Statement of Work - Emergency Electric Pumps.doc.pdf

STATEMENT OF WORK (SOW)

1.0 Scope. This requirement is for the repair and/or overhaul of Emergency Electric Pumps (NSN:

4320-14-397-0828, Part Number A5029190) utilized on the HH65 aircraft. Upon receipt of the Emergency Electric Pump, the contractor shall perform a test and evaluation to determine the condition of the item. Any item where the condition is found to be No Fault Found (NFF) or Beyond Economical Repair (BER) shall be returned to the United States Coast Guard (USCG) in accordance with (IAW) paragraphs 2.2 and 2.3.2. All other items shall be repaired IAW this Statement of Work (SOW).

The objective for the contractor will be to provide the Aviation Logistics Center (ALC) with repaired/overhauled Emergency Electric Pumps that are Ready for Installation (RFI) in support of our efforts to sustain 102 aircraft. The contractor should be capable of delivering repaired Emergency Electric Pumps within a 45-day Turn-Around-Time (TAT) After Receipt of Order (ARO). The USCG anticipates the material will be shipped to the vendor within five (5) days after issuance of a delivery order. The contractor will not be penalized if the USCG is not timely in the shipment of the material.

2.0 Major Tasks. Work under this contract shall be performed at the contractor’s facility or USCG approved facility. The contractor shall provide all necessary parts, materials, labor, tooling, test equipment and facilities to evaluate and repair the components listed in this contract at the firm-fixed prices listed in the schedule. The contractor shall perform all repairs IAW the Original Equipment Manufacturer (OEM) Component Maintenance Manuals (CMM) and Technical Orders (TO). All services shall be accomplished on an as required basis, as directed by the Government. Request for clarification shall be directed to the Contracting Officer.

2.1 Original Equipment Manufacturer (OEM) Procedures. Hydroperfect International is the OEM of the Emergency Electric Pump. The contractor must have access to required repair specifications and test/acceptance criteria and data to ensure all components are tested and repaired IAW the OEM’s current specifications and procedures. The USCG may review repair manuals and performance/test/ acceptance criteria as required. The contractor is solely responsible for obtaining any and all specifications required for this effort. Original design or functional capabilities of the end item and parts thereof shall not be changed unless authorized or directed by the requirements of this SOW.

2.2 Test and Evaluation. If, after visual and functional inspections, an item is found to meet manufacturer's minimum performance specifications and is considered to be Ready for Installation (RFI) or is considered to be BER IAW paragraph 2.3.2, the contractor will be allowed the firm fixed price for test and evaluation only. The contractor shall prepare a failure data report IAW paragraph 2.3.3 in these instances. This report shall be included with the returned component. The parts shall be marked "RFI” or “BER” and returned to the address identified under “Shipping Instructions” in paragraph 15.0. A copy of the failure data report shall be attached to the invoice.

2.3 Repair. Non-Ready for Installation (NRFI) components shall be repaired and returned to RFI condition IAW the OEM minimum functional performance specifications. Components shall be repaired for the specific fault noted on the DD Form 1577-2, Unserviceable (Repairable) Tag-Material, or CG-1577-A (11-90), Unsatisfactory Report Tag, which will be attached to each non-RFI item. The contractor shall perform an inspection and correct deficiencies found. This shall include, but is not limited to, replacement of missing or broken parts and the removal of any foreign matter or corrosion.

Discrepancies (over and above repair items) may be identified during initial evaluation. Over and above repair items consist of any finding where an overhaul is necessary IAW paragraph 2.3.1 or any findings of unusual damage IAW paragraph 2.3.6. The contractor shall be responsible for documenting and reporting all over and above repair items to the Contracting Officer no later than fifteen (15) business days after receipt of components at the contactor’s facility. The quotation shall be valid for thirty (30) days and the documentation must include:

− Description of each discrepancy found − Number of man-hours per discipline required to complete each discrepancy − Parts costs (if the part is not listed on the separately priced parts list, this must be notated in the quotation and price for each part will be negotiated IAW paragraph 2.3.4) − Total dollar amount for each discrepancy − Total dollar amount for complete list of discrepancies

The Contracting Officer will be responsible for reviewing the list of discrepancies and either accept, negotiate or decline the contractor’s proposal. Additional work shall not be performed until the quotation is accepted and a modification to the delivery order is provided by the Contracting Officer.

