SOW EXHIBITS

October 2011

List of Exhibits

EXHIBIT

SOW

REF.

TITLE PAGE

1 Post Exhibit 3 2 List of Required Forms 4

2A 5.3.2.1 Contractor Information Worksheet 5 2B 13.3.6 Inventory of Government Provided Equipment 8 2C 11.1.1 Key Personnel Resume 9 2D 5.1.2.6 Lautenberg Statement 11 2E 13.3.1 Receipt for Government Property 12 2F 9.22.3 Record of Time of Arrival and Departure from Building 13 2G 7.2.1.4 Non-Disclosure Agreement 14 2H 9.17.3 DHS Form 3155, Offense/Incident Report 18

2I Exhibit 9E DHS Form 11000-14, Identification Access Control Card Request

2J Exhibit 9E DHS Form 11000-27, Federal Emergency Response Official Designation Request

3A 7.2.1 Contractor’s Certification of Basic Training 25

3B 6.3.1 Contractor’s Certification of Initial and Transitional-Platform Firearms and Less-Than-Lethal Weapons Training

3C 6.3.1 Contractor’s Certification of Government-Provided Training 27 3D 6.3.1 Contractor’s Certification of Refresher Training 28 3E 6.3.1 Contractor’s Certification of Weapons Refresher Training 29 4 6.4 Required Training 30

4A 6.2 Contractor’s Training Schedule and Plan 31 4B 6.4.1.2 Contractor-Provided Basic Training 32

4C 6.6.2 Contractor-Provided Initial and Transitional-Platform Firearms and Less-Than-Lethal Weapons Training and Qualifications

4D 6.6.5 Contractor-Provided Annual Weapons Refresher Training and Qualification

4E 6.4.1.3 Contractor-Provided Refresher Training 44 4F 6.7.2 Government-Provided Orientation Training 49 4G 6.7.3 Government-Provided Screener Training 51 5 7.2.1 Contractor and PSO Data Files 52 6 9.21 Post Tracking System Instructions 56 7 5.2 Medical Questionnaire/Physical Abilities Test Manual 57

8A 14.6 Contractor-Provided Uniform Items 84 8B 14.7 Contractor-Provided Supplementary Equipment 86 8C 14.4 Contractor-Provided Firearms and Ammunition 87 8D 14.5 Contractor-Provided Personal Protective Equipment 90

EXHIBIT

SOW

REF.

TITLE PAGE

8E 14.2 Contractor-Provided Communications Equipment 91 8F 14.3 Contractor-Provided Vehicles 92 9A 13 Government-Provided Uniform Items 93 9B 13 Government-Provided Supplementary Equipment 94 9C 13 Government-Provided Personal Protective Equipment 95 9D 13 Government-Provided Communications Equipment 96

9E 13 Government-Provided HSPD-12 Personal Identification Verification (PIV) Card

9F 13 Form I-9 List of Acceptable Documents 99

10 1.4.6 Federal Management Regulations Subpart C, Conduct on Federal Property (41 CFR 102-74)

Exhibit 1 Post Exhibit

Contract:

Performance Start Date:

Task Order:

Performance End

B u ild in g N u m b er

A d d re ss

P o st

ID

P st T yp e

P o st L o ca ti n

S ta rt T im e

E n d T im e

H o u rs

P er

D ay

O p er at in g

D ay s

R el ie f

P S

O R eq u ir ed

D ri n g

B re ak ec u ri ty C le ar an ce

A d d it io n al

R eq u ir em en ts ta rt D at e

(T em p

E n d D at e

(T em p

C L

IN

T ta l D ay s

T o ta l H o rs

Exhibit 2 List of Required Forms

Form

SOW

Reference

Form Title

Location

5.3.2.1 Contractor Information Worksheet Exhibit 2A

5.3.2.1 e-Verify Confirmation Notice e-Qip

5.3.2.1 Foreign National Relatives or Associates Statement

e-Qip

13.3.6 Inventory of Government Provided Equipment

Exhibit 2B

11.1.1 Key Personnel Resume Exhibit 2C

5.1.4 Lautenberg Amendment Statement

e-Qip

Exhibit 2D

5.2.2.1 Medical Questionnaire/Physical Abilities Test Administrator’s Manual

Exhibit 7

13.3.1 Receipt for Government Property Exhibit 2E

9.2 Security Post Assignment Record (Post Orders)

On Post

DD 254 5.4.1.1 Security Requirements Checklist Provided by Government

DD 441 5.4.1.5 Security Agreement Provided by Government

DHS 139 9.22.3

Record of Time of Arrival and Departure from Building

Exhibit 2F

DHS

11000-6

7.2.1.4 Non-Disclosure Agreement Exhibit 2G

DHS

11000-9

5.3.2.1 Disclosure and Authorization Pertaining to Consumer Reports pursuant to the Fair Credit Reporting Act e-Qip

FD 258 5.3.2.1 Fingerprint Application Card Provided by Government

DHS 3155 9.17.1 Offense/Incident Report Exhibit 2H SF 85P 5.3.2.1 Questionnaire for Public Trust Positions e-Qip

