Attachment J.4 – Non-Disclosure Agreement .docx

Attachment J.4

FMCSA NON-DISCLOSURE AGREEMENT

FEDERAL MOTOR CARRIER SAFETY ADMINISTRATION

NON-DISCLOSURE AND CONFIDENTIALITY AGREEMENT FOR

FEDERAL EMPLOYEES, CONTRACTOR, AND SUBCONTRACTOR EMPLOYEES

I. I__________________________________ do solemnly swear (or affirm) that I understand the high standards of trustworthiness and integrity required of me with regard to materials and information which may come to my attention in connection with the work I perform for the Federal Motor Carrier Safety Administration (FMCSA), while I am an employee, contractor, or subcontractor for FMCSA. I understand and acknowledge that I may be granted access to sensitive, protected, and/or confidential information related to the Federal Motor Carrier Safety Administration (FMCSA), including, but not limited to, information about individuals, including personally identifiable information, which is protected by the Privacy Act of 1974 and other federal laws: other enforcement or audit data owned or used by FMCSA, information related to the business, personnel and physical or information technology security practices of the U.S. DOT and/or FMCSA. I agree to use such information only in the course of my official duties.

II. Except as necessary in the performance of my duties for FMCSA, I will not:

A. Reveal, divulge, or publicize any matters dealt with for FMCSA

B. Disseminate any oral or written information obtained as a result of the performance of my work for FMCSA

C. Remove or transmit any documents from the place of contract performance or otherwise obtained during the contract performance, except as approved in advance by the Contracting Officer’s Representative or Contracting Officer.

Furthermore, while working as an employee, contractor, or subcontractor for FMCSA, I will abide by the rules and regulations governing the treatment of National Security Information (NSI) (classified) and/or Sensitive But Unclassified (SBU) information as outlined in Title 28, Code of Federal Regulations. I agree to report immediately to FMCSA’s Contracting Officer’s Representative (COR), FMCSA’s Information System Security Manager (ISSM), or U.S. DOT when appropriate, any unauthorized use, unauthorized disclosure, or other breach of sensitive, protected, and confidential information of which I become aware, or which I suspect has occurred or may occur. In addition, immediately at the conclusion of my work (no later than 1 business day) under this program/contract, I agree to notify FMCSA, in writing, that I no longer require access to FMCSA Information Resources.

Sensitive PII should only be accessed via FMCSA approved portable electronic devices (PEDs) such as laptops, encrypted USB flash drives, and external hard drives (including contractor-owned equipment or a system that is approved to be used as a government system). Personally-owned USB flash drives may not be used.

III. As federal employee, contractor, or subcontractor for FMCSA, I understand that all materials provided by the Government, including any copies, notes or working papers derived or produced therefrom, are the property of the Government. I will promptly surrender all such materials and derived copies, notes, and/or working papers which are in my custody or control upon demand or upon completion or termination of my work with FMCSA as applicable, whichever comes first.

I understand that my failure to surrender such materials promptly or my conversion of such materials to a use not called for under my work for FMCSA (e.g. delivery of a document, or a copy thereof: or notes containing information taken from the document to someone not working as an employee, contractor, or subcontractor for FMCSA on the particular matter may be at a minimum, a violation of 18 U.S.C. 641 (theft of Government property) and may subject me to fines (up to $10,000) and imprisonment (up to 10 years).

IV. At the conclusion of my work under this program/contract, I will verify with the FMCSA COR and/or Contracting Officer that I have surrendered or destroyed any and all FMCSA PII that has come into my custody while working under this program/contract, in a manner consistent with FMCSA security requirements. Or, if applicable, I will direct the COR or Contracting Officer to the appropriate contractor/company personnel for further information regarding destruction of PII information.

V. This agreement may be formally modified or changed by the Government in those instances in which the courts (e.g. grand jury investigations), statutory requirements (e.g. civil investigative demands), or specific circumstances dictate such a modification or change. This Agreement shall not apply to: (1) Disclosures of sensitive, protected, confidential, and all other types of information approved in advance in writing by the Contracting Officer or an FMCSA employee who is at the Senior Executive Service level or above: or (2) Information that is or was publicly available by means other than my disclosure: or (3) Compliance with a valid court order: provided, however, that I agree to inform the FMCSA Office of Chief Counsel as soon as possible after, and in no event more than one business day after, my receipt of such a court order, and to provide the FMCSA Office of Chief Counsel with a complete and unabridged copy of the order.

VI. If applicable, 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 (I) 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 the public health or safety, (4) any other whistleblower protection. The definitions, requirements, obligations, rights, sanction, and liabilities created by controlling Executive orders and statutory provisions are incorporated into this agreement and are controlling.

VII. The prohibitions and requirements in this agreement have no expiration. By signing this agreement, I certify that I have read this nondisclosure agreement and agree to these terms.

IN WITNESS WHEREOF, I hereby agree to this Non-disclosure Agreement as evidenced by my signature below:

By:________________________________________

Signature: __________________________________

Print Name: __________________________________

Date: ________________________________________

Title: ________________________________________

Company/Agency: _________________________________________________

If applicable, contract number: ________________________________________________

Attachment J.4 – FMCSA NON-DISCLOSURE AGREEMENT Page 1 of 3 RFP No. 693JJ426R000002