The contractor will have forty-five (45) days to complete the repairs and return the items to the Government. In the event that a quotation is declined by the Contracting Officer, the contractor shall return the item “As-Is”.

2.3.1 Overhaul. Emergency Electric Pumps will necessitate an overhaul when it has been determined that the Stator Motor (Part Number 9503-400) needs to be replaced. The overhaul shall consist of the repair, replacement or servicing as necessary of the Stator Motor followed by the reassembly and bench check. Upon completion of the overhaul process, the Emergency Electric Pumps shall be RFI.

2.3.2 Beyond Economic Repair (BER). After receipt of a quotation for over and above repair items, the Contracting Officer may determine that an item is BER and will provide a written modification to the contractor. All items found to be BER shall be immediately returned to the USCG. Items shall not be scrapped at the contractor’s facility. The items shall be clearly marked as “BER” with the supporting evidence. The contractor shall be entitled to compensation for Test and Evaluation only in accordance with the firm-fixed price specified herein.

2.3.3 Failure Data Report. The contractor shall submit a failure data report for each repaired component. This report shall include National Stock Number, Part Number, Serial Number, nomenclature, date of repair, contract delivery order number, line item number, description of repaired failure, the USCG’s reported failure, a listing of parts repaired and a listing of parts replaced. The contractor’s in-house work order may be used to satisfy this requirement if it includes the information requested above. This report shall be attached to the packing slip and shipped with the repaired component.

2.3.4 Replacement Parts. Parts of a component found to be in a serviceable condition as a result of functional testing shall be reused. Missing parts and parts found to be defective or that require replacement by manufacturer’s instructions shall be replaced with parts meeting the manufacturer’s specifications and drawings. Replacement parts shall be new. The cost for parts that are replaced systematically during repair shall be included in the price listed in the schedule for these operations.

The contractor shall submit a listing of all systematically replaced parts and other replacement parts to be utilized in support of the maintenance procedure of each component. The replacement parts listing must show the following information: Item Description, OEM Part Number and Price.

2.3.5 Corrosion Treatment. During inspection and functional test, the presence of corrosion in a component shall constitute reason for a more thorough disassembly and inspection. Should corrosion be found, disassembly shall be made to the extent necessary to remove corrosion or replace the part, or parts, affected. Corroded parts shall be replaced, except in those cases where removal of corrosion from a part will not impair efficiency or safe operation of the part. Corrosion removal and treatment of affected areas will be accomplished IAW OEM specifications and Federal Aviation Administration (FAA) Advisory Circular AC 43-4A, dated 07/24/1991, Corrosion Control for Aircraft.

2.3.6 Exclusions – Unusual Damage. Prices do not include components that have been cannibalized or severely damaged due to mishandling, water immersion, or crash damage. Additionally, the HH-65 helicopter is used primarily around salt water at low altitude for search and rescue missions. Therefore, corrosion is to be anticipated and is considered "normal" for the aircraft. Corrosion does not constitute unusual damage. See paragraph 2.3.5.

2.3.6.1 Components received which indicate obvious misuse, cannibalization or severe damage due to mishandling; water immersion or crash damage may dictate an exclusion from the prices specified in the contract schedule. Such components shall be inspected, repair costs determined, and authorization to proceed obtained from the Contracting Officer prior to commencement of work. If the contractor considers a component to be a candidate for exclusion, the Contracting Officer shall be notified within fifteen (15) days of receipt of the component. Verbal notification to the Contracting Officer shall be confirmed in writing. The contractor's delivery obligation for the component shall be suspended as the date of notice to the Contracting Officer. The Contracting Officer will make a unilateral written determination (subject to the Disputes Clause, FAR 52.233-1), within thirty (30) days of written notice, as to exclusion validity. The Government retains the right to unilaterally set the price for exclusion items in the event an agreement on price cannot be reached. The contractor's delivery obligation shall resume upon receipt of the Contracting Officer's determination.

2.3.6.2 The Government shall not be liable for any amount expended by the contractor in excess of the applicable firm fixed price reflected in the schedule unless prior written authorization has been given by the Contracting Officer.

