only. Clearance adjudications must be facilitated by the contractor’s FSO and adjudicated by Defense Security Services.

**When available, a Visitor Authorization Request (VAR) letter must be submitted with the CIW.

Privacy Act Information Authority: 5 U.S.C. § 301; 44 U.S.C. § 3101; Homeland Security Act of 2002, Pub. L. No. 107-296, 116 Stat. 2135; Executive Order (EO) 9397; EO 10450; EO 12968;

and 5 CFR Part 731 authorize the collection of this information.

Purpose: The primary purpose of this collection is to facilitate the screening of an individual for a contractor position to perform services for the Federal government.

Routine Uses: The information collected may be disclosed as generally permitted under 5 U.S.C. § 552a (b) of the Privacy Act of 1974, as amended. This includes using the information as necessary and authorized by the routine uses published in DHS/ALL-023 - Department of Homeland Security Personnel Security Management, 75 FR8088 (February 23, 2010).

Disclosure: Participation is voluntary; however, failure to provide this information may delay the individual from being able to perform services for the Federal Government.

(1) Denotes fields required for completing an Exit Request.

FPS CIW V4. FEB 2015

Instructions – Completing the Contractor Information Worksheet

General

The FPS Contractor Information Worksheet (CIW) is used by Contractor Officer’s Representatives (COR) to request that the Personnel Security Division (PSD) or the Regional Contract Adjudications (RCA) units perform appropriate fitness screening on contractor employees associated with Protective Security Officer Program.

Section – Request Type

Please enter the date of the request, and select one of the following request types:

• New Request – Select “New Request” when the contractor employee is new to FPS.

• Position Change – Select “Position Change” when the contractor obtains a new position associated with the PSO contract.

• Contract Change – Select “Contract Change” if the contractor employee is changing PSO contracts.

• Periodic Re-Investigation – Select “Periodic Reinvestigation” when the contractor is due for their updated e-QIP and associated investigation.

• Name Change – Select “Name Change” if the contractor employee has legally changed their name.

o When “Name Change” is the Request Type, documentation supporting the name change shall be attached.

• Dual Contractor – Select “Dual Contractor” when the contractor is currently serving on an existing PSO contract.

• Separation – Select “Separation” when the contractor employee has left the contract o When “Separation” is the Request Type, a reason shall be indicated on the CIW.

Section I – Requesting Official/Organization

Please complete all fields in Section I.

• Requesting Official – Only the Contracting Officer’s Representative (COR) can be the requesting official.

Section II – Individual to be screened

Please complete all fields in Section II.

Section III – Position Designation

The position designation is essential to the contractor fitness process as it determines the Investigative requirements associated with the position. For example the minimum investigative standard for a Moderate Risk Position is a Moderate Background Investigation (MBI) completed within the last five years. For FPS, the minimum position designation for any Protective Security Officer (PSO) is Moderate Risk. If during the fitness process it is determined that the individual has been investigated by another Federal agency, FPS will use this investigation whenever practical. There are designated costs associated with each level of investigation. Therefore it is critical that the appropriate position designation be made on the CIW, to avoid unnecessary expenditures of time and funds.

Please select only one.

Section IV – Position Security Clearance Requirement

On Classified Contracts, some or all positions may require access to national security information (NSI). In this instance, the contractor employee must have an active clearance at, or higher than, the level designated by the FPS position. Please note, FPS does not grant security clearances to contract employees.

Please complete this section for positions associated with CLASSIFIED contracts. When practical, submit a Visitor Authorization Request (VAR) sent to you from the company Facility Security Officer. FPS will validate this information with Defense Security Services and update the DHS Integrated Security Management System accordingly.

Electronic Transmittal of the CIW

Important: FPS PSD and RCA units will only accept a CIW submitted by FPS CO, COTR, or Federal Points of Contacts. CIW forms submitted by Contractor Employees or Contractor Company representatives will not be processed. A completed worksheet includes Sensitive Personal Identification Information and requires encryption outside of the DHS network.

