26-SIMACQ-E30-0034_FORM2210.4_PED.pdf

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26-SIMACQ-E30-0034 Cell Phone Repeater Removal and Replacement
Solicitation number
N6339426Q4056
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26-SIMACQ-E30-0034-26Q40560002_8242026.pdf PDF
26-SIMACQ-E30-0034_Sol_26Q40560001_8192026.pdf PDF
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26-SIMACQ-E30-0034_SOL_N6339426Q4056_7292026.pdf PDF

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PORTABLE ELECTRONIC DEVICE (PED) PERMIT

NSWCPHD 2210/4 (Rev. 3/19) LiveCycle Designer 11.0 Reason for exemption (supporting documentation must be attached):

I understand that it is my responsibility to prevent any accidental or intentional imaging, recording, or exporting of any classified information or controlled unclassified information.

I understand that this device can only be used in the above specified area(s). If I fail to comply, disciplinary actions will follow.

MY SIGNATURE AFFIXED TO THIS STATEMENT IS CERTIFICATION THAT I HAVE READ AND THOROUGHLY UNDERSTAND THE ABOVE CONTENTS.

APPROVING OFFICIALS

THIS SIGNED PERMIT MUST BE CARRIED ON PERSON AT ALL TIMES.

Copy of this signed permit must be retained for 2 years from the date of signature.

PREVIOUS EDITION IS OBSOLETE

Device does have capability to record, transmit, or transfer.

If no, no further action is necessary.

11.0.1.20130826.2.901444.899636

Name:
WorkPhone:
WorkEmail:
CommandCompany:
DeptCode:
DateRequested:
LocationofUse:
Dates:
ContractNumber:
NSWCPHDPOC:
NSWCPHDPOCPHONE:
PEDDeviceType:
PEDDeviceSerioal:
Reasonforexemption:
ApplicantSignature:
CheckBox1: 0
CheckBox1: 0
CheckBox1: 0
CheckBox1: 0
CheckBox1: 0
ReasonforDisapproval:
DepartmentManagerSignature:
CheckBox2: 0
DateField1:
CommandISSMSignature:
SecurityManagerSignature:
CSOSignature:

File details come from the government source that posted it. Updated .