2.4 Technical Support Services. The contractor shall provide technical support services as required. The contractor shall provide up to ten (10) man-hours per quarter, at no additional cost to the USCG, to support the USCG's continuous quality improvement program. In the event that a requested task cannot be completed within ten (10) man-hours per quarter, the contractor shall immediately notify the Contracting Officer, or representative, that the task cannot be completed within the allotted time frame and provide a preliminary estimate of the time and costs required for completion. The Contracting Officer will transmit requirements for additional support services in writing as they are identified. Upon receipt of a request for quote for a specific task, the contractor shall prepare and submit to the Contracting Officer, or representative, a proposal reflecting the hours, materials and other costs associated with performance of the task. The Government will utilize the labor rate specified in the Schedule to determine the final price. Specific deliverables will be identified on individual delivery orders.

3.0 Government Documents.

3.0.1 FAA Advisory Circular AC 43-4A, dated 25 July 1991, Corrosion Control for Aircraft. A copy of this circular is available at www.faa.gov.

http://www.faa.gov/

3.0.2 FAA Advisory Circular 43-205, dated 25 September 1998, Guidance for Selecting Chemical Agents and Processes for Depainting and General Cleaning of Aircraft and Aviation Products. A copy of this circular is available at www.faa.gov.

3.0.3 Coast Guard Technical Order 1H-65A-11-292911 Revision 3, dated 1 September 2000, Emergency Electric Pump Component Maintenance Manual. Before obtaining copies of this manual, contractors shall be registered in the Defense Logistics Agency’s Joint Certification Program. More information on this certification can be found at http://www.dlis.dla.mil/jcp/Default.aspx. After ensuring registration, the contractor shall complete DHS Form 11000-6, Sensitive but Unclassified Information Non-Disclosure Agreement (Enclosure 2) and return with a written request to Crystal.G.Taber@uscg.mil. Copies will not be posted to the Federal Business Opportunities website.

3.1 Industry Documents.

3.1.1 OEM CMMs and other applicable technical specifications for the components set forth in the Schedule.

3.2 Order of Precedence. In the event of conflicts between OEM specifications and procedures and USCG specifications and procedures, the order of precedence is as follows:

3.2.1 USCG specifications and procedures.

3.2.2 OEM specifications and procedures.

4.0 Government Furnished Property (GFP). Emergency Electric Pumps requiring service will be will be direct shipped to the contractor’s facility from the ALC and documented using DD Form 1577-2, Unserviceable (Repairable) Tag-Material, CG-1577-A (11-90), Unsatisfactory Report Tag or Form 1348. These documents will accompany and remain with the equipment. Equipment shall be returned to ALC upon completion of the delivery order, unless otherwise directed by the Contracting Officer.

4.1 Government Property Records. Upon receipt, the contractor shall update Government Property Records based on the DD Form 1577-2, Unserviceable (Repairable) Tag-Material, CG-1577-A (11-90), Unsatisfactory Report Tag or Form 1348 information provided and any discrepancies. The contractor shall account for all end-items received from, and shipped to, the Government. The contractor shall provide a copy of its Government Property Records to the Contracting Officer no later than the 15th of each month. Government Property Records will include the following minimum information:

− Kit/Equipment/Component Description, Part Number, Serial Number − USCG consignee − Date received − Status of contract service − Expected contract service completion date

4.2 Component Repair Record (CRR) or Equivalent. The CRR records the maintenance performed on a serial number tracked component and enrolls or disenrolls components from the Aviation Computerized Maintenance System (ACMS) when those components are scrapped, added to, or removed from the USCG inventory. The contractor shall document repair actions, including the specifications and/or technical orders used as authority, on the CRR. In addition, the contractor shall record the completion of any Service Bulletin and/or Time Compliance Technical Order (TCTO).

http://www.faa.gov/ http://www.dlis.dla.mil/jcp/Default.aspx mailto:Crystal.G.Taber@uscg.mil

The contractor shall mail one copy of the CRR to USCG Aviation Logistics Center, ATTN:

AVENG/ACMS, Elizabeth City, NC 27909-5001 no later than five (5) working days following completion of the rework effort. One copy shall be attached to the invoice. The original CRR shall be packed with the component. The contractor shall retain a copy of each CRR for 90 calendar days.