INSTRUCTIONS for PSO PIV CARD REVOCATION & DESTRUCTION REQUEST [Only use for those personnel no longer employed on a PSO Security Services contract]

Column A: Enter the PIV Card Holder's full legal name, i.e.; as provided on a birth certificate, Social Security Card, or driver's license, etc.

Column B: Enter the Type of Identifier and the PIV Card Holder's EDIPI or Person Handle Identifier Number (Both identifiers can be located in ISMS) Example: EDIPI: 1234567890 or PH: 0123456789 (must be a 10-digit number)

Column C: Identify the PIV Card Holder's position title [Use the drop-down selector for Protective Security Officer, Key Personnel, or Staff]

Column D: Enter the HSPD-12 PIV Card number located on the back of the card; example: 1000002156 DHS001-7000-02104

Column E: Use the drop-down to select [Cessation of Operation]

Column F: Identify the Region the applicant is supporting [Use the drop-down selector for Region 1 through Region 11]

Column G: Enter the Contracting Officer's Representative (COR) name

Column H: Enter the Prime Contractor Name

Column I: Enter the Prime Contract Number [Not Telephone Number]

FOR GOVERNMENT ONLY

Column J: Enter the Name of the Federal Employee that destroyed the PIV card

Column K: Enter the Date that the PIV card was destroyed **NOTE** The PIV Card shall be destroyed using a cross-cut shredder

Column L: Enter the FPS 3155 Case Number for all Lost or Stolen PIV Cards [*PIV Cards not returned to the COR upon exiting contract]

NOTES

*The COR shall email the completed worksheet to the FPS HSPD-12 Program Office at: FPSHQHSPD-12@ice.dhs.gov

*The FPS HSPD-12 Program Office will review and validate the Integrated Security Management System (ISMS) and the Identity Management System (IDMS) to ensure profiles are updated appropriately

*Once the review is complete, the FPS HSPD-12 Program Office will provide the COR with a current status update

EXHIBIT 2a

PSO Security Services Contracts HSPD-

12 PIV Card Request

POC: FPS HSPD-12 Program Office

FPSHQHSPD-12@hq.dhs.gov

(703) 235-6187

Applicant's Full Legal Name (Last/First/Middle) Applicant's EDIPI or Person Handle Position Title Reason Weapons Bearer FERO FPS Region COR Name (First/Last) Prime Contractor Name Prime Contract Number Comments

Protective Security Officer New Yes Approved Region 1

Key Personnel Inoperable No Disapproved Region 2

Staff Replace (Damaged) Region 3

Replace (Expired) Region 4

Replace (Lost) Region 5

Replace (Stolen) Region 6

Replace (Name Change) Region 7

Other Region 8

Region 9

Region 10

Region 11

*The FPS HSPD-12 Program Office will review and validate the Integrated Security Management System (ISMS) and the Identity Management System (IDMS) to ensure the applicant has a current and valid profile

*Once the review is complete, the FPS HSPD-12 Program Office will provide the COR with a sponsorship notice or current status, if not able to sponsor

Column H: Enter the name of the Contracting Officer's Representative (COR)

Column I: Enter the Prime Contractor Name

Column J: Enter the Prime Contract Number

*The COR shall email the completed worksheet to the FPS HSPD-12 Program Office at FPSHQHSPD-12@hq.dhs.gov

INSTRUCTIONS. [Prior to submitting a request, CORs should validate that the contractor employee has an active and current ISMS profile (with correct personal and contract information) and (at a minimum) a Pre-App Decision Granted/Date (aka: Entry on Duty) for the contract identified in Column J]

Column A: Enter the applicant's full legal name, i.e.; as provided on a birth certificate, Social Security Card, or driver's license, etc.

