Exhibit_6_HSPD-12_Documents.pdf

Section I HSPD-12 Security and Credentialing Requirements

PART 1 - SECURITY REQUIREMENTS AND PERSONAL IDENTITY VERIFICATION AND

CREDENTIALING PROCEDURES FOR CONTRACTORS

(NON-CLASSIFIED CONTRACT)

1.1 The General Services Administration (GSA) reserves the right to verify the identities of Contractor personnel with routine, unaccompanied access to GSA facilities or to Information Technology (IT) systems and networks, to make contractor personnel fitness determinations based on background investigations, and control access to GSA facilities and IT systems and networks based on those determinations. The term ‘Contractor’ refers to the General/Prime Contractor Company or lessor on a GSA contract and any related Subcontractor(s) company and Vendor(s). The term ‘Contractor Personnel’ refers to any Contractor personnel supporting GSA contracts. The Contractor and their Contractor Personnel shall comply with the GSA Personal Identity Verification (PIV) procedures outlined below, that implement Homeland Security Presidential Directive-12 (HSPD-12), Office of Management and Budget (OMB) guidance M-05-24, and the Federal Information Processing Standards Publication (FIPS PUB) Number 201, as amended. HSPD-12 requires Federal agencies to issue standardized PIV credentials to Federal employees and contractors and use the credentials for access to Federal facilities and IT networks and systems. GSA branded the PIV card that GSA issues to its personnel as the GSA Access Card. The GSA Access Card enables routine, unescorted access to GSA facilities and IT systems and networks.

1.2 In accordance with FAR 52.204-9 (Personal Identity Verification of Contractor Personnel (Jan 2011), the Contractor shall account for all GSA credentials issued to Contractor Personnel in connection with the performance under this contract. The Contractor Personnel shall immediately return credentials issued by GSA under any of the following conditions, as stipulated in FAR 52204-9:

All Contractor Personnel who will perform work on a GSA contract and will require routine access to GSA facilities or IT systems and networks may be required to obtain a GSA Access Card. The GSA Contracting Officer or their Designated Representative and/or the Security Officer will define routine access. Contractors must receive a favorable result on their Federal Bureau of Investigation (FBI) Fingerprint Check and GSA must have initiated a minimum of a National Agency Check with Written Inquiries (NACI) before GSA can issue an Access Card.

GSA will revoke the Access Card for a Contractor who receives an unfavorable final fitness determination based on the NACI or higher background investigation. GSA may also remove the Contractor from the GSA contract and restrict access to GSA facilities and IT systems and networks if the Contractor receives an unfavorable final fitness determination.

A. GSA maintains full and complete control over granting, denying, withholding or terminating fitness determinations for Contractor Personnel supporting GSA contracts.

GSA grant an interim determination to Contractor Personnel. A interim fitness determination by GSA does not guarantee that GSA will grant a final favorable determination. A favorable temporary, preliminary or final fitness determination by GSA shall not prevent, preclude, or bar GSA from withdrawing or terminating a fitness determination.

B. HSPD-12 standards establish the minimum background investigation requirements and adjudication guidelines for GSA to issue an Access Card. GSA may require Contractor Personnel to obtain a higher-level background investigation than the minimum required background investigation for an Access Card, based on the Contractor Personnel’s contract employment job duties.

C. Contractor Personnel may be required to submit additional personnel information to other Government Agencies affected by the contract work and based on working within that Agency’s space.

1.3. GSA may require Contractor Personnel who need less than 6 months of routine access to GSA facilities to receive a favorable result on a Special Agency Check (SAC) to access GSA facilities. The GSA Contracting Officer or their Designated Representative and/or the Security Officer will define the level of access to GSA facilities and will define how long the access is valid. Contractor Personnel that are not required to receive a favorable fitness determination may be required to be escorted at all times while in non-public GSA space.

1.4. The Contractor shall account for all GSA credentials issued to Contractor Personnel in connection with the performance under this contract. The Contractor Personnel shall immediately return credentials issued by GSA under any of the following conditions:

A. When the Contractor Personnel is no longer required for contract performance.

B. Upon completion of the Contractor Personnel’s employment.

C. Upon contract completion or termination.

D. If the Contractor Personnel is removed from the contractor based on an unfavorable determination on any background check.