SF 85PS 5.3.2.1

Supplemental Questionnaire for Selected Positions e-Qip

SF 86 5.4.3.1

Questionnaire for National Security Positions e-Qip

DHS

11000-14

Exhibit 9E Identification Access Control Card Request Exhibit 2I

DHS

11000-27

Exhibit 9E Federal Emergency Response Official Designation Request

Exhibit 2J

Exhibit 2A Contractor Information Worksheet

Type Contractor

PSO Non-PSO Prefer

Online (e-QIP) (MBI / LBI / BI only)

Routine Expedite (Extra Cost)

1. Contract Employee Information NAME: Last/Family

First/Given

Middle

Suffix

Social Security

Date of Birth

MMDDYYYY

Place of Birth: City

State

Country

E-mail Address

Phone # (Day)

Phone # (Cell)

Position (Job) Title

IT/System Admin

Position?

Prior Investigation?

Yes No

Investigation Date

Sex

Male Female

U.S. Citizen

Yes No Aliens: Port of Entry City and State

Date of Entry

Alien Registration #

Citizenship

2. Contract Information Company Name

Company is

Prime Sub Contractor If Sub, Name of Prime

Contract /Work Order / RWA #

Contract Start Date

End Date

Has Option Years OR End Date TBD

Company Point of Contact (POC) Name

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

GSA Building #

Building Address

4. Type of Investigation Requested for: HSPD-12 PIV Card Credential Public Trust Positions (Suitability) Moderate Risk - (LBI / MBI) HIGH Risk - (BI) National Industrial Security

Clearance CONFIDENTIAL (NACLC) SECRET (NACLC) TOP SECRET

(SSBI)

5. Requesting Official (Sponsor) Information

Sponsor's Name

Title

Is COR/COTR

Yes

FPS Regional Office Number

Forms Reviewed

Yes Review Date

6. DHS Federal Protective Service Contract Suitability Adjudication (Staff use ONLY) Personnel Security Investigation:

OPM PIPS Inv

Inv #

Status

Date of INV e-QIP Invitation #

Date E-Mail Sent

Release Form

CER

Med Release

GSA 3665

FD 258

CS Case

FD 258 RAP

Just

Date Forms Received

SF85PReviewed

Scanned/TIF

Date Sent to OPM

Suitability Decision Preliminary Date

Favorable Unfavorable

Final Date

Favorable Unfavorable

Notify Preliminary Decision eMail: COTR/ Requesting Official eMail: Subject eMail: Subject’s Company POC

Final Decision eMail: COTR/ Requesting Official eMail: Subject eMail: Subject’s Company POC

Comments/Notes:

Contractor Information Worksheet Instructions

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 DHS 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.

Submission Information

1. Ensure all information is complete and accurate

2. Return this form to your Supervisor/Contracting Officer for delivery to FPS Regional Field Contract Suitability Adjudication Office for “e- QIP” invite.

3. If a contractor opts to fill out a "Hard Copy" version of the SF-85P due to emergency operations, complete the background investigation package and send it along with Contractor Information Worksheet. SF-85P is available on GSA InSite

4. MAILING INSTRUCTIONS FOR FPS Staff:

If the contractor is a Non-Protective Security Officer (PSO) and performing contract administrative duties on the PSO contract at the federal government facilities, the background investigation package must be mailed to the respective FPS Regional Contract Suitability Adjudication Field Offices listed below:

http://contacts.gsa.gov/webforms.nsf/0/25292D2D26D8B5EC85256A730051F924/$file/sf85p.pdf