Column B: Enter the Type of Identifier and the applicant's EDIPI or Person Handle Identifier Number (Both identifiers can be located in ISMS) Example: EDIPI: 2354633 or PH: 0023433

Column C: Identify the applicant's position title [Use the drop-down selector for Protective Security Officer, Key Personnel, Staff]

Column D: Identify the applicant's reason for a HSPD-12 PIV Card [Use the drop-down to select the appropriate reason] NOTE: If the Reason is for Replace (Lost/Stolen) a FPS 3155, Incident Report, Case Number shall be entered into the Comments Section (Column K)

Column E: Identify the applicant's need for Weapons Bearer on the HSPD-12 PIV Card [Use the drop-down to select Yes or No] PSOs Only

Column F: Identify the applicant's need for the Federal Emergency Response Official (FERO) Stripe on the HSPD-12 PIV Card [Use the drop-down to select Yes or No] PSOs Only

Column G: Identify the Region the applicant is supporting [Use the drop-down selector for Region 1 through Region 11

Exhibit 2a

PSO Security Services Contracts

HSPD-12 PIV Card Revocation/Destruction

PIV Card Holder Full Legal Name (Last/First/Middle) PIV Card Holder's EDIPI or Person Handle Position Title HSPD-12 PIV Card Number Reason** FPS Region COR Name (First/Last) Prime Contractor Name Prime Contract Number Destroyed by: (Last/First Name) Destroyed Date 3155 Case #

FOR GOVERNMENT ONLY

Protective Security Officer Cessation of Operation Region 1

Key Personnel Key Compromised Region 2

Staff Superseded Region 3

Region 4

Region 5

Region 6

Region 7

Region 8

Region 9

Region 10

Region 11

*Once the review is complete, the FPS HSPD-12 Program Office will provide the COR with a current status update

*The FPS HSPD-12 Program Office will review and validate the Integrated Security Management System (ISMS) and the Identity Management System (IDMS) to ensure profiles are updated appropriately

*The COR shall email the completed worksheet to the FPS HSPD-12 Program Office at FPSHQHSPD-12@hq.dhs.gov

Column K: Enter the Date that the PIV card was destoryed **NOTE** The PIV Card shall be destroyed using a cross-cut shredder

Column L: Enter the FPS 3155 Case Number for all Lost or Stolen PIV Cards

Column J: Enter the Name of the Federal Employee that destroyed the PIV card **NOTE** The PIV Card shall be destroyed using a cross-cut shredder

Column I: Enter the Prime Contract Number

Column H: Enter the Prime Contractor Name

Column G: Enter the Contracting Officer's Representative (COR) name

Column F: Identify the Region the applicant is supporting [Use the drop-down selector for Region 1 through Region 11

**Superseded: A PIV Card Holder has a change in clearance or any other change to the card topology, to include damaged or inoperable cards

**Key Compromised: A PIV Card is lost or stolen. **NOTE** Shall provide the 3155 Case Number in Column L.

POC: FPS HSPD-12 Program Office FPSHQHSPD-12@fps,dhs.gov (703) 235-6187

**Cessation of Operation: A PIV Card Holder is retiring, resigning, or is fired

Column E: Identify the reason for HSPD-12 PIV Card Return [Use the drop-down to select the appropriate reason - definitions below]

Column D: Enter the HSPD-12 PIV Card number located on the botton of the card; example: 1000002156 DHS001-7000-02104

Column B: Enter the Type of Identifier and the PIV Card Holder's EDIPI or Person Handle Identifier (Both can be located in ISMS) Example: EDIPI 2345433 or PH 5465324

Column A: Enter the PIV Card Holder's full legal name, i.e.; as provided on a birth certificate, Social Security Card, or driver's license, etc.

INSTRUCTIONS

Column C: Identify the applicant's position title [Use the drop-down selector for Protective Security Officer, Key Personnel, or Staff]

Exhibit 2a

DEPARTMENT OF HOMELAND SECURITY

NON-DISCLOSURE AGREEMENT

Protected Critical Infrastructure Information (PCII)

Agreement in consideration of my being granted conditional access to certain information, specified below, that is owned by, produced by, or in the possession of the United States Government.

(Signer will acknowledge the category or categories of information that he or she may have access to, and the signer's willingness to comply with the standards for protection by placing his or her initials in front of the applicable category or categories.)

Initials:

I attest that I am familiar with, and I will comply with all requirements of the PCII program set out in the Critical Infrastructure Information Act of 2002 (CII Act) (Title II, Subtitle B, of the Homeland Security Act of 2002, Public Law 107-296, 196 Stat. 2135, 6 USC 101 et seq.), as amended, the implementing regulations thereto (6 CFR Part 29), as amended, and the applicable PCII Procedures Manual, as amended, and with any such requirements that may be officially communicated to me by the PCII Program Manager or the PCII Program Manager's designee.