1.5. The Contracting Officer may delay final payment or execute an equitable adjustment under the contract, if the Contractor and/or their Contractor Personnel fail to comply with the requirements in paragraph 1.4.

1.6. Contractor shall insert these requirements in all subcontracts. It shall be the responsibility of the Contractor to return all credentials issued by GSA in accordance with the terms set forth in paragraph 1.4, above of this section.

PART 2 - FEDERAL DEBT REDUCTION AND OVERSIGHT OF FEDERAL FUNDS

2.1 The GSA has a fiduciary responsibility to provide oversight of federal funding. The Contractor will work with the GSA to reduce expenditures, and assure oversight of federal tax dollars when requesting background checks. In order to reduce expenses and ensure prudent use of federal funds, the Contractor will make every effort to pre-screen or interview prospective personnel to help ensure they are eligible for a credential and are able to pass a background check prior to submitting employee applications to GSA.

2.2 The Contractor company shall assign and dedicate a single Point of Contact (POC) for the overall control, management, and oversight of all background investigation applications for its Contractor employees. The Contractor POC is responsible for collecting all of the Contractor employee background investigation documents and submitting them to the Contracting Officer or their Designated Representative to ensure the completion of the background investigation request. The Contractor POC shall follow the method identified by the GSA Contracting Officer or their Designated Representative and/or the Security Officer to submit the background investigation documents to GSA. The Contractor POC must provide follow-up and monitoring to ensure that the Contractor Personnel who needs an investigation responds to requested information and completes all required forms within the prescribed times allowed, so as not to delay the project schedule or project completion date.

2.3 The Office of Personnel Management may send written notification to contractor personnel requesting clarification, additional information, or supporting documentation pertaining to the background investigation requested. The POC shall ensure the Contractor Personnel responds to such inquiries so as not to cause adjudication delay, and the POC shall consider submitting an alternate applicant so as not to cause delay with the project schedule or project completion date.

PART 3 - ADJUDICATION AUTHORITY

3.1 GSA and its Authorized Agent, the Office of Personnel Management or any other named designee, will be responsible for conducting the HSPD-12 background investigations, and credentialing of Contractor Personnel. GSA has the final authority to process the HSPD-12 background investigations, as directed by the Office of Personnel Management (OPM).

PART 4 -PROCESSING OF HSPD-12 INVESTIGATIONS AND CREDENTIIALING

PROCEDURES

4.1 Submission of Forms: All Contractor Personnel requiring facility or IT system and network access may be responsible to fill out and complete HSPD-12 security forms and fingerprint cards, or electronic fingerprint scans, prior to being allowed access. GSA will provide detailed instructions on the HSPD-12 process, the forms to be submitted, and the handling of the forms after the contract has been awarded. A maximum of fifteen (15) days is expected for the completion and submission of all forms by the applicant. More importantly, the Contractor Personnel and the Contractor Point of Contact (POC) have the responsibility to submit applications in a timely fashion so as not to delay any project activities or the overall project schedule. Complete submissions of all investigation forms are necessary a minimum of thirty

(30) days prior to access being required when a GSA Access Card is not needed. When a GSA Access Card is required, submissions are necessary sixty (60) days prior to access being required. Access requirements by Contractor Personnel shall be based on the contract time performance requirements and the planned activities on the approved project schedule.

The Contracting Officer or their Designated Representative and/or Security Officer will notify the Contractor POC in writing if any Contractor Personnel receive an unfavorable decision on their background investigation, and effective immediately, the individual will no longer be allowed to work on the project. The Contractor shall be responsible for planning and scheduling its work in such a manner as to account for the facility and IT access requirements. Difficulties encountered by the Contractor Personnel in gaining access when required by not fulfilling application requirements in a timely manner shall not be an excuse for Contractor non-performance under the contract or for the granting of any time extensions.