Region Regional CSA PoC Phone # FAX Street Suite, Room

City ST Zip + 4

HQ Evelyn Flores

(202) 245-

(202) 245-

1900 Half St SW Rm 5354 Washington DC 20528

HQ Sean Mihaly (202) 245-

(202) 245-

1900 Half St SW Rm 5351 Washington DC 20528

ARRA Terry Hudson (202) 245-

(202) 245- 2610 1900 Half St SW

Rm 5350- S

Washington DC 20528

1 Valerie DiMare (617) 565-

(617) 565-

10 Causeway St 935 Boston MA 02222-

2 George L. Ware

(212) 264-

(212)264-

26 Federal Plaza 17-130 New York NY 10278-

3 Lisa M. Leo (215) 521-

(215) 521-

701 Market St 4200 Philadelphia PA 19106-

4 Todd Ware

(404) 893-

(404) 893-

180 Spring St, NW 525 Atlanta GA 30303-

5 Doris Meaux

(312) 353-

(312) 353-

230 S. Dearborn St. 3540 Chicago IL 60604-

Sara Reisenbichler

(816) 426-

(816) 426-

601 E 12TH ST 1712

Kansas City MO 64106-

7 Contact COTR

8 "Mike" Prado (303) 236-7813 x326

(303) 236-

W 6TH Ave & Kipling St

Lakewood CO 80225-

9 May S. Joe

(213) 894-

(213) 894-

300 N Los Angeles St. 2207 Los Angeles

CA 90012-

10 Janis Davis

(253) 815-

(253) 815-

32125 - 32nd Ave S. 2nd Fl Auburn WA 98001-

11 Contact COTR

Type of Investigation Requirements- Contractor

Position Type

Position Sensitivity Levels

Clearance Levels DHS Investigation Requirement

Special & Critical Sensitive

Top Secret / Top Secret-SCI

SSBI – Single Scope Backgrnd Inv National Security

Non-Critical Sensitive Secret / Confidential NACLC – National Agency Checks w/Law & Credit

High Risk N/A BI – Background Investigation Moderate Risk N/A MBI – Minimum Background Investigation

Public Trust Low Risk N/A

NACI – National Agency Check w/Written Inquiries

Exhibit 2B Inventory of Government-Provided Equipment

Inventory of Government Provided Equipment

Item Brand Name Model Serial # Misc Issued To

Exhibit 2C Key Personnel Resume

Employee’s Name: SSN: - -

PROPOSED POSITION TITLE: ______________________________________

SUPERVISOR'S NAME: ____________________________________________

CURRENT POSITION WITH THE CONTRACT FIRM: ____________________

TIME IN CURRENT POSITION: (Yrs. Mos.) ____________________________

RESPONSIBLE FOR THE WORK OF: ___________ PERSONS

DESCRIPTION OF SCOPE OF CURRENT JOB: (Use attached sheet if necessary)

WORK EXPERIENCE: (Beginning with the most recent for the past 10 years.)

Dates (From – To)

Position or Title Company Name and Address Reference and Phone Number

Employee’s Name: SSN: - -

EDUCATION SUMMARY:

Name and Address of Institution

Dates Attended

Diploma or Certificate

High School College Technical Trade Schools

PROVIDE A BRIEF STATEMENT OF WHY CONTRACTOR BELIEVES THAT THIS

INDIVIDUAL HAS THE QUALIFICATIONS FOR THIS CONTRACT.

Exhibit 2D Lautenberg Statement

Public Law 104-208 & Title 18 USC Sections 921, 922 and 925

1. Public Law 104-208 has amended Title 18, United States Code, Sections, 921, 922 and 925, making unlawful for any person convicted of a misdemeanor crime of domestic violence (spouse abuse, parent abuse, child abuse, etc.) to ship, transport, possess, or receive firearms or ammunition. Presently, there are no exceptions or time limits included in this law.

2. Therefore, anyone ever convicted of the subject crime(s) would be affected by its provisions. Since a person convicted of a misdemeanor crime of domestic violence can NOT possess a firearm or ammunition, such a person may NOT perform as an armed Contract employee.

3a. Have you ever been convicted of a misdemeanor crime of domestic violence, as defined by 18 U.S.C. §921(a)(33)?

YES__________ NO ____________

3b. If you answered YES, provide the following information with respect to each conviction:

a. Court/Jurisdiction:

b. Docket/Case Number:

c. Statute/Charge:

d. Date Sentenced:

3c. I certify that, to the best of my information and belief, all of the information provided by me here is true, correct, current, complete and made in good faith. I understand that false or fraudulent information provided herein may be grounds for adverse action, up to and including removal, and is also criminally punishable pursuant to Federal law, including 18 U.S.C. §1001.

Signature:

Date Signed:

Name:

(Print your complete legal name)

Exhibit 2E Receipt for Government Property

Federal Protective Service Government Property Hand Receipt

TRANSFERRED FROM (AGENCY):

TYPE OF TRANSFER Page_______of _______

Date

Permanent Temporary

TRANSFERRED TO (COMPANY):

Property Custodian

Transfer Loan Telephone Number

Estimated return date if temporary:

Instructions or Remarks:

Item No.

(1)

Description (2)

Bar Code Number (3)

Serial Number (4)

Unit of Issue (5)

Original Cost (6)

Acceptance of Responsibility: I certify that I received the above listed Government Accountable Property, it is in my physical custody, and that the list includes all currently issued items. I am responsible for the proper use, care, and safeguarding of all Government Property in my possession or under my accountability and stewardship control. I will report any changes to this Hand Receipt within five (5) business days to the Property Custodian.

