Attachment F - Request for Controlled Unclassified (CUI) Building Information Form.docx
DOCX document 129 KB Posted
- Attached to
- Solicitation - Construction Manager as Constructor (CMc) Food and Drug Administration New Laboratory
- Solicitation number
- 47PJ0022R0054
About this file
This document contains a request for controlled unclassified information building information form and disposal statement for a solicitation seeking a construction manager as constructor for a new Food and Drug Administration laboratory building. The General Services Administration is seeking these services for the construction of a new laboratory facility on the Denver Federal Center grounds to replace an outdated building and demonstrate integrated design approaches. Offerors must complete the building information request form providing company and point of contact details, which are verified by the contracting officer before release of controlled unclassified building plans. The disposal statement certifies that upon contract completion, all building information will be destroyed or deleted and no unauthorized copies were retained.
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Text version
Attachment F - Request for Controlled Unclassified Information (CUI) Building Information.
Solicitation/Contract Number _____47PJ0022R0054____________________________ The requester shall complete the information below and return the entire Request for Controlled Unclassified Information (CUI)Building Information document to the Contracting Officer or Contract Specialist. By signature below, the requestor of CUI building information acknowledges the requirement to maintain controls, as stated herein, to safeguard the information, and shall return or destroy the CUI building information as required by this Agreement. The undersigned acknowledges that the requester shall abide by this Agreement and shall only disseminate CUI 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 CUI building information is approved by:
| ________________________________________ | _____________________ |
| Joseph Dorsey | Date |
Contracting Officer
DISPOSAL STATEMENT FOR CONTROLLED UNCLASSIFIED INFORMATION BUILDING INFORMATION
Solicitation/Contract Number ________________________________________ I hereby certify that all Controlled Unclassified Information(CUI) 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 that no unauthorized physical or electronic copies of such CUI building information were made or are being retained.
Company Name: ______________________________________________ Name of Individual: ____________________________________________ Signature: ___________________________________________________ Title: _______________________________________________________ Date: _________________ image1.png
File details come from the government source that posted it. Updated .