4.3 Service Bulletins. The contractor shall provide the Contracting Officer with two (2) copies of all service bulletins within ten (10) calendar days of receipt. The Contracting Officer will notify the contractor in writing when incorporation of mandatory or optional service bulletins is required. The contractor shall submit, within thirty (30) calendar days after receipt of this notification, a detailed proposal which shall include a listing of replacement parts and/or materials required, the time needed to affect the modifications, estimated price breakdown of each part, and the number of labor hours required. The applicable labor rate will be specified in this contract for service bulletins.

4.4 Product Improvements Proposal/Engineering Change Proposal (ECP). The contractor will continually analyze the overhaul documentation for each component identified in the schedule. The contractor may develop designs and/or processes that will improve the reliability, maintainability, or operational performance of the components being overhauled. A PIP/ECP showing the new design and/or process may be provided to the ALC Contracting Officer for approval. The PIP/ECP shall include a proposal for an incremental charge to be assessed each time the PIP/ECP is incorporated into the component. The proposal shall contain a breakdown of labor hours, material, and other costs. The PIP/ECP will then be evaluated by the Short Range Recovery Division’s Engineering and the Contracting Officer. Upon agreement of the price for incorporation of the PIP/ECP, the Contracting Officer will issue a supplemental agreement reflecting the incorporation of the approved PIP/ECP. The contractor shall not incorporate approved PIPs/ECPs prior to contract modification.

4.5 Publications/Updates. Within forty-five (45) calendar days following contract award, the Contractor shall provide the Contracting Officer an updated copy of all applicable OEM-approved CMMs for components listed in the schedule. The CMMs shall reflect the latest procedures used in the overhaul of components. If the contractor determines that current procedures detailed in the CMM should be changed, two copies of recommended changes shall be submitted to the USCG's Contracting Officer for review and approval/disapproval. The contractor shall continuously update all applicable CMMs during the life of the contract. The contractor shall submit revisions to CMMs to the USCG Contracting Officer, or representative, within forty-five (45) calendar days of receipt.

4.6 Warranty. The contractor’s standard warranty for repaired items will be incorporated into the contract.

5.0 Quality Control. The contractor is required to be certified and maintain a quality system that complies with the requirements of ISO 9001-2000 Quality Management Systems – Requirements or equivalent. The contractor is responsible for performing or assuring all inspections, tests and calibration necessary to substantiate that the goods or services furnished conform to Government’s requirements.

The contractor shall take prompt action to correct conditions that have or could result in goods or services that do not conform to contractual requirements. Records of conformance shall be maintained on file at the contractor’s facility and made available or provided for review by the Government upon request. The Government reserves the right to conduct surveillance at contractor’s facility to verify the existence, adequacy and effectiveness of the quality system. Upon request of the Government, the contractor(s) shall forward a copy of their current certification and Quality Assurance Manual for review.

5.1 Certification. The contractor shall maintain, at a minimum, one of the following: FAA, Department of Defense (DOD), OEM and/or USCG certifications for repair and modification of components identified in the Schedule for the entire duration of this contract. The Contractor shall provide immediate notification to the Contracting Officer upon loss of any required certifications.

5.2 Certificates. All parts repaired under the provisions of this contract must be airworthy and suitable for installation on USCG aircraft. Each returned component shall be tagged with a DD Form 1574 Serviceable Condition Code Tag or a FAA Form 8130-3, Airworthiness Approval Tag, completed in its entirety. The contractor shall furnish a Certificate of Airworthiness in accordance with FAA procedures (or USCG approved alternate procedure) and a Certificate of Conformance IAW FAR 52.246-15 for all components. These forms shall be packaged with each component and copies shall be included with the invoice.

FAILURE TO SUBMIT THE APPROPRIATE CERTIFICATES SHALL CONSTITUTE AN

IMPROPER INVOICE AND WILL RESULT IN NONPAYMENT.

6.0 Aircraft on Ground (AOG) Situations. Upon notification from the USCG that an AOG situation exists, the contractor shall expedite repair and initiate shipment within seven (7) calendar days or less. Material shall be shipped by the fastest traceable means, e.g. Air Freight "next day delivery".

The shipping container shall be marked on the outside in highly visible lettering "A.O.G." At the time the contractor is notified of an AOG requirement, the contractor shall advise the Contracting Officer, or their representative, if there are additional shipping charges. The Contracting Officer will provide special shipping instructions and authorization for reimbursement in these instances. The quantity of AOG units is limited to a maximum of five (5) units in any seven (7) calendar day period.

