Military_Data_DD2345Form-CompleteLLC.pdf

AIJ3 2' 2012

MILITARILY CRITICAL TECHNICAL DATA AGREEMENT OMS No. 0704-0207

(Please read Agency Disclosure Notice and Instructions on back OMB approval expires before completing this form.) Apr 30. 2011

MAIL THE ORIGINAL, COMPLETED COPY OF THIS FORM AND A COPY OF YOUR COMPANY'S INCORPORATION CERTIFICATE, STATE/ PROVINCIAL BUSINESS LICENSE, SALES TAX IDENTIFICATION FORM OR OTHER OOCUMENTATION WHICH VERIFIES THE LEGITIMACY

OF THE COMPANY TO:

U.S./CANADA JOINT CERTIFICATION OFFICE

DLA LOGISTICS INFORMATION SERVICE

FEDERAL CENTER, 74 WASHINGTON AVE., NORTH

BATTLE CREEK, Ml USA 49037-3084

1. TYPE OF SUBMISSION (X one) X I a. INITIAL SUBMISSION I b. REVISION I c. S·YEAR RENEWAL

2. ENTERPRISE OR INDIVIDUAL DATA (Referred to as a "certified contractor" upcn acceptance of certification by the U.S.!Canada- JCO)

a. NAME (Name of £nterpnse or Individual) b. ADDRESS (Physical address. mcludfng P.O Box 1f appliCable)

Ten Tech LLC 3235 Sawtelle Blvd. Unit 19

c. NAME OF SUBSIDIARY/DIVISION/DEPARTMENT Los Angeles, CA 90066-1648 ~ot Applicable --

d. CAGE CODE 6JBM1

3. DATACUSTODIAN

a. NAME OR POSITION DESIGNATION (See Instructions) b. TELEPHONE NUMBER (Include Area Code)

William Villers (424) 704-3235

c. TITLE d. E-MAIL ADDRESS

Director of Engineering wvillers@tentechllc.com

4. DESCRIPTION OF RELEVANT BUSINESS ACTIVITY (Pnnt or type) Computer-Aided Engineering Services: structural and thermal analysis of mechanical systems (i'IAICS Code 541330)

5. AS A CONDITION OF RECEIVING MILITARILY CRITICAL TECHNICAL DATA, THE ENTERPRISE OR INDIVIDUAL CERTIFIES THAT:

a. CITIZENSHIP/RESIDENCY STATUS.

The individual designated either by name or pos1t1on designation in Item 3, who d. They will not prov1de access to militarily critical technical data to persons other will act as custodian of the militarily critical technical data on behalf of the contractor than the1r employees or eligible persons des~gnated by the registrant to act on their is a citizen or person admitted lawfully for permanent residence into· behalf unless such access is perm1tted by U.S DoDD 5230.25, Canada's TDCR, or (X (1) or (2)) by the U.S. or Canad1an Government agency that provided the technical data.

X l111 THE UNITED STATES L!2) CANADA

b. The data are needed to bid or perform on a contract w1th any agency of the U S.

e. No person employed by the enterprise or eligible persons designated by the registrant to act on their behalf, who will have access to militarily critical tect1n1cal Government or the Canadian Government or for other legitimate business activities data, IS disbarred, suspended, or otherw1se Ineligible to perform on U.S. or in which the contractor is engaged, or plans to engage.

Canadian Government contracts or has violated U.S or contravened Canadian

c. They {1) acknowledge all responsibilities under applicable US export control export control laws or has had a certification revoked under the provisions of U S laws and regulations (inc1ud1ng the obligation under certain circumstances, to obtam DoDD 5230 25 or Canada's TDCR.

an export license from the U S. Government prior to the release of militarily crit1cal technical data within the United States) or applicable Canadian export control laws f They are not themself debarred, suspended, or otherwise Ineligible to perform on and regulatiOns, and (2) agree not to dissemmate militarily critical technical data in a U S. or Canadian Government contracts, and have not violated U S. or contravened manner that would violate applicable U.S. or Canadian export control taws and Canad1an export control laws, and have not had a certification revoked under the regulations. provisions of U S. DoDD 5230.25 or Canada's TDCR.

6. CONTRACTOR CERTIFICA T!ON

I certify that the information and certifications made by me are true, complete, and accurate to the best of my knowledge and belief and are made in good fa1th. I understand that a knowing and willful false statement on this form can be punished by fine or imprisonment or both.

(For U.S contractors see U.S. Code, Title 18, Section 1001 and for Canadian contractors see Sectton 26 of the Defense Production Act.)

a. TYPED NAME (LAST, First. Middle Initial) b. TITLE c. SIGNATURE ( / I d. DATE SIGNED

William Villers Director of Engineering

~ / I 08/22/2012 t-

7. CERTIFICATION ACTION (ForJCO Use Only)

a. CERTIFICATION ACCEPTED. This certification number, a!ong with a b. NUMBER c. EXPfrtfN DATE statement of intended data use, must be included w1th each request for ool.kt5'7 1 s " ' g militarily critical technical data.

B. DOD OFFICIAL 9. CANADIAN OFFICIAL

a. TYPED NAME (LAST, First, Middle lnitia/J a. TYPED NAME (LAST First, Middle lm1ial)

MIAAn ( 'Moten NORMAN WEIR

b. TITLE U.S. clepresentative b. TITLE Canadian Representative

J.S./Canaoa Joipt Certification Office U.S./Canada Joint Certification Office

~1f:'Mc d. DATE SIGNED c.

SIGNATn A

d. DATE SIGNED

~ oridJ#- .Ml4 2013 J,\N l ~ 2013

DO FORM 2345, MAR 2011 PREVIOUS EDITION IS OBSOLETE. Adobe Professional S 0