Sensitive Security Information (SSI)Initials:

I attest that I am familiar with, and I will comply with the standards for access, dissemination, handling, and safeguarding of SSI information as cited in this Agreement and in accordance with 49 CFR Part 1520, "Protection of Sensitive Security Information," "Policies and Procedures for Safeguarding and Control of SSI," as amended, and any supplementary guidance issued by an authorized official of the Department of Homeland Security.

Other Sensitive but Unclassified (SBU)Initials:

As used in this Agreement, sensitive but unclassified information is an over-arching term that covers any information, not otherwise indicated above, which the loss of, misuse of, or unauthorized access to or modification of could adversely affect the national interest or the conduct of Federal programs, or the privacy to which individuals are entitled under Section 552a of Title 5, as amended, but which has not been specifically authorized under criteria established by an Executive Order or an Act of Congress to be kept secret in the interest of national defense or foreign policy. This includes information categorized by DHS or other government agencies as: For Official Use Only (FOUO); Official Use Only (OUO); Sensitive Homeland Security Information (SHSI); Limited Official Use (LOU); Law Enforcement Sensitive (LES);

Safeguarding Information (SGI); Unclassified Controlled Nuclear Information (UCNI); and any other identifier used by other government agencies to categorize information as sensitive but unclassified.

I attest that I am familiar with, and I will comply with the standards for access, dissemination, handling, and safeguarding of the information to which I am granted access as cited in this Agreement and in accordance with the guidance provided to me relative to the specific category of information.

I understand and agree to the following terms and conditions of my access to the information indicated above:

3. I attest that I understand my responsibilities and that I am familiar with and will comply with the standards for protecting such information that I may have access to in accordance with the terms of this Agreement and the laws, regulations, and/ or directives applicable to the specific categories of information to which I am granted access. I understand that the United States Government may conduct inspections, at any time or place, for the purpose of ensuring compliance with the conditions for access, dissemination, handling and safeguarding information under this Agreement.

I, , an individual official, employee, consultant, or subcontractor of or to

(the Authorized Entity), intending to be legally bound, hereby consent to the terms in this

1. I hereby acknowledge that I have received a security indoctrination concerning the nature and protection of information to which I have been provided conditional access, including the procedures to be followed in ascertaining whether other persons to whom I contemplate disclosing this information have been approved for access to it, and that I understand these procedures.

2. By being granted conditional access to the information indicated above, the United States Government has placed special confidence and trust in me and I am obligated to protect this information from unauthorized disclosure, in accordance with the terms of this Agreement and the laws, regulations, and directives applicable to the specific categories of information to which I am granted access.

DHS Form 11000-6 (10/18)

8. If I violate the terms and conditions of this Agreement, such violation may result in the cancellation of my conditional access to the information covered by this Agreement. This may serve as a basis for denying me conditional access to other types of information, to include classified national security information.

4. I will not disclose or release any information provided to me pursuant to this Agreement without proper authority or authorization. Should situations arise that warrant the disclosure or release of such information I will do so only under approved circumstances and in accordance with the laws, regulations, or directives applicable to the specific categories of information. I will honor and comply with any and all dissemination restrictions cited or verbally relayed to me by the proper authority.

5. (a) For PCII - (1) Upon the completion of my engagement as an employee, consultant, or subcontractor under the contract, or the completion of my work on the PCII Program, whichever occurs first, I will surrender promptly to the PCII Program Manager or his designee, or to the appropriate PCII officer, PCII of any type whatsoever that is in my possession.

(2) If the Authorized Entity is a United States Government contractor performing services in support of the PCII Program, I will not request, obtain, maintain, or use PCII unless the PCII Program Manager or Program Manager's designee has first made in writing, with respect to the contractor, the certification as provided for in Section 29.8(c) of the implementing regulations to the CII Act, as amended.