The contractor will stock and maintain five (5) of each approved panel to meet the USCG’s AOG requirements. At the completion of the contract, the USCG will purchase all of the finished items designated for AOG requirements, not to exceed five (5) of each type of panel.

7.0 Environmental Requirements. All parts must be thoroughly cleaned IAW applicable CMMs or FAA Advisory Circular 43-205, Guidance for Selecting Chemical Agents and Processes for Depainting and General Cleaning of Aircraft and Aviation Products, to ensure they are as free as practicable of all hazardous dust to include hexavalent chromium, cadmium, lead, etc., prior to being returned to ALC.

ALC may take random samples of parts to ensure they are free as practicable of all hazards. Information on these hazards can be found in Occupational Safety and Health Standards 1910.1025 (lead),

1910.1026 (Hexavalent Chromium) and 1910.1027 (Cadmium).

8.0 Period of Performance. The period of contract performance includes a one-year base period and, if exercised, four (4) one-year option periods.

9.0 F.O.B. Point. The F.O.B. point for shipments under this contract is F.O.B. Destination. Prices in the schedule include all applicable customs, duties, taxes and shipping charges; therefore, no additional charges for shipping will be allowed unless indicated by a bilateral modification to the individual delivery order.

10.0 Contractor Verification of Receipt of Components. The contractor shall provide written notification to the Contracting Officer within five (5) business days following receipt of component(s).

Email or fax notification is acceptable.

11.0 Government Required Delivery. The table below is shows the required delivery for each Line Item. Early deliveries are desired and acceptable. The required delivery dates remain the same for all respective option year line items.

Line Item Item Description IAW SOW Paragraph

Due No Later Than:

0001 Test and Evaluation 2.2 Fifteen (15) days after receipt of components

0002 Repair 2.3 Forty-five (45) days after receipt of components

0003 Overhaul 2.3.1 Forty-five (45) days after receipt of components

0004 Unusual Damage 2.3.6 Exclusion notice within fifteen (15) days after receipt of components

0005 Technical Support Services

2.4 To be determined on individual delivery

orders

0006 Service Bulletins 4.3 Ten (10) days after receipt of the service bulletin/Proposal within thirty (30) days of notice of incorporation by Contracting Officer

0007 Product Improvement/ Engineering Change Proposal

4.4 As needed

0008 Repair Quote 2.3 Five (5) days after receipt of components

0009 Failure Data Report 2.3.3 Shall be shipped with the component 0010 Publications/Updates 4.5 Forty-five (45) days after receipt of revisions 0011 Government Property

Record Reports

4.1 The 15th of each month

0012 Component Repair Record

4.2 Five (5) business days after completion

of work

0013 Contractor Verification of Receipt of Components

10.0 Five (5) business days after receipt of

components

12.0 Packaging Instructions. Packaging and preservation shall include the following information:

12.1.1 The USCG ALC is a supply depot; therefore material will be stored and transshipped to various users. The container shall be packed and labeled suitable for shipment via land, air or sea.

12.1.2 Packaging material shall NOT consist of the following: popcorn, shredded paper, Styrofoam of any type, or peanut packaging.

12.1.3 Each item shall be individually preserved, packaged and packed in accordance with best commercial practices. Returned components shall be returned in the original shipping container or contractor shall ship in container IAW Mil-Std-2073-1E.

12.1.4 Each part number shall be individually packed. The internal packing material shall be sufficient to prevent damage during shipment, handling and storage. Preservation and protection shall be provided to prevent corrosion, deterioration, or decay during warehouse storage for a period of one year.

13.0 Marking Instructions. All shipping containers/packages shall be marked for delivery IAW the contract or delivery order. All components, which require special care during packing, handling or shipping shall be identified and marked appropriately. The exterior of the package or shipping container shall be legibly marked with the following information in such a manner that the marking shall not be rendered illegible when opened.

