NonDisclosure Agreement_NIHAI2012152.pdf

PROSPECTIVE OFFEROR NON-DISCLOSURE AGREEMENT

SOLICITATION #NIHAI2012152

Each prospective offeror who may have access to non-public information in order to prepare an offer shall complete the form: Rocky Mountain Laboratories AMOB Prospective Offeror Non- Disclosure Agreement. The agreement is on the next page of this document.

A copy of each Agreement shall be submitted to Lynda Kieres lkieres@niaid.nih.gov AND

Tamara McDermott tamara.mcdermott@nih.gov or faxed to (406) 363-9288 before additional information regarding radioactive materials will be released.

Carefully read the following directions.

To Complete the NDA Form using a DIGITAL Signature

1. Fill out the online form.

2. Using your digital signature, sign the Agreement form. [If unsure how to do this, fill the form out manually]

3. Save the file.

4. Once the file has been saved, remove the directions page and save it again (only retaining the

Agreement portion of the form).

5. You are now ready to email the signed Agreement form to the POCs listed above.

To Complete the NDA Form using a MANUAL Signature

1. Print the NDA form and fill it out.

2. Sign the Agreement in front of a witness and have the witness sign it.

3. Fax or email the Agreement portion of the form to POCs listed above.

mailto:lkieres@niaid.nih.gov mailto:tamara.mcdermott@nih.gov

ROCKY MOUNTAIN LABORATORIES AMOB

PROSPECTIVE OFFEROR NON-DISCLOSURE AGREEMENT

Request For Proposal (RFP):_______________________________________________ Project Title:_____________________________________________________________ _____________________________(Organization’s name), intends to respond to the Government’s Solicitation/Project title indicated above. The Government has determined that the solicitation requires prospective offerors to have access to sensitive information in order to prepare an offer.

I, ___________________________________________(Offeror Official name and title), of __________________________________________________(Organization’s name), on this _____day of _____________, 20___, on behalf of my organization hereby request access to the sensitive information described in RFP sited above.

I, the undersigned, understand that the Government has determined that any individual having access to the sensitive information described in the RFP must meet the requirements identified in Section 3.5 of the RFP cited above.

I, the undersigned, do hereby affirm the following:

I have certification of FBI fingerprinting, background investigation, and criminal history records check in accordance with Nuclear Regulatory Commission (NRC) Order EA-07-305 (copy attached).

I will be the corporate official solely responsible for appropriately safeguarding the sensitive information while in the possession of ____________________(Organization’s name);

The sensitive information will be used solely for the purpose of preparing an offer;

I will not release, publish, or disclose the sensitive information to unauthorized personnel; and

I will protect the sensitive information in accordance with provisions of the following laws and any other pertinent laws and regulations governing the confidentiality of sensitive information;

o 18 U.S.C. 641 (Criminal Code: Public Money, Property of Records) o 18 U.S.C. 1905 (Criminal Code: Disclosure of Confidential Information) o Public Law 96-511 (Paperwork Reduction Act)

Signature of Prospective Offeror Official:______________________________________ Name of Prospective Offeror Official:_________________________________________ Name of Prospective Offeror:_______________________________________________ Date:___________________________________________________________________

Signature of Witness:_____________________________________________________ Name of Witness:_________________________________________________________ Date:___________________________________________________________________