(b) For SSI and SBU - I hereby agree that material which I have in my possession and containing information covered by this Agreement, will be handled and safeguarded in a manner that affords sufficient protection to prevent the unauthorized disclosure of or inadvertent access to such information, consistent with the laws, regulations, or directives applicable to the specific categories of information. I agree that I shall return all information to which I have had access or which is in my possession 1) upon demand by an authorized individual; and/or 2) upon the conclusion of my duties, association, or support to DHS; and/or 3) upon the determination that my official duties do not require further access to such information.

6. I hereby agree that I will not alter or remove markings, which indicate a category of information or require specific handling instructions, from any material I may come in contact with, in the case of SSI or SBU, unless such alteration or removal is consistent with the requirements set forth in the laws, regulations, or directives applicable to the specific category of information or, in the case of PCII, unless such alteration or removal is authorized by the PCII Program Manager or the PCII Program Manager's designee. I agree that if I use information from a sensitive document or other medium, I will carry forward any markings or other required restrictions to derivative products, and will protect them in the same matter as the original.

7. I hereby agree that I shall promptly report to the appropriate official, in accordance with the guidance issued for the applicable category of information, any loss, theft, misuse, misplacement, unauthorized disclosure, or other security violation, I have knowledge of and whether or not I am personally involved. I also understand that my anonymity will be kept to the extent possible when reporting security violations.

9. (a) With respect to SSI and SBU, I hereby assign to the United States Government all royalties, remunerations, and emoluments that have resulted, will result, or may result from any disclosure, publication, or revelation of the information not consistent with the terms of this Agreement.

(b) With respect to PCII I hereby assign to the entity owning the PCII and the United States Government, all royalties, remunerations, and emoluments that have resulted, will result, or may result from any disclosure, publication, or revelation of PCII not consistent with the terms of this Agreement.

10. This Agreement is made and intended for the benefit of the United States Government and may be enforced by the United States Government or the Authorized Entity. By granting me conditional access to information in this context, the United States Government and, with respect to PCII, the Authorized Entity, may seek any remedy available to it to enforce this Agreement including, but not limited to, application for a court order prohibiting disclosure of information in breach of this Agreement. I understand that if I violate the terms and conditions of this Agreement, I could be subjected to administrative, disciplinary, civil, or criminal action, as appropriate, under the laws, regulations, or directives applicable to the category of information involved and neither the United States Government nor the Authorized Entity have waived any statutory or common law evidentiary privileges or protections that they may assert in any administrative or court proceeding to protect any sensitive information to which I have been given conditional access under the terms of this Agreement.

Page 2 of 3DHS Form 11000-6 (10/18)

11. Unless and until I am released in writing by an authorized representative of the Department of Homeland Security (if permissible for the particular category of information), I understand that all conditions and obligations imposed upon me by this Agreement apply during the time that I am granted conditional access, and at all times thereafter.

12. Each provision of this Agreement is severable. If a court should find any provision of this Agreement to be unenforceable, all other provisions shall remain in full force and effect.

13. My execution of this Agreement shall not nullify or affect in any manner any other secrecy or non-disclosure Agreement which I have executed or may execute with the United States Government or any of its departments or agencies.

14. These provisions are consistent with and do not supersede, conflict with, or otherwise alter the employee obligations, rights, or liabilities created by existing statute or Executive Order relating to (1) classified information, (2) communications to Congress, (3) the reporting to an Inspector General of a violation of any law, rule, or regulation, or mismanagement, a gross waste of funds, an abuse of authority, or a substantial and specific danger to public health or safety, or (4) any other whistleblower protection. The definitions, requirements, obligations, rights, sanctions, and liabilities created by controlling Executive Orders and statutory provisions are incorporated into this agreement and are controlling.

15. Signing this Agreement does not bar disclosures to Congress or to an authorized official of an executive agency or the Department of Justice that are essential to reporting a substantial violation of law.

16. I represent and warrant that I have the authority to enter into this Agreement.

17. I have read this Agreement carefully and my questions, if any, have been answered. I acknowledge that the briefing officer has made available to me any laws, regulations, or directives referenced in this document so that I may read them at this time, if I so choose.