− NSN

− Part Number − Nomenclature − Serial Number − Contract Number − Delivery Order/Line Item Number − Contractor’s Name and Address

13.1 Markings of Warranted Items. Pursuant to the requirements of FAR 46.706 (b) (5), the contractor shall stamp or mark the supplies delivered, or otherwise furnish notice with the supplies, of the existence of the warranty. For commercial items, the contractor’s trade practice in warranty marking is acceptable if sufficient information is presented for supply personnel and users to identify warranted supplies. Markings may be brief, but should include the information below:

− A brief statement that a warranty exists − The substance of the warranty − The duration of the warranty − Who to notify if the supplies are found to be defective

14.0 Inspection and Acceptance. Inspection and acceptance shall be performed at destination by USCG personnel for count, condition and proper completed documentation. Inspection and acceptance deficiencies may delay or cause rejection of invoice payments. Equipment found to have operational deficiencies will be reported on standard form "SF 368", Product Quality Deficiency Report, to the contractor for investigation. The contractor shall report findings of the investigation to the Contracting Officer, within thirty (30) calendar days after receipt of quality deficient exhibit.

14.0.1 Contractors shall provide a Certificate of Conformance signed by the contractor's authorized representative in accordance with Federal Acquisition Regulation (FAR) 52.246-15.

15.0 Shipping Instructions. Unless otherwise specified on individual delivery orders issued hereunder, deliverable items shall be shipped to the following address:

USCG Aviation Logistics Center Receiving Section, Bldg. 63 Elizabeth City, NC 27909-5001

Contract No. ______________________________ (To be assigned at time of issuance)

Delivery Order No. ______________________________ (To be assigned at time of issuance)

16.0 Invoicing. Unless otherwise specified in the schedule or on individual delivery orders issues under this contract, the contractor’s invoice shall be submitted IAW FAR 52.212-4 to the designated billing office for payment as noted below. A properly completed Commercial Shipping Document shall be attached to the original invoice. The Contractor is HIGHLY encouraged to submit invoices electronically to ALC-Fiscal@uscg.mil.

Chief, Fiscal Branch USCG Aviation Logistics Center Fiscal Branch, Bldg. 63 1664 Weeksville Road Elizabeth City, NC 27909 Contract no. (To be assigned at time of issuance Delivery Order no. (To be assigned at time of issuance)

Requirements for a proper invoice include − Name and address of the contractor;

− Invoice date and number;

− Contract Number and contract line item number, − Delivery Order number and delivery order line item − NSN, part number and serial number − Description, quantity, unit of measure, unit price and extended price of the items delivered;

− Shipper/Shipping Method including Tracking Data, and date of shipment;

− Terms of any discount for prompt payment offered;

− Name, title, and phone number of person to notify in event of defective invoice;

− Taxpayer Identification Number (TIN). The contractor shall include its TIN on the invoice − Electronic funds transfer (EFT) banking information − Payment remit to address

16.1 Payment Information. All payments will be made electronically IAW FAR 52.232-33. The contractor may submit invoice five (5) days after shipment of items. The invoice will not be approved until all items have been receipted.

mailto:ALC-Fiscal@uscg.mil

DEPARTMENT OF HOMELAND SECURITY

NON-DISCLOSURE AGREEMENT

Protected Critical Infrastructure Information (PCII)

DHS Form 11000-6 (08-04)

I, _______________________________________, an individual official, employee, consultant, or subcontractor of or to

_____________________ (the Authorized Entity), intending to be legally bound, hereby consent to the terms in this

Agreement in consideration of my being granted conditional access to certain information, specified below, that is owned by, produced by, or in the possession of the United States Government.

(Signer will acknowledge the category or categories of information that he or she may have access to, and the signer’s willingness to comply with the standards for protection by placing his or her initials in front of the applicable category or categories.)

Initials:

I attest that I am familiar with, and I will comply with all requirements of the PCII program set out in the Critical

Infrastructure Information Act of 2002 (CII Act) (Title II, Subtitle B, of the Homeland Security Act of 2002, Public Law

107-296, 196 Stat. 2135, 6 USC 101 et seq.), as amended, the implementing regulations thereto (6 CFR Part 29), as amended, and the applicable PCII Procedures Manual, as amended, and with any such requirements that may be officially communicated to me by the PCII Program Manager or the PCII Program Manager’s designee.

Sensitive Security Information (SSI) Initials:

I attest that I am familiar with, and I will comply with the standards for access, dissemination, handling, and safeguarding of SSI information as cited in this Agreement and in accordance with 49 CFR Part 1520, “Protection of

Sensitive Security Information,” “Policies and Procedures for Safeguarding and Control of SSI,” as amended, and any supplementary guidance issued by an authorized official of the Department of Homeland Security.