Issued by (print name): Received by (print name):

Date Signature and Title Date Signature and Title

Exhibit 2F Record of Time

Arrival and Departure from Facility

RECORD OF TIME OF ARRIVAL

AND DEPARTURE FROM

BUILDINGS (DURING SECURITY

HOURS)

BUILDING YEAR MONTH

TIME OF

DATE

PRINT NAME

(Last - First - Initial)

SIGNATURE

AGENCY

OR FIRM

ROOM

NUMBE

R

PURPOSE

OF VISIT

*SEE

FOOTNOTE ARRIVA

L

DEPARTUR

E

*Federal Protective Service and Contract Administration personnel, when conducting an investigation, must place an "X" in this column.

Exhibit 2G Non-Disclosure Agreement

DEPARTMENT OF HOMELAND SECURITY

NON-DISCLOSURE AGREEMENT

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:

Protected Critical Infrastructure Information (PCII)

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 Law107-296, 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)

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)

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.

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

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.

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 specific 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 specific 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.

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.

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.

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.

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.

DEPARTMENT OF HOMELAND SECURITY

NON-DISCLOSURE AGREEMENT

Acknowledgement

Typed/Printed Name:

Telephone Number:

Government/Department/Agency/Business Address

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

WITNESS:

Typed/Printed Name:

Telephone Number:

Government/Department/Agency/Business Address

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

Exhibit 2H Offense/Incident Report

INSTRUCTIONS

1. TYPE. Enter an X to indicate if this is an original, continuation page, or a supplement to a report previously made.

2. CODE NO. (OFFENSE/INCIDENT CODE). *Enter 4-digit offense/incident code that corresponds to the offense/incident. In cases of vandalism, enter the offense/incident code number 1010 or 1020 and enter the word "vandalism" in Item 3, followed by the estimated dollar amount of damage. (Round off amount to nearest dollar; do not use decimal or cents.)

2a. SORT. In those incidents involving the use of Special Operations Response Teams (SORT), place an X in this block.

3. TYPE OF OFFENSE OR INCIDENT. Enter in words the type of offense or incident being reported.

4. CASE CONTROL NO. Enter 11-character alphabetical/ numerical case number which is obtained from the control center. The case control number is constructed as follows: first and second places designate the region; third place, the district; fourth place, the zone; fifth place thru ninth, the number of cases listed consecutively through tout the calendar year; 10th place, a letter designating the month, e.g., A=January, B=February, C=March, etc. The 11th place designates the calendar year. Only the last digit of the calendar year is entered. For example: in Region 8, District 2, Zone 5, the 4392 case of the year, occurring in FEBRUARY 1983, would be entered as 082504392B83.

5. BUILDING NO. Enter 8-character GSA building number. When building number does not apply, enter NA (not applicable) . (It is the responsibility of each region to provide these numbers to all officers.)

6. ADDRESS. Enter street, city, and State where offense/incident occurred.

7. AGENCY/BUREAU NAME. Enter agency/bureau name (i.e., Internal Revenue Service (IRS)).

8. AGENCY/BUREAU CODE. Enter 4-character agency/ bureau code in which offense/incident occurred.

(It is the responsibility of each region to provide these numbers to all officers.)

9. SPECIFIC LOCATION. Enter in words a brief description of location of offense/incident. Always begin with general area, then room area, and then specific location (e.g., 1st floor, office, desk). Refer to example in Item 10.

10. LOCATION CODE. *Enter alphabetical/numerical code. The first two places identify the general area or floor level where the incident occurred. The third and fourth places identify the room area; the fifth and sixth places provide the specific location of the incident. For example, if the offense/incident occurred on the first floor, in an office, from a desk code 010FDK would be entered for Item 10. (the last two places are used primarily in theft incidents. When use of the fifth and sixth places is inappropriate, enter NA (not applicable)).

11a and b. DATE/TIME OF OFFENSE/INCIDENT. Enter month, day, year and military time of offense/incident. Months must be entered in numerical order (i.e., January-01 through December-12). (If the date of the offense/incident is March 9, 1998, it would be recorded as 030998.) If exact date is unknown, but date last seen can be determined, enter that date. If neither of these dates is known, enter UNK (unknown).

12. DAY. Enter 2 letters for day of week on which the offense/incident occurred. Codes for days of the week are: SU, MO, TU, WE, TH, FR, SA, and UK (unknown).

13a and b. DATE/TIME REPORTED. Follow same instructions as in Item 11.

14. DAY. Follow same instructions as in Item 12.

1. JURISDICTION. Enter an X in the appropriate box.

2. NO. OF DEMONSTRATORS. Enter the estimated number of demonstrators.

3. NO. EVACUATED. Enter the estimated number of evacuees.

17a. TIME START. Enter the time when evacuation began (use military time).