A. Throughout the life of the contract, the Contractor shall be responsible to follow these same procedures for any new Contractor personnel who require access to GSA’s space or IT systems and networks.

B. Also throughout the life of the contract, the Contractor shall maintain a listing of current/active personnel and their subcontractors’ personnel that have received a favorable fitness determination and/or have a GSA Access Card. The Contractor shall provide the Contracting Officer or their Designated Representative, an updated listing of current/active personnel or subcontractors’ personnel when requested.

4.2. Unfit Personnel: If the Contracting Officer receives an unfit determination on any Contract Personnel, or if the GSA finds a prospective Contractor Personnel to be unfit for their assigned duties, the Contractor POC shall be advised immediately by the Contracting Officer or their Designated Representative and/or the Security Officer that the Contractor Personnel cannot continue to work or be assigned to work under the contract. The Contractor must then take action to remove the Contractor Personnel from the GSA contract.

4.3 Criteria for Eligibility: Refer to OPM Memorandum dated, July 31, 2008, “Final Credentialing Standards for Issuing Personal Identity Verification Cards under HSPD-12” which outlines the disqualifying and mitigating factors for personnel acceptance.

4.4 Prior Background Investigation: Contractor Personnel background investigations obtained through an HSPD-12 process may be acceptable if the investigation can be validated and is equal to or higher level than required for the contract. Also, any break in service since the prior adjudication must be less than two years. The Contracting Officer or their Designated Representative and/or the Security Officer in consultation with OPM will determine whether there is a break in service and whether a prior background investigation meets GSA’s requirements to grant access to GSA facilities and IT systems and networks. GSA requires the Contractor Personnel to submit required background investigation documents for GSA to determine whether a prior investigation meet’s GSA requirements to grant access to GSA facilities and IT systems and networks.

4.5. Identification Credential: The following paragraphs describes GSA’s requirements for Contractor Personnel to display GSA credentials, follow GSA building screening procedures, and follow procedures to report lost GSA credentials.

A. Contractor Personnel with GSA Access Cards are required to comply with all applicable security screening procedures at the Government location, just as other personnel possessing similar credentials and as determined by the building’s Facility Security Committee.

B. All Contractor Personnel possessing credentials shall visibly display their credentials at all times while in the building(s) where work is being performed.

C. The Contractor shall be responsible for ensuring that all GSA identification is returned to the GSA when Contactor Personnel are no longer employed, are no longer providing service under the contract, when the contract ends, or the Contractor Personnel is removed as a result of an unfit determination.

D. The Contractor Personnel shall notify the GSA when GSA identification is lost.

If the Contractor Personnel is determined to be negligent, the Contractor may be responsible for reimbursing the Government for the cost of issuing a replacement credential.

PART 5 - GSA ACCESS CARD: CONTRACTOR’S TRAVEL COSTS

5.1. Contractor personnel who require routine access to GSA-controlled facilities and/or access to GSA IT systems must receive a preliminary favorable HSPD-12 security background investigation, before receiving a GSA Access Card.

5.2. Following a favorable HSPD-12 background investigation, Contractor Personnel may be required to activate a GSA Access Card at a designated location. The GSA Access Card is a photo Identification card, which includes biometric information. The following information is provided to assist the Contractor in estimating the costs that may be associated with this requirement:

The Contractor Personnel will be expected to utilize the nearest credentialing site to their offices or place of contract performance. The credentialing station may be a mobile station or a fixed station. Location(s) can be identified at:

http://www.fedidcard.gov/centerlocator.aspx. Credentialing centers that are listed as “Open to all Agency personnel” are open to GSA Contractors. Credentialing centers that are listed as “For use by personnel from this Agency only” are only open to personnel of the specific agency listed. Currently, a minimum of two visits to a credentialing center may be required to enroll and activate the GSA Access Card. The first visit is to enroll and the second visit is required to pick-up and activate it. Additional visits to a credentialing center are required when the card holder needs to renew their credential certificate (after 3 years) and when the credential expires (after 5 years). Additional visits may also be required for lost or damaged cards which need replacement.