Other Sensitive but Unclassified (SBU) Initials:

As used in this Agreement, sensitive but unclassified information is an over-arching term that covers any information, not otherwise indicated above, which the loss of, misuse of, or unauthorized access to or modification of could adversely affect the national interest or the conduct of Federal programs, or the privacy to which individuals are entitled under

Section 552a of Title 5, as amended, but which has not been specifically authorized under criteria established by an

Executive Order or an Act of Congress to be kept secret in the interest of national defense or foreign policy. This includes information categorized by DHS or other government agencies as: For Official Use Only (FOUO); Official Use

Only (OUO); Sensitive Homeland Security Information (SHSI); Limited Official Use (LOU); Law Enforcement

Sensitive (LES); Safeguarding Information (SGI); Unclassified Controlled Nuclear Information (UCNI); and any other identifier used by other government agencies to categorize information as sensitive but unclassified.

I attest that I am familiar with, and I will comply with the standards for access, dissemination, handling, and safeguarding of the information to which I am granted access as cited in this Agreement and in accordance with the guidance provided to me relative to the specific category of information.

1. I hereby acknowledge that I have received a security indoctrination concerning the nature and protection of information to which I have been provided conditional access, including the procedures to be followed in ascertaining whether other persons to whom I contemplate disclosing this information have been approved for access to it, and that I understand these procedures.

I understand and agree to the following terms and conditions of my access to the information indicated above:

2. By being granted conditional access to the information indicated above, the United States Government has placed special confidence and trust in me and I am obligated to protect this information from unauthorized disclosure, in accordance with the terms of this Agreement and the laws, regulations, and directives applicable to the specifi c categories of information to which I am granted access.

3. I attest that I understand my responsibilities and that I am familiar with and will comply with the standards for protecting such information that I may have access to in accordance with the terms of this Agreement and the laws, regulations, and/or directives applicable to the specifi c categories of information to which I am granted access. I understand that the United States Government may conduct inspections, at any time or place, for the purpose of ensuring compliance with the conditions for access, dissemination, handling and safeguarding information under this Agreement.

8. If I violate the terms and conditions of this Agreement, such violation may result in the cancellation of my conditional access to the information covered by this Agreement. This may serve as a basis for denying me conditional access to other types of information, to include classified national security information.

4. I will not disclose or release any information provided to me pursuant to this Agreement without proper authority or authorization. Should situations arise that warrant the disclosure or release of such information I will do so only under approved circumstances and in accordance with the laws, regulations, or directives applicable to the specific categories of information. I will honor and comply with any and all dissemination restrictions cited or verbally relayed to me by the proper authority.

5. (a) For PCII - (1) Upon the completion of my engagement as an employee, consultant, or subcontractor under the contract, or the completion of my work on the PCII Program, whichever occurs first, I will surrender promptly to the PCII Program Manager or his designee, or to the appropriate PCII officer, PCII of any type whatsoever that is in my possession.

(2) If the Authorized Entity is a United States Government contractor performing services in support of the PCII Program, I will not request, obtain, maintain, or use PCII unless the PCII Program Manager or Program Manager’s designee has first made in writing, with respect to the contractor, the certification as provided for in Section 29.8(c) of the implementing regulations to the CII Act, as amended.

(b) For SSI and SBU - I hereby agree that material which I have in my possession and containing information covered by this Agreement, will be handled and safeguarded in a manner that affords sufficient protection to prevent the unauthorized disclosure of or inadvertent access to such information, consistent with the laws, regulations, or directives applicable to the specific categories of information. I agree that I shall return all information to which I have had access or which is in my possession 1) upon demand by an authorized individual; and/or 2) upon the conclusion of my duties, association, or support to DHS; and/or 3) upon the determination that my official duties do not require further access to such information.

6. I hereby agree that I will not alter or remove markings, which indicate a category of information or require specific handling instructions, from any material I may come in contact with, in the case of SSI or SBU, unless such alteration or removal is consistent with the requirements set forth in the laws, regulations, or directives applicable to the specific category of information or, in the case of PCII, unless such alteration or removal is authorized by the PCII Program

Manager or the PCII Program Manager’s designee. I agree that if I use information from a sensitive document or other medium, I will carry forward any markings or other required restrictions to derivative products, and will protect them in the same matter as the original.