17b. TIME END. Enter the time the evacuees returned to evacuated area (use military time).

18. PERSONS INVOLVED. (Suspect, Victim, Witness, Reporting Party). If there are more than two people involved, prepare an additional GSA Form 3155. Use the same case number and fill in only the appropriate blocks.

18a. ID (IDENTIFICATION) CODE. Enter appropriate codes of persons involved: SU-suspect;

VI-victim; WI-witness; RP-reporting party. If there is more than one person in same category, enter a numeric suffix as 1, 2, etc., (e.g., SU1, SU2, etc.).

18b. NAME AND ADDRESS. Enter name(s) and address(es) of person(s) identified. Record subject's full name. Show last name first, followed by first name, then middle initial. If subject doesn't have a middle initial, use NMI (no middle initial) to indicate this.

18c. AGE. Enter age if known; otherwise, enter UNK (unknown).

18d. SEX. Enter M-male or F-female.

18e. RACE. Enter appropriate code: A-Asian Pacific/Oriental; H-Hispanic, I-American Indian; B- Black; W-White; O-Other (explain in narrative), X-Unknown.

18e1. COUNTRY OF BIRTH. Enter Country Name if known.

18e2. NATIONALITY. Enter Nationality if known

18f. INJURY CODE. Enter appropriate code: O-none; 1-refused treatment; 2-first aid only; 3-hospitalized;

4-deceased.

18g. TELEPHONE. If known, enter area code(s) and number(s); otherwise, enter UNK (unknown).

19. VEHICLE. If more than one vehicle is involved, prepare an additional GSA Form 3155. Use the same control number and fill in only the appropriate blocks.

19a. STATUS. Check the appropriate box(es).

19b. YEAR. Enter model year of vehicle.

19c. MAKE. Enter make of vehicle.

19d. MODEL. Enter model of vehicle.

19e. COLOR. *Enter appropriate color code. If more than one color, list in order from top to bottom and separate by slashes. Example: Cream vinyl top with blue body is entered as cmr/blu.

19f. IDENTIFYING CHARACTERISTICS. List any identifying characteristics of the vehicle, such as a cracked window, dented fenders, etc.

19g. REGISTRATION. Enter year, State and registration number printed on vehicle tag.

19h. VIN (VEHICLE IDENTIFICATION NUMBER). Enter vehicle identification number.

*HB, FPS UNIFORMED FORCE OPERTION, CHAPTER 8. HB, FPS, STAFF OFFICER'S GUIDE,

CHAPTER 5.

19i. VALUE. Enter estimated value of vehicle.

20. ITEMS TAKEN. If there are more than 2 items taken, prepare an additional GSA Form 3155. Use the same case number and fill in only the appropriate blocks.

20a. NAME OF ITEM. Identify item (e.g., typewriter, tools, radio equipment. etc.).

20b. QUANTITY. Enter number of items (e.g., for one item enter 001).

20c. OWNERSHIP. Check the appropriate box.

20d. BRAND NAME. Enter brand name (e.g., Remington).

20e. SERIAL NUMBER. Enter serial number, the word "none", or "unknown", as appropriate.

20f. COLOR. Enter color*. Separate multi-colors with a slash (e.g., red, brown, and blue = red/bro/blu).

20g. MODEL. Enter model or number, if any.

20h. VALUE. Enter value (or estimated value) of items stolen. (Round the amount off to the nearest dollar;

do not use decimal or cents).

20i. UNUSUAL OR UNIQUE FEATURES. List any features that will assist in identifying the property, such as an owner applied number (i.e., owner's social security number).

20j. PROPERTY WAS. Enter an X in appropriate box.

20k. STATUS OF PROPERTY. Enter an X in the appropriate box. If property is partially recovered, enter value of the amount recovered.

20l. through 20v. same as 20a. through 20k.

1. NARRATIVE. Enter details of offense/incident not included elsewhere in report, or when the word "other" has been used. If additional space is required, continue on page 2 of form and/or use and attach a blank sheet of paper.

2. NOTIFICATION. As required, enter time (military time) of notification and arrival of appropriate units. 23a and b. EVIDENCE. Enter an X in the appropriate box, and the evidence tag number if applicable.

23c. TYPE. Identify type of evidence. 23d. WHERE STORED. Give current location of evidence.

1. ATTACHMENTS. Enter an X in the appropriate boxes, or specify in block marked "Other Attachments" (such as traffic accident forms).

