Attachment 6 - Form FDA 3398.pdf

PDF 465 KB Posted

Attached to
Renovation of Buildings 26 and 50 Roof Replacement
Solicitation number
75F40123R00088
Issued by

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This document is an employee agreement form for contractors working with non-public information from the Food and Drug Administration. The form outlines the legal requirements for contractors to protect confidential FDA information accessed during contract performance under 21 U.S.C. 331(j), 21 U.S.C. 360j(c), 18 U.S.C. 1905, and associated laws and regulations. By signing the agreement, employees of FDA contractors acknowledge legal penalties for violating nondisclosure provisions. The form requires contractors to provide the contract number, description of released information, employee and witness names and signatures, and dates. It also specifies the employer name be included. No products, services, pricing or other procurement details are referenced as this document appears to be an attachment template for a confidentiality agreement rather than a solicitation itself.

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Other files

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Amendment 4 75F40123R00088.pdf PDF
Amendment 3 75F40123R00088.pdf PDF
Attachment 2 Site Visit Attendee List.pdf PDF
Amendment 2 75F40123R00088.pdf PDF
Attachment 1 NCTR Bldg 26 - Roof asbestos survey.pdf PDF
Amendment 1 75F40123R00088.pdf PDF
Attachment 2 Bldg 26 Roof Replacement Project Manual.pdf PDF
Attachment 5 Wage Decision.pdf PDF
Attachment 3 Bldg 50 Roof Replacement Drawings.pdf PDF
Attachment 8 Past Performance Evaluation Questionnaire.docx DOCX document
Attachment 4 Bldg 50 Roof Replacement Project Manual.pdf PDF
Sol Doc 75F40123R00088.pdf PDF
Attachment 1 Bldg 26 Roof Replacement_Drawings.pdf PDF
Attachment 7 Sample Client Authorization Letter.docx DOCX document
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COMMITMENT TO PROTECT NON-PUBLIC INFORMATION

EMPLOYEE AGREEMENT

Whereas access to non-public information from the files of the Food and Drug Administration (FDA) is required in the performance of my official duties, under Contract Number between FDA and my employer

I, on this day of , 20 hereby agree that I shall not further release, publish or disclose such information and that I shall protect such information in accordance with the provisions of 21 U.S.C. 331(j), 21 U.S.C. 360j(c), 18 U.S.C. 1905 and other pertinent laws and regulations governing the confidentiality of non-public information.

I understand the provisions of 21 U.S.C. 331(j), 21 U.S.C. 360j(c), 18 U.S.C. 1905 and that I am subject to criminal penalties prescribed by law for any violation(s) thereof.

Signature: Date:

Type or Print Name:

Witnessed by: Date:

Type or Print Name:

DESCRIPTION OF INFORMATION RELEASED:

FORM FDA 3398 (10/10)

DEPARTMENT OF HEALTH AND HUMAN SERVICES

FOOD AND DRUG ADMINISTRATION

Please type a description of information released here:
Please type witness's name here:
Please type your name here:
Please type date of the witness's signature here in 2 digit month/2 digit day/4 digit year format:
Please type the signature date here in 2 digit month/2 digit day/4 digit year format:
Please type the employer's name here, first line:
Please type the employer's name here, second line:
Please type the current day here:
Please type the current month here:
Please type the current 2 digit year here: 21
Please type the contract number here:
Contract Number:
Attachment Number: FDA 3398

File details come from the government source that posted it. Updated .