7. I hereby agree that I shall promptly report to the appropriate official, in accordance with the guidance issued for the applicable category of information, any loss, theft, misuse, misplacement, unauthorized disclosure, or other security violation, I have knowledge of and whether or not I am personally involved. I also understand that my anonymity will be kept to the extent possible when reporting security violations.

9. (a) With respect to SSI and SBU, I hereby assign to the United States Government all royalties, remunerations, and emoluments that have resulted, will result, or may result from any disclosure, publication, or revelation of the information not consistent with the terms of this Agreement.

(b) With respect to PCII I hereby assign to the entity owning the PCII and the United States Government, all royalties, remunerations, and emoluments that have resulted, will result, or may result from any disclosure, publication, or revelation of PCII not consistent with the terms of this Agreement.

10. This Agreement is made and intended for the benefit of the United States Government and may be enforced by the

United States Government or the Authorized Entity. By granting me conditional access to information in this context, the

United States Government and, with respect to PCII, the Authorized Entity, may seek any remedy available to it to enforce this Agreement including, but not limited to, application for a court order prohibiting disclosure of information in breach of this Agreement. I understand that if I violate the terms and conditions of this Agreement, I could be subjected to administrative, disciplinary, civil, or criminal action, as appropriate, under the laws, regulations, or directives applicable to the category of information involved and neither the United States Government nor the Authorized Entity have waived any statutory or common law evidentiary privileges or protections that they may assert in any administrative or court proceeding to protect any sensitive information to which I have been given conditional access under the terms of this Agreement.

DHS Form 11000-6 (08-04) Page 2

11. Unless and until I am released in writing by an authorized representative of the Department of Homeland Security (if permissible for the particular category of information), I understand that all conditions and obligations imposed upon me by this Agreement apply during the time that I am granted conditional access, and at all times thereafter.

12. Each provision of this Agreement is severable. If a court should find any provision of this Agreement to be unenforceable, all other provisions shall remain in full force and effect.

13. My execution of this Agreement shall not nullify or affect in any manner any other secrecy or non-disclosure

Agreement which I have executed or may execute with the United States Government or any of its departments or agencies.

14. These restrictions are consistent with and do not supersede, conflict with, or otherwise alter the employee obligations, rights, or liabilities created by Executive Order No. 12958, as amended; Section 7211 of Title 5, United

States Code (governing disclosures to Congress); Section 1034 of Title 10, United States Code, as amended by the

Military Whistleblower Protection Act (governing disclosure to Congress by members of the military); Section

2302(b)(8) of Title 5, United States Code, as amended by the Whistleblower Protection Act (governing disclosures of illegality, waste, fraud, abuse or public health or safety threats); the Intelligence Identities Protection Act of 1982 (50

USC 421 et seq.) (governing disclosures that could expose confidential Government agents); and the statutes which protect against disclosure that may compromise the national security, including Sections 641, 793, 794, 798, and 952 of Title 18, United States Code, and Section 4(b) of the Subversive Activities Act of 1950 (50 USC 783(b)). The definitions, requirements, obligations, rights, sanctions, and liabilities created by said Executive Order and listed statutes are incorporated into this agreement and are controlling.

15. Signing this Agreement does not bar disclosures to Congress or to an authorized official of an executive agency or the Department of Justice that are essential to reporting a substantial violation of law.

16. I represent and warrant that I have the authority to enter into this Agreement.

17. I have read this Agreement carefully and my questions, if any, have been answered. I acknowledge that the briefing officer has made available to me any laws, regulations, or directives referenced in this document so that I may read them at this time, if I so choose.

DHS Form 11000-6 (08-04)

DEPARTMENT OF HOMELAND SECURITY

NON-DISCLOSURE AGREEMENT

Acknowledgement

Typed/Printed Name: Government/Department/Agency/Business Address Telephone Number:

I make this Agreement in good faith, without mental reservation or purpose of evasion.

Signature:

Typed/Printed Name: Government/Department/Agency/Business Address Telephone Number:

Signature:

WITNESS:

This form is not subject to the requirements of P.L. 104-13, “Paperwork Reduction Act of 1995” 44 USC, Chapter 35.