2. SUSPECT'S STATUS. Enter an X in the appropriate box.

3. DISPOSITION OF SUSPECT. Enter an X in the appropriate box. Enter number of any citation issued to suspect.

4. TIME (OF OFFENSE/INCIDENT). Use military time. 27a. RECEIVED. Enter the assignment received. 27b. ARRIVED. Enter time arrived on scene. 27c. RETURNED TO SERVICE. Enter time returned to service. 28a. REVIEWED BY. Enter an X in the appropriate box to indicate FPS (Federal Protective Service) or CG (Contract Guard).

28b and c. NAME AND SIGNATURE. Enter printed name and the signature of immediate supervisor reviewing report.

28d. DATE. Enter date report was reviewed.

29a. BADGE. Enter badge number of FPO completing the offense/incident report. Contract guards will enter the letters "CG". (when filling in these blocks, begin on the left and work from left to right).

29a1. CALLSIGN. Enter call sign number of FPO/Contract guard if known.

29a2. K9. Place an X in this box if FPO/Contract guard accompanied by K9. 29a3. CONTRACT GUARD COMPANY. Enter company name if known.

29b and c. NAME AND SIGNATURE. Enter printed name and the signature of FPO or contract guard completing the offense/incident report.

29d. DATE SUBMITTED. Enter date report submitted.

1. CASE REFERRED TO. Enter an X in the appropriate box(es). (The approving official is responsible for completing this block.)

2. CASE STATUS. Enter an X in the appropriate box. A case is closed when the offender has been identified, sufficient evidence has been collected to charge him/her, and he/she has been taken into custody. A case is also closed in instances where some element beyond police control precludes the placing of formal charges' against an offender (e.g., the U.S. Attorney refuses to prosecute).

32a and c. APPROVING OFFICIAL (SIGNATURE AND NAME). Completion of these blocks will indicate the report has been reviewed for accuracy and completeness of data. Enter printed name and the signature of approving official (to be designated by the district supervisor). This should not be the same as the reviewing official.

32b. DATE. Enter date report was approved.

33. DETECTIVE STATUS. This set of blocks is to be used by the detectives only. These blocks will be filled out showing what results occurred to the offense/incident report upon completion of a follow-up investigation, if conducted.

33a. CASE NUMBER. Enter Detective Section case number assigned.

33b. HOW CLOSED. Place an X in appropriate box to signify how the investigation was closed.

33c. SUSPECT. Place an X in the box if a suspect was developed or arrested.

33d. ENTERED NCIC (NATIONAL CRIME INFORMATION CENTER). Enter an X in the appropriate box.

33e. PROPERTY RECOVERED. Enter an X in the box to indicate if stolen property was recovered.

33f. VALUE OF PROPERTY. If property recovered, indicate the value of recovered property.

33g. CLEARED NCIC. Enter an X in the appropriate box.

33h. REFERRED TO. If follow-up investigation was referred to another investigative unit and accepted, indicate name.

33i. DATE REFERRAL ACCEPTED. Enter date referral was accepted.

*HB, FPS UNIFORMED FORCE OPERTION, CHAPTER 8. HB, FPS, STAFF OFFICER'S GUIDE, CHAPTER 5.

Exhibit 2I Identification Access Control Card Request

Exhibit 2J Federal Emergency Response Official

Designation Request

Exhibit 3A Contractor’s Certification of Basic Training

Employee’s Name: _____________________________________________________

SSN: - -

I hereby certify that the above named employee successfully completed all required Basic Training subjects including practical exercises and examinations in accordance with SOW, as required by Contract number ________________________________________.

Basic Training provided from ___________ to __________

(DATE) (DATE)

Basic Training Subjects presented by:

________________________________ of ___________________________________ (Name of Instructor) (Name of Company)

Employee’s Score: _______________________

Employee’s Signature: ______________________________

CERTIFIED BY:

(Printed Name of Contractor’s Authorized Representative) (Signature) (Date)

Information provided in this certification is subject investigation and verification under Title 18, Section 1001, United States Code. Any false or misleading information may be punishable by fine or imprisonment.

Exhibit 3B Contractor’s Certification of Initial Weapons Training

I hereby certify that the above named employee successfully completed required Weapons Training subjects, identified below, including practical exercises and examinations in accordance with SOW, as required by Contract number _________________________________________.

Initial Firearms Training provided from ___________ to __________

(DATE) (DATE)

Initial Baton Training provided from ___________ to __________

(DATE) (DATE)

Initial OC Training provided from ___________ to __________

(DATE) (DATE)

Other Firearms Training provided from ___________ to __________ (Weapon Type ____________________) (DATE) (DATE)

Transition/Platform Firearms Training provided from __________ to __________ (Weapon Type ____________________) (DATE) (DATE)

Weapons Training Subjects presented by:

_________________________________ of __________________________________ (Name of Instructor) (Name of Company)

Employee’s Score: _______________________

Employee’s Signature: ______________________________

CERTIFIED BY:

(Printed Name of Contractor’s Authorized Representative) (Signature) (Date)

Information provided in this certification is subject investigation and verification under Title 18, Section 1001, United States Code. Any false or misleading information may be punishable by fine or imprisonment.

