Attachment 1_N00024-17-IWS5A-01 Material Request Form_final.pdf

N00024‐17‐IWS5A‐01

BROAD AGENCY ANNOUNCEMENT MATERIAL REQUEST FORM

Those companies who wish to receive the material relevant to the Broad Agency Announcement (BAA)

N00024‐17‐IWS5A‐01 are to submit this form to:

Name Email Role

Shannon Vineyard shannon.l.vineyard.civ@us.navy.mil Procuring Contracting Officer

Vinny Bianco vincenzo.l.bianco.civ@us.navy.mil Contract Specialist

Meg Stout margaret.c.stout2.civ@us.navy.mil Contract Officer Representative

Material Request

Supplements Requested (select those desired)

Submarine Signal Processing and Displays Surface Ship Signal Processing and Displays Submarine and/or Surface Ship Sensors Theater Undersea Warfare

Company Name

CAGE Code

Facility Clearance Level (FCL)

Level of Safeguarding

FSO Validation of FCL/Safeguarding

Unclassified Mailing Address

Classified Mailing Address

Classified Mailing POC Name:

Phone:

E‐mail:

Facility Security Officer Name:

Phone:

E‐mail:

Recipient for Copy 1

Name:

E‐mail:

FSO validation of clearance

O p ti o n al Recipient for Copy 2

Name:

FSO validation of clearance

Requested Method of Delivery (if other than USPS)

Fed Ex CTR Fed Ex Account Number:

Contractor Courier Pick Up Name: