Attachment 5-Supplemental Vendor Certification and Eligibilty Form.pdf

Attachment 5

FA561325Q0023/AMENDMENT 0003

SUPPLEMENTAL VENDOR CERTIFICATION & ELIGIBILITY FORM

For Solicitation: FA561325Q0023 (SCIF Installation Requirement) In accordance with ICD/ICS 705 Technical Specifications

SECTION 1: COMPANY INFORMATION

Company Name: __________________________________________

UEI/CAGE Code: ________________________________________

Place of Incorporation: _____________________________________

Country of Ownership/Control: _______________________________

Business Type: ☐ U.S.-Owned ☐ Foreign-Owned ☐ Joint Venture

SECTION 2: PERSONNEL & CLEARANCE ELIGIBILITY

2.1 – U.S. Citizenship Requirement Per IC Tech Spec for ICD 705, Chapter 4, Section d, Para 7 and Chapter 5, Section F, Paragraph 8(a-c), all SCIF construction, installation, and maintenance work shall be performed by U.S. citizens and U.S. owned firms.

General construction of SCIFs shall be performed using U.S. citizens/personnel and U.S.

firms.

The use of workers from countries identified as critical for Technical or Human Intelligence threats or listed on the U.S. Department of State’s Prohibited Countries Matrix, is prohibited.

The use of foreign national citizens or firms is not authorized unless explicitly approved by the Accrediting official (AO) and in accordance with the OSPB standards, with appropriate mitigation strategies outline din the Construction Security Plan (CSP).

☐ I certify that all personnel assigned to this project are U.S. citizens, and no personnel from prohibited or high-risk countries will be used.

2.2 – Personnel Security Clearance As stated in the solicitation and confirmed by the Government:

“Minimum clearance level for personnel is: SECRET” “Installation supervisor (The requesting unit) must hold: TOP SECRET”

☐ I certify that all personnel assigned to this effort have active SECRET or higher DoD clearances.

☐ Security clearance information will be provided upon the Government’s request.

Attachment 5

FA561325Q0023/AMENDMENT 0003

SECTION 3: MATERIAL HANDLING & DELIVERY

☐ I confirm that all ICD 705-covered material will be delivered directly to the U.S.

Government site upon arrival in country, as required by ICD 705, Chapter 4, Section E Para 1f and Chapter 4, Section G, Para 2.

SECTION 4: CERTIFICATION OF COMPLIANCE

☐ I confirm that the contractor will comply with all requirements outlined in the solicitation and intended facility Accreditation Process, including:

- Construction, Installation, and Maintenance by U.S. citizens only (ICD 705, Chapter 4, Section d, Para 7)

- Secure handling of materials and delivery to the Government

- Clearance verification

- Compliance with installation detail submissions (penetration points, cable routing, etc.)

☐ I acknowledge that failure to meet any of these requirements will result in disqualification from this solicitation.

Authorized Representative Name: ____________________________

Title: _________________________

Signature: _____________________

Date: ________________________

Supporting Quote from ICD/ICS 705:

ICD/ICS 705 Tech Spec Section Chapters 4-5:

“Cleared U.S. citizens shall be used to perform all work in the SCIF area... The use of uncleared personnel or foreign nationals is not authorized without prior written approval from the Accrediting Official.”