NON-DISCLOSURE AGREEMENT

Acknowledgement Typed/Printed Name: Government/Department/Agency/Business Address Telephone Number:

Typed/Printed Name: Government/Department/Agency/Business Address Telephone Number:

I make this Agreement in good faith, without mental reservation or purpose of evasion.

Signature:

WITNESS:

This form is not subject to the requirements of P.L. 104-13, "Paperwork Reduction Act of 1995" 44 USC, Chapter 35.

Date:

Signature: Date:

DHS Form 11000-6 (10/18) Page 3 of 3

Exhibit 4

DISCLOSURE AND AUTHORIZATION

PERTAINING TO CONSUMER REPORTS

PURSUANT TO THE FAIR CREDIT REPORTING ACT

This is a release for the Department of Homeland Security to obtain one or more consumer/credit reports about you in connection with your application for employment or in the course of your employment with the Department. One or more reports about you may be obtained for employment purposes, including evaluating your fitness for employment, promotion, reassignment, retention, or access to classified information and/or sensitive, but unclassified information.

I, , hereby authorized the Department of Homeland Security to obtain such report(s) from any consumer/credit reporting agency for employment purposes. Copies of this authorization that show my signature are as valid as the original signed by me.

Signature

Date

Social Security Number

Current Organization Assigned

The Privacy Act, 5 U.S.C. 552a, requires that federal agencies inform individuals, at the time information is solicited from them, whether the disclosure is mandatory or voluntary, by what authority such information is solicited, and what uses will be made of the information. You are hereby advised that authority for soliciting your Social Security Number (SSN) is Executive Order 9397. Your SSN will be used to identify you precisely when it is necessary to conduct and/or obtain a credit report on you. Although the disclosure of your SSN is not mandatory, your failure to do so may impede the acquisition of a credit report concerning you and possibly result in the denial of your being approved for access to classified and/or sensitive, but unclassified information.

DHS Form 11000-9 (10/08)

Lautenberg Amendment Certification (Exhibit 5)

FACT SHEET

On September 30, 1996, Title 18, United States Code, Section 922 (g)(9), was signed into law. This legislation makes it illegal for anyone who has been convicted of a misdemeanor crime of domestic violence to possess, receive, ship or transport any firearm or ammunition. This law applies without exception to any person who has ever been convicted of a misdemeanor crime of domestic violence within the meaning of the statute. The inability of an individual to lawfully possess a firearm disqualifies that person from any position authorizing firearm privileges.

The position for which you have applied authorizes firearm privileges. Therefore, in order to determine your qualifications for this position, you must complete a certification form. Please carefully review the statute and all of the following information before responding to the inquiry.

QUALIFICATION INQUIRY – Prospective New FPS LEO

For new applicants, you must complete the Lautenberg Certification Form and return it following instructions provided. In completing the form, you are advised that:

• The purpose is to obtain information regarding your qualification to possess or receive firearms or ammunition.

• You must complete and return the form in a timely manner to receive consideration for the position to which you are applying. If you fail to complete and/or return the form in a timely manner you will automatically be deemed not qualified.

REQUALIFICATION INQUIRY – Current FPS LEOs

Current FPS LEOs must complete the Lautenberg Certification Form annually, when provided by your supervisor at the time of their performance review.

THE LAW

The Lautenberg Amendment to Title 18, U.S.C., Section 922 (g) provides:

(g) It shall be unlawful for any person –

(9) who has been convicted in any court of a misdemeanor crime of domestic violence, to ship or transport in interstate or foreign commerce, or possess in or affecting commerce, any firearm or ammunition; or to receive any firearm or ammunition which has been shipped or transported in interstate or foreign commerce.

As defined in 18 U.S.C. Section 921 (a)(33), a “misdemeanor crime of domestic violence” means an offense that:

(i) is a misdemeanor under Federal or State law; and

(ii) has, as an element, the use or attempted use of physical force, or the threatened use of a deadly weapon, committed by a current or former spouse, parent, or guardian of the victim, by a person with whom the victim shares a child in common, by a person who is cohabiting with or has cohabited with the victim as a spouse, parent, or guardian or by a person similarly situated to a spouse, parent, or guardian of the victim.