5.3. If a GSA Access Card is required, the Contractor is responsible for all travel and labor costs associated with fingerprinting to meet the background investigation requirement, and the costs associated with the card enrollment and activation requirements, unless stated otherwise elsewhere in the contract. Travel costs may be comprised of mileage, vehicle rental, or other modes of transportation, per diem, and lodging. These costs are considered reasonable to the extent that they do not exceed, on a daily basis, the maximum rates in effect at the time of travel, as set forth in the Federal Travel Regulation, Chapter 301 – Temporary Duty (TDY) Travel Allowances, which can be accessed at the following website: http://www.gsa.gov/ftr.

Information on Privately Owned Vehicle (POV) Mileage Reimbursement Rates can be accessed at the following website: http://www.gsa.gov/travelpolicy.

5.4 Any annual training requirements associated with IT access that may be required for continued use of the GSA Access Card is expected to be completed within a timely fashion.

Otherwise, the Contractor Personnel’s access may be revoked and the card taken away.

Contractor Information Worksheet (CIW) Version 4 (updated 12/2/10) Completion Instructions

Top of page:

(GSA Requesting Official to complete) Type Contractor: Select “appropriate contractor type” ARRA long term: Select if work related to ARRA or Not Applicable Investigation Preference:Select “e-QIP” (all submissions are required via e-QIP online).

Priority: Select “Routine” Sponsoring Office Symbol: Input appropriate office symbol GSA Region: Enter 10 Section 1: Contract Employee Information (Contract Company Representative to complete) Name: Provide full first, middle and last name. If initial only, enter the appropriate initial and “IO”. If no middle name, enter “NMN”.

Suffix: If none, leave blank, if the applicant has one, enter appropriate suffix (Sr., Jr., III, etc).

Social Security #: Enter the full SSN with dashes.

Date of Birth: Use the MM/DD/YYYY format.

Place of Birth: City: Enter the appropriate city. State: Enter the appropriate two letter abbreviation. If born outside the continental United States, this may be left blank. Country:

Enter US or other country as appropriate.

Sex: Select the appropriate box.

Home Street Address: Enter complete home address with no abbreviations (ex. East).

E-Mail: Required for e-QIP submissions. This can be the contract company’s representative, or the contract employee’s personal or business e-mail address.

Phone # (Day) and Phone # (Cell): Both boxes must be filled in; these two numbers may be the same.

Position (Job) Title: Be specific as to the job the applicant is filling. For example use electrician, fence installer, janitorial, etc.

IT/System Admin Position: Select this box only if the individual is currently filling a position as a system administrator on a Government Information Technology System.

Prior Investigation: Select either yes or no.

Investigation Date: Only complete if you selected “yes” in the previous box, and you have a verifiable date for the previous investigation. If prior investigation, please notate in the comments/note section the government agency that conducted the background, adjudicators name and contact information and email as an attachment any adjudication letters received.

US Citizen: Select the appropriate box.

Non-US Citizens (if the applicant is a US citizen, this may be left blank):

Port of Entry City and State: Enter the US city and state of entry.

Date of Entry: Enter the date the applicant entered the US.

<3 Yrs. US Resident: Select if you have been a US Resident for 3 years or more.

Alien Registration #: Enter the applicant’s registration number.

Citizenship: Enter the applicant’s current country of citizenship.

Section 2: Contract Information (GSA Requesting Official completes, Contract Company completes any remaining portions)

Company Name: Enter the name of the company the applicant works for.

Company is: Select either Prime or Subcontractor, as appropriate.

If Sub, Name of Prime: Only enter information here if the company is a subcontractor. Enter the name of the prime contractor company.

Task Order/Delivery Order: Enter the appropriate number here. Applicable number may include Lease Number, Purchase number or RWA number.

Contract Number Type: Select appropriate Contract Start Date: Enter the date the contract or lease started.

Contract End Date: Enter the end date of the contract or lease.

Has Option Years OR End Date TBD: Select the box if applicable.

Company Point of Contact (POC) Name: Enter the company’s POC.