Exhibit 3C Contractor’s Certification of

Government-Provided Training

I hereby certify that the above named employee successfully completed all required Government Provided Training subjects including practical exercises and examinations in accordance with SOW, as required by Contract number

Government Provided Subject(s):

Orientation Training Screener Training Other Training (specify): _____________________________ provided from ___________ to __________ by:

(DATE) (DATE)

(Name of Instructor) (Name of Agency)

CERTIFIED BY:

(Printed Name of Contractor’s Authorized Representative) (Signature) (Date)

Exhibit 3D Contractor’s Certification of Refresher Training

I hereby certify that the above named employee successfully completed all required Refresher Training subjects including practical exercises and examinations in accordance with SOW, as required by Contract number ____________________________________.

Refresher Training provided from ___________ to __________

(DATE) (DATE)

Refresher Training Subjects presented by:

CERTIFIED BY:

(Printed Name of Contractor’s Authorized Representative) (Signature) (Date)

September 2011

Exhibit 3E Contractor’s Certification of Weapons Refresher Training

I hereby certify that the above named employee successfully completed all required Weapons Training subjects including practical exercises and examinations in accordance with SOW, as required by Contract number ____________________________________.

Semi-annual Firearms Training provided from ___________ to __________

(DATE) (DATE)

Refresher Baton Training provided from ___________ to __________

(DATE) (DATE)

Refresher OC Training provided from ___________ to __________

(DATE) (DATE)

Other Training____________ provided from ___________ to __________

(TYPE) (DATE) (DATE)

Weapons Training Subjects presented by:

CERTIFIED BY:

(Printed Name of Contractor’s Authorized Representative) (Signature) (Date)

Information provided in this certification is subject investigation and verification under Title 18, Section 1001, United States Code. Any false or misleading information may be punishable by fine or imprisonment.

Exhibit 4 Required Training

Training Frequency Provider Section

Reference Exhibit

1 AED

ARC/AHA

Requirements Contractor 6.8 N/A

Contractor-Provided Basic Training

*One Time Only Contractor 6.4.1.2 4B

3 CPR

ARC/AHA

Requirements Contractor 6.8 N/A

Contractor-Provided Annual Weapons Refresher Training (Firearms)

Semi-Annual Contractor 6.6.3 4C & 4D

5 First Aid

ARC/AHA

Requirements Contractor 6.8 N/A

Contractor-Provided Initial Weapons Training and Qualification

*One Time Only Contractor 6.6.2 4C

Contractor-Provided Annual Weapons Refresher Training (Less-Than-Lethal Weapons)

Annual Contractor 6.6.5 4C & 4D

Government-Provided Orientation Training

*One Time Only Government 6.7.2 4G

Contractor-Provided Refresher Training

Every 3 Years Contractor 6.4.1.3 4E

Government-Provided Screener Training

Annual Government 6.7.3 4G

Government-Administered Written Examination

Upon completion of Basic Training

Government 6.5 N/A

* One Time Only – If PSO completes training satisfactorily.

Exhibit 4A Contractor’s Training Schedule and Plan

Use the below format for all training.

Date: XX September 2009 Times: 0800 – 1630 (30 minutes for lunch) Instructor(s): Mr. Jones Training Facility Address: Street, City, State, Zip Code

Time – Course Hours

0800 – 0900 Overview of the Department of Homeland Security and the Federal Protective Service

(CHAPTER ONE, SGIM)

0900 – 1000 Overview of the Roles & Responsibilities of a Contract Security Guard (CHAPTER TWO, SGIM)

1000 – 1100 Ethics and Professionalism Part I: Overview

(CHAPTER TWO, SGIM)

1100 – 1200 Ethics and Professionalism Part II: Interactive Training

Exhibit 4B Contractor-Provided Basic Training

IMPORTANT NOTE: INSTRUCTOR MUST USE FPS SECURITY GUARD

INFORMATION MANUAL (SGIM) AS AN ESSENTIAL COMPONENT OF THIS

TRAINING, CROSS-REFERENCING TOPICS WHERE APPLICABLE FOR

EFFECTIVE PRESENTATION OF MATERIAL.

Contractor must present 64 hours of basic training to all students. Hours listed in “Hours” column are recommended times needed for effective coverage of material, to include questions and answers, interactive tasks, and reviews/quizzes of the material.

Instructor shall use his/her expertise in evaluating PSO progress in comprehending and applying concepts and materials taught. There may be some fluctuation in actual time covered for each subject, but under no circumstances shall the Instructor provide less than 64 hours of training.