Section 921(a)(33) further provides:

(B)(i) A person shall not be considered to have been convicted of such an offense for purpose of this chapter, unless—

(I) the person was represented by counsel in the case, or knowingly and intelligently waived the right to counsel in the case; and

(II) in the case of a prosecution for an offense described in this paragraph for which a person was entitled to a jury trial in the jurisdiction in which the case was tried either:

(aa) the case was tried by a jury, or

(bb) the person knowingly and intelligently waived the right to have the case tried by a jury, by guilty plea or otherwise.

(B)(ii) A person shall not be considered to have been convicted of such an offense for purposes of this chapter if the conviction has been expunged or set aside, or is an offense for which the person has been pardoned or has had civil rights restored (if the law of the applicable jurisdiction provides for the loss of civil rights under such an offense) unless the pardon, expungement or restoration of civil rights expressly provides that the person may not ship, transport, possess, or receive firearms.

15.1.4.2-A

Exhibit 5a

Lautenberg Amendment Certification

CONTRACTOR EMPLOYEE INFORMATION

Name

Contractor Contract #

PART I: INQUIRY Yes No Initial Date

Have you ever been convicted of a misdemeanor crime of domestic violence within the meaning of the statute?

If you answered “No”, skip to PART II of the form. If you answered “Yes”, review the attached information on the Lautenberg Amendment and then provide the information requested below and complete PART II of the form.

Court/Jurisdiction

Docket/Case Number

Statute/Charge

Date Sentenced

PART II: CERTIFICATION

I hereby certify that, to the best of my knowledge and belief, all of the information provided by me is true, correct, and complete, and made in good faith. I understand that a false statement on any part of this inquiry may be grounds for not hiring me or for firing me after I begin work. False or fraudulent information provided herein is also criminally punishable pursuant to federal law, including 18 U.S.C. 1001.

Date Social Security Number

Privacy Statement

Authority and Purpose: FPS is collecting this information to assess your eligibility to possess or receive firearms or ammunition as an FPS law enforcement officer. Collection of this information is necessary to ensure FPS complies with 18 U.S.C. § 922(g)(9), which prohibits individuals convicted in any court of a misdemeanor crime of domestic violence from possessing a firearm or ammunition that has been shipped or transported in interstate or foreign commerce. The last four digits of your Social Security Number are requested in order to identify you and ensure that this form is maintained in the correct personnel file. The authority for collection of this information is 18 U.S.C. § 922.

Disclosure: Furnishing this information is mandatory. For current law enforcement officers, failure to provide this information will result in loss of eligibility to carry a firearm and may result in disciplinary action up to and including removal from a law enforcement officer position.

Routine Uses: This information will be used within FPS to confirm that current law enforcement officers are not b

15.1.4.2-A

Exhibit 5b

ANNUAL ACTIVE THREAT AWARENESS CERTIFICATION

CONTRACTOR EMPLOYEE INFORMATION

Contractor Contract #

Responding to an Active Shooter Situation

A. Active Shooter - An Active Shooter is an individual actively engaged in killing or attempting to kill people in a confined and populated area; in most cases, active shooters use firearms(s) and there is no pattern or method to their selection of victims. Active shooter situations are unpredictable and evolve quickly. Typically, the immediate deployment of law enforcement is required to stop the shooting and mitigate harm to victim

B. PSO Active Shooter Response - The PSO duty book and/or post orders provide specific procedures for responding to an Active Shooter situation. PSOs will not serve as part of the Tactical Contact or Rescue team and will comply with all direction given by the Unified Response Force or the appropriate Federal or State law enforcement authority.

C. PSO Actions

1. Immediately notify the MegaCenter of an active shooter situation.

2. Follow the emergency notification instructions in post orders.

3. Relay the following information, if known:

a. Suspect location

b. Suspect description

c. Weapons used/carried

d. Description of any device carried or used

e. Suspect direction of travel

f. Number and location of casualties and assistance needed Number of friendly by-standers secured at your location.