POC Phone # (Day): Enter the phone number for the company’s POC.

POC email address: Enter the email address of the company point of contact.

Section 3: Project/Work Location Information (GSA Requesting Official to complete) GSA Building Number: Enter the complete GSA building number(s).

GSA Building Name: Enter the name of the building(s) where the applicant will be working.

Building Address: Enter the complete address of the facility or facilities.

Section 4: Type of Investigation Requested for: HSPD-12 Credential (GSA Requesting Official to complete) Select Low Risk (NACI) SF-85P for work/clearances over six (6) months OR select Non- HSPD-12 Credential for work/clearance that is less than six (6) months.

Section 5: Requesting Official (Sponsor) Information (GSA Requesting Official to complete; a requesting official may be a contracting officer, property manager, project manager. The requesting official is required to review the CIW for accuracy, appropriate security clearance, contract number and expiration date).

Sponsor’s Name: Enter the GSA Requesting Official’s name.

Title: Enter the GSA Requesting Official’s job title.

Is COR/COTR: Select if the GSA associate is the COR.

Email address: Enter the appropriate email address for the GSA associate.

Phone # (Day): Enter the phone number for the GSA requesting official.

Date Forms were reviewed: enter the date given to Contract Company Comments: GSA Security Office (r10pbssecurity@gsa.gov) must be notated here.

Section 6: DHS Federal Protective Service CSA:

(Leave blank)

GSA R10 ESCORT POLICY

Escorts are permitted for temporary contractors for very short duration; jobs ten days or less. Escorts may be government employees or long term contractors (including contract guards) who have received an EOD and whose NACI is in process. Escorts must maintain control and be in sight of those they are escorting at all times. The ten day rule is not to be used throughout a project, but rather for a simple portion of the project that will be under ten days. In order to be approved for an escort, the following approval process must be followed:

1. Project Manager must fill out the R10 escort approval form

2. Project Manager must send to the appropriate GSA

Property Manager for approval.

3. Project Manager will send form to the GSA R10 Security

Office at r10securityem@gsa.gov

4. Security Office will verify if applicant has previously under gone a background investigation and to validate that an “unfavorable” or “unfit” determination had not been previously issued. Security will also enter all information for tracking purposes into GCIMS. If Security notes that the applicant is being escorted on multiple occasions, security may not approve and require applicant undergo a background investigation.

5. If the security office denies an escort request, the contractor must either not work on that project or must undergo the appropriate background investigation and adjudication prior to beginning work.

Note: It is important the project manager discuss the security plan for each project. Each project and facility will be different, however it is important to know what the building security rules and procedures are and that each contract company is made fully aware on how to comply. For example, if work is going to be done after hours in a level (4) facility with tenants that have high security concerns and there is no after hours security guard, it may be necessary to hire a guard or develop an escort plan. The intent here is to ensure we don’t have a large number of contractors with full access to a federal facility with no security protocols put in place. The security office is available to assist with these plans.

mailto:r10securityem@gsa.gov

(a quick guide)

Right click on file or folder.

Select Send To, Compressed (zipped) folder; new zipped file is created with the same name.

Double-click on new file; WinZip opens.

Select Encrypt.

Enter password. Click 256-bit then OK.

Exit WinZip.

Attach zipped file to email.

IMPORTANT NOTE: Send password over the phone or in a separate email which does NOT contain the word “password.”

How to Use WinZip to Encrypt Files

Page 1 of 1 WinZip_Iinstructions.docx 2015-06-22

10-Steps to Sensitive and PII Data E-Mail Transmission Compliance

1. From your Desktop right click on “Start” button at the bottom left of the screen and select “Open Windows Explorer”.

2. Locate the folder and/or file(s) to encrypt. They are found the normal way you locate any file and/or folder.

3. When you locate the file(s) and/or folder(s) you want to encrypt select each one or all of them, (they will appear as highlighted), and then right click.

Select “Send To” and then select “Compressed (zipped) folder.

4. The file(s) and/or folder(s) will be added to a “Zipped File” of the name one of the file included in the zipped file, (located at the top or bottom of your file list). Double Click on that file to “Open” the WinZip utility.