64 Hours

Subject Hours Scope Overview of the Department of Homeland Security and the Federal Protective Service

(CHAPTER ONE, SGIM)

The mission, role, and responsibilities of DHS and FPS as well as the role contract security officers play in facility security. Instructor will also discuss the five types of facilities and security levels.

Overview of the Roles & Responsibilities of a Contract Security Guard (CHAPTER

TWO, SGIM)

The typical duties of a Contract Security Officer and responsibilities associated with being a contract Security Officer at a Federal facility.

Ethics and Professionalism Part I: Overview

(CHAPTER TWO, SGIM)

Police professionalism today, including the expanding use of contract security officers and indicate by current trends, where it may be headed in the future. Provide instruction in police ethics, using practical examples, both desirable and undesirable. Discuss ideas that will lead to improved cooperation between the local, state, and Federal law enforcement security officers and the contract security officers.

Ethics and Professionalism Part II: Interactive Training

Role-playing or other interactive methods between instructor and students using scenarios of ethical and professional behavior by security officers based on the overview of this topic. Use of audio-visual materials, case studies, and other materials to facilitate training objectives are acceptable.

Principles of Communications Part I: Overview

(CHAPTER TWO, SGIM)

Familiarize the security officers with the concept surrounding effective communications and development of communication skills. Present the contract security officer with the theory of communications; various types of obstacles that can hinder the development and maintenance of effective communication; the senses and their role in the communication process and the main and essential skills that accompany the development of communication effectiveness.

Principles of Communications Part II: Interactive Training

Role-playing or other interactive methods between instructor and students using scenarios of communication methods based on the overview of this topic. Use of audio-visual materials, case studies, and other materials to facilitate training objectives are acceptable.

Professional Public Relations Part I: Overview

(CHAPTER TWO, SGIM)

Instruction provided to the security officers that will increase their effectiveness in the use of basic social skills, enhance their employer’s reputation and contract performance as well as the positive image portrayed by the U.S. Government.

Such instruction should include (but not limited to) proper display of the uniform, shoeshine, haircuts, and other forms of personal grooming.

Professional Public Relations Part II: Interactive Training

Role-playing or other interactive methods between instructor and students using scenarios of communication methods based on the overview of this topic. Use of audio-visual materials, case studies, and other materials to facilitate training objectives are acceptable.

Understanding Human Behavior, Part I: Overview

(CHAPTERS TWO AND

NINE, SGIM)

The basic knowledge needed for the security officers to understand their own actions, and those of the people they work with, in the performance of their assigned duties.

Behavior under stress (both natural and man induced); actions of mentally disturbed; irrational conduct created by the use of drugs or alcohol; job (performance) related problem; are a part of this discussion. Give special attention to the changes in human behavior that might occur in the contract security officer with the introduction of badge and gun.

Understanding Human Behavior, Part II: Interactive Training

Role-playing or other interactive methods between instructor and students using scenarios of human behavior based on the overview of this topic. Use of audio-visual materials, case studies, and other materials to facilitate training objectives are acceptable.

The Law, Legal Authorities, Jurisdiction and Responsibilities (CHAPTER

THREE, SGIM)

History of laws, applicable laws, regulations, and the concept of legal jurisdiction as it pertains to the security officers’ duties and authority.

Crimes and Offenses

(CHAPTER THREE, SGIM)

Present the security officers with an (understanding of the types of offenses they are most likely to encounter in their duties. Instruct on the methods of successful investigative techniques.

Search and Seizure (CHAPTER

THREE, SGIM)

Provide the security officer with the knowledge of the legal application of search and seizure law in the performance of duties as a contract officer in a Federal facility. Instruction should provide a comprehensive survey of laws pertaining to search and seizure to include “Stop and Frisk”.

Authority to Detain

(CHAPTER THREE, SGIM)

Provide the security officer with knowledge of how officers shall exercise their authority to detain as defined by local, state, and Federal regulations. Instruction will define detention procedures and legal rules governing practices involving: confessions, self-incrimination, eyewitness identifications, and complaints. Security officers should become completely familiar with the extent of their authority obtained from the various jurisdictions involved.

Use of Force

(CHAPTER THREE AND

APPENDIX FOUR, SGIM)

Instruct on the use of force, to include the various degrees of force authorized in the performance of duties under this contract. Reporting procedures related to such use of force.

The consequences for a security officer for the unauthorized or misuse of force.

Crime Scene Protection

(CHAPTER THREE, SGIM)

The important facets of the preliminary investigation and the protection, preservation, and subsequent search of the crime scene.

Rules of Evidence (CHAPTER

THREE, SGIM)

Definition of evidence (direct, circumstantial, and real).

Admissibility of evidence as it relates to competency, relevancy, materiality, and hearsay. Information on the exclusionary rule and other related items.