4. PSO will maintain assigned posts as long as it is tactically feasible to do so.

5. Direct the building occupants in accordance with the Occupant Emergency Plan.

6. Secure all entrances.

7. PSO will defend self and others as necessary in compliance with their contractually required use of force training.

8. If the shooter is outside, do not let the tenants and visitors go outside of the facility.

9. Stay out of the view of the doors and windows.

10. Turn off the lights and close the shades/ curtains, if possible.

11. Stay put until you receive the “ALL CLEAR” signal from recognized law enforcement.

12. Do not impede law enforcement personnel and follow their directions accordingly.

PSO CERTIFICATION

I hereby certify that I have read the above situational awareness information and understand my roles and responsibilities during an active threat situation. I also understand that if I required clarification of my active threat responsibilities that I will contact my supervisor, company instructor, or an FPS Inspector.

Printed

Date PSO ID (last four SSN)

Exhibit 6 List of Required Training and Certifications

Item Training/Qualification Frequency Provider Section Reference

1 Basic Training One – Time Contractor 6.4.2/Exhibit 8 2 Firearms Training Initial/Semi-

Annual Contractor 6.6.2/Exhibit 8

3 Firearms Training (Transitional) When applicable Contractor 6.6.4/Exhibit 8 4 Firearms Training (Platform) When applicable Contractor 6.6.5/Exhibit 8 6 Firearms Qualification Initial/Semi-

Annual Contractor 6.6.3/Exhibit 8

7 Firearms Certification (Transitional) When applicable Contractor 6.6.4/Exhibit 8

8 Firearms Certification (Platform) When applicable Contractor 6.6.5/Exhibit 8

9 Intermediate Weapons Initial/Annual Contractor 6.6.6/Exhibit 8

10 AED, CPR, & First Aid AHA/ARC standards

Contractor 6.5.3

11 EMT (When applicable) NREMT standards

Contractor 6.5.1.1

12 Refresher Training (36-hr) Every 3-years Contractor 6.4.3/Exhibit 8

13 Orientation Briefing One – Time Government 6.8.2/Exhibit 9

14 Written Examination One – Time Government 6.4.2

15 NWDTP Initial/OJT Contractor 6.7/Exhibit 8 & 9

16 DHS Privacy Training/ PII SPII/Information Security Training/Records Management

Initial/Annual Contractor 4.2.1

17 Other Special Training When applicable As determined 6.9

18 Active Threat Awareness Certification Annual Contractor 6.10/Exhibit 7

19 Annual IRS Security Awareness Training Annual Contractor 6.10/Exhibit 7

Exhibit 7

Contractor's Certification of

Training and Qualification Employee's Name (Specify)

Employee's SSN

First/MI/Last

Contractor's Name

Contract Number

Last 4 only

Training/Qual. Type

Training/Qual. Date to

Score (if applicable)

Qualification

Signature Date

Instructor's Name

Title/First Initial/Last

Instructor's Signature (Required)

Representative's Signature (when applicable)

Authorized Contractor

Representative Title/First/MI/Last

Authorized Contractor Representative

Signature/Date (Required)

I hereby certify the above-named instructor presented the training material and the above-named employee successfully completed all blocks of instruction in accordance with this SOW.

TRAINING CONDUCTED BY

Company's Name

FPS REPRESENTA TIVE (as required)

Representative's Name

Information provided in this certification is subject to investigation and verification under Title 18, Section 1001, United States

Code. Any false or misleading information may be punishable by fine and/or imprisonment.

Exhibit 7a

Contractor's Validation of

Employee Personal Data

Employee's Name

1. Has a valid Social Security Card from the Social Security Administration

2. Has a verified Alien/Immigration Status (I-9 or e-Verify Certificate)

3. (a) Has a minimum of two years of verifiable security or law enforcement experience;

(OR)

(b) Has a minimum of two years of honorable service as a member of any U.S. Armed Forces component

(c) Has successfully completed a federal or state certified law enforcement education and training or police office's standard training course, that may result in a law enforcement appointment or commission

4. (a) Has a high school or general equivalency diploma from an accredited institution of higher learning or as identified on DD Form 214 (Certificate of Release or Discharge from…