5. Select the “Encrypt” option. You may get a “Caution Dialogue” box. Select the box “Do not display this dialog box in the future.” Click “OK”.

6. You are in the dialogue box titled “Encrypt” at the top. You will need to type in a password twice. Make sure the “Mask Password” is checked.

Under “Encryption method” make sure 256-Bit AES encryption (stronger) is selected. Click “OK”.

7. After the file(s) and/or folder(s) have been encrypted, click on “File” and select “Exit”.

8. To verify that the encrypted file has been created, you can go to the folder assigned during encryption and look for the file name. You do this by going back to “Step #1” and locating the WinZip “File Name.zip”.

9. Your file is now “Encrypted”, in compliance with the GSA Privacy and Policy, and ready to be an “Attachment” in your E-Mail transmission outside of the GSA firewall.

10. You will have to give the E-Mail recipient the encryption password.

*Contact the individual by telephone to provide the password. If you’re unable to reach by telephone you can send the password in a separate E- Mail. The “zipped file attachment and password” Should Not be transmitted in the same E-Mail. Also, Do Not put the “Password” in the subject line.

C O

R /P

M C on tr ac tc or

In ve st ig at io n Te am

(C

IT

Start

4. Creates/Updates GCIMS record and Sponsor contractor

End

Process Step

Decision

KEY

Sequence Flow

Termination Point

Trigger Point

Yes

No

G

SA

C on tr ac to r/

Ve nd or P

O C 1. GSA Contractor fills out CIW and Vendor POC provides CIW soft copy via email - Word Document only that should be encrypted (no scanned documents)

M SO 7b. Email enrollment instructions

11. Release fingerprints electronically to OPM

IC

A

M

D iv is io n 6b. Complete sponsorship through

GCIMS to MSO interface

8b. Schedule enrollment appointment

9. Enroll at MSO enrollment center

10. Request release of fingerprints electronically through

MSO Adjudicator Portal

6a. Mass eQIP invite

7a. Complete eQIP application by Click-to-Sign and upload forms (306 and 3665 credit release in a separated document) to eQIP

12. Conducts Initial and Final Investigation and Notify GSA

5. Send email to contractor about 1) instruct him/ her to expect an email with enrollment instructions from MSO and 2) instructions to complete eQIP process

13. Update GCIMS with Investigation and send results to GSA POC and Vendor POC

SS

O a nd

R eg io na l

PO

C s

O

PM

2. Verifies CIW and provides to HSPD-

12 POC

3. CIW verified and filled out completely

8c. Help Desk Support – Assist

Contractors with e- QIP issues

8a. Assist with regional contractor questions

IC

A

M

D iv is io n C

O R

/P M

C on tr ac tc or

In ve st ig at io n

Te am

(C

IT

Start

4. Creates/Updates GCIMS record and Sponsor contractor

End

Process Step

Decision

KEY

Sequence Flow

Termination Point

Trigger Point

Yes

No

G

SA

C on tr ac to r/

Ve nd or P

O C 1. GSA Contractor fills out CIW and 306 form and Vendor POC provides CIW soft copy via email - Word Document only that should be encrypted (no scanned documents) and 306 form (PDF, TIFF or PNG only)

M SO 7a. Email enrollment instructions

11. Release fingerprints electronically to OPM

6a. Complete sponsorship through

GCIMS to MSO interface

8a. Schedule enrollment appointment

9. Enroll at MSO enrollment center

10. Request release of fingerprints electronically through

MSO Adjudicator Portal

5. Send email to instruct him/her to expect an email with enrollment instructions from MSO

13. Update GCIMS with Investigation and send results to GSA POC and Vendor POC

SS

O a nd

R eg io na l

PO

C s

O

PM

2. Verifies CIW (Word Document) and 306 form (PDF, TIFF or PNG only) and provides to HSPD-12 POC

3. Is CIW (Word Document) and 306 form (PDF, TIFF or PNG only) verified and filled out completely

12. Conducts Investigation and Notify GSA

7c. Upload 306 form (PDF, TIFF or PNG only) to OPM Portal

6b. Regional POC

Yes

No

8b. Upload 306 form (PDF, TIFF or PNG only) to OPM Portal

7b. SSO POCs send 306 form (PDF, TIFF or PNG only) to CIT

ARRA Temporary Contractors:

Complete GSA Form 850 instead of CIW

For Official Use Only Contractor Information Worksheet (CIW)

Version 4 (Updated 12/2/10) Pg. 1 of 2

Type Contractor (Definitions on Pg. 2)

ARRA Long Term Contractor

ARRA Temporary (Short Term) Contractors: Use GSA Form 850

Investigation Preference

(if option offered in region)

Priority (Option available for MBI / LBI / BI only)

Sponsoring Office Symbol

GSA Region (Options on Pg.2)

1. Contract Employee Information Name (Last/Family)

First (Given)

Middle (or NMN if none)

Suffix

Social Security #

Date of Birth

Place of Birth (POB): City

POB: State

Country

Sex

Home Address Street e-Mail

Address Street (line 2)

Phone Number (Day)

Phone Number (Cell)

City

State

Zip

Position (Job) Title

IT System Administrator

Prior Investigation

Investigation Date

Agency that Adjudicated Prior Investigation

U.S. Citizen

Non-U.S. Citizens Only: Port of Entry City and State

Date of Entry

Less than 3 Yrs.

U.S. Resident

Alien Registration #

Citizenship Country

2. Contact Information Company Name

Company is:

If Sub, Name of Prime

Task Order (TO) / Delivery Order (DO) Number (Enter Contract Base Number if TO / DO is Not Applicable)

Contract Number Type

Contract Start Date

Contract End Date

Has Option Yrs.

Or End Date TBD

Company Point of Contact (POC) Name

POC Phone Number (Day)

POC Email Address

3. Project/Work Location Information (Government site where contractor is working) GSA Building Number

Building Name

Building Address

4. Type of Investigation Requested for: GSA Access Card

Note: National Security positions are processed by GSA Personnel Security (CIS)

5. Requesting Official (Sponsor) Information Sponsor’s Name

Title

Is COR/COTR

Email Address

Phone Number (Day)

Date Forms Were Reviewed

Alternate POC and Phone Number or Comments

6. Personnel Security Office:

OPM PIPS Inv Status e-QIP Invitation # Date e-Mail Sent

[ ] Release Form

[ ] CER

[ ] Medical Release [ ] GSA Form3665

[ ] FD 258

[ ] CS Case

[ ] FD 258 RAP

[ ] Just

Date Received

[ ] Reviewed [ ] Scan/TIF

Date Sent to OPM

Suitability Decision Preliminary Date [ ] Unfavorable [ ] Favorable

Final Date [ ] Unfavorable [ ] Favorable

Notify Preliminary Decision [ ] Email: hspd12.security@gsa.gov [ ] Email: COTR/Requesting Official [ ] Email: Subject [ ] Email: Subject’s Company Notify Final Decision [ ] Email: hspd12.security@gsa.gov [ ] Email: COTR/Requesting Official [ ] Email: Subject [ ] Email: Subject’s Company

Contractor Information Worksheet Instructions

Version 4 (Pg. 2 of 2)

Applicability of Contractor Information Worksheet Use this Contractor Information Worksheet for all GSA contractors except ARRA temporary contractors. For all ARRA temporary contractors, use the GSA Form 850 available at http://gsa.gov/forms.

How to Enable Macros if You Are Not Able to Enter Information or Select Options Electronically If you receive an option to enable macros when you open the file, select Enable Macros.

If you are not able to make selections or enter text on the form, please adjust your macros security settings. To adjust your settings, open the file. Click on Tools, then move your cursor to Macros, then select Security. On the Security window that appears, select Low, then click OK. Save the file to your workstation. When you reopen it, the form should work properly.

Type Contractor Definitions (Any GSA Service or Office May be Associated with Building Support, Embedded Contractors):

Building Support: Building maintenance or construction support contractor Embedded: “Side-by-side” or white collar contractor providing business services, and may have staff-like access to GSA space and IT systems External: Does not access GSA building or IT systems but requires a check or investigation Child Care: Child care worker

GSA Region Options: Region 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, NCR, or CO

Transmitting the Contractor Information Worksheet Do not save completed forms on your workstation. Per GSA requirements:

If Personally Identifiable Information (PII) needs to be transmitted over the Internet, it must be sent using encryption methods defined in Chapter 5, Paragraph 7 of GSA Order CIO P 2100.1E GSA Information Technology (IT).

o All passwords must be encrypted in storage.

o All sensitive information, such as PII, as deemed by the data owner, which is transmitted outside the GSA firewall, must be encrypted. Certified encryption modules must be used in accordance with FIPS PUB 140-2, “Security requirements for Cryptographic Modules.”

o When using password generated encryption keys, a password of at least 8 characters with a combination of letters, numbers, and special characters is required. A password of at least 12 characters is recommended.

o Systems implementing encryption must follow the key management procedures and processes documented in CIO IT Security Procedural guide 09-43, “Key Management.”

If PII needs to be emailed within the GSA network, at a minimum Lotus Notes encryption is required.

For additional protection the information also can be encrypted as described in Chapter 5, Paragraph 7 of this IT security policy.

If PII needs to be sent by courier, printed, or faxed several steps should be taken. When sending PII by courier mark "signature required" when sending documents. This creates a paper trail in the event items are misplaced or lost. Don't let PII documents sit on a printer where unauthorized employees or contractors can have access to the information. When faxing information use a secure fax line. If one is not available, contact the office prior to faxing so they know information is coming and contact them after transmission to ensure they received it. For each event the best course of action is limit access of PII only to those individuals authorized to handle it, create a paper trail, and verify information reached its destination.

Submission Information Check with your GSA regional point of contact for instructions on how to submit the completed form.

Privacy Act Notice In compliance with the Privacy Act of 1974, the following information is provided: Solicitation of the information is authorized by the Federal Property and Administrative Services Act of 1949, as amended, and Part III of Title 5, U.S.C; O. 9397 Disclosure of the information is voluntary. This form will be used as a means to prepare and issue a credential or pass. Information will be transferred to appropriate Federal, State, local or foreign agencies, when relevant to civil, criminal or regulatory investigations or prosecutions, or pursuant to a request by GSA or such other agency in connection with the firing or retention of an employee, the issuance of a security clearance, the investigation of an employee, the letting of a contract, or the issuance of a license, grant, or other benefit. If the individual does not provide some or any part of the requested information, the employee will not be issued a credential and will not be allowed to enter a GSA-controlled building after normal working hours or when the building is under security.

http://gsa.gov/forms

GSA R10 Escort Application Form

This form must be completed and submitted via E-mail to the R10 Security Office (r10securityem@gsa.gov) for approval at least ten business days prior to the need for contractor escort Contractor Information Worksheets (CIWs) must be submitted for the individuals to be escorted if this escort permit is denied.

1. GSA Requestor (e.g. CO, COR, Project Manager, Property Manager).

Name: Title:

Phone Number: Request Date:

E-mail Address:

Contract Information:

Building Number: Building Name:

GSA Contract Number:

Project Location:

Client or Tenant Agency (e.g. customer):

3. Escort Information (Person to provide the escort) Escort’s Name: Contract Company’s Name:

Company Phone Number:

E-mail Address:

Prime Contactor’s Name (If Subcontractor):

4. Escortee’s Information (Person(s) to be escorted) Escortee(s) Name:

Contract Company’s Name:

5. Dates to be escorted:

X Ann Smith or Kandice Petorak GSA Personel Security

This application, if approved, must be kept on each contract employee that is escorted, to include the escort. This form is considered invalid if the form’s approval date has passed.

Each escort can escort up to five contract employees and must keep them in sight at all times (breaks must be coordinated). All escort privileges will be suspended if anyone is found in violation of the GSA Region 10 escort policy.

mailto:r10securityem@gsa.gov