PR10918288_RestrictedAccessForm.docx

DOCX document 33 KB Posted

Attached to
U. S. Mission Conakry, Guinea - Local Guard Services Federal contract opportunity
Solicitation number
PR10918288
Issued by
Department of State Office of Acquisition Management

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Contractor Info Sheet.docx DOCX document
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US Mission Conakry– Local Guard Program Restricted Access Request

RESTRICTED ACCESS REQUEST - LOCAL GUARD PROGRAM

U.S. MISSION CONAKRY, GUINEA

PR10918288

THIS FORM MUST BE FILLED OUT IN ITS ENTIRETY*. ANY INFORMATION NOT SUPPLIED WILL RENDER THIS REQUEST INVALID.

1. Requester Information

a. Company Name _____________________________________________________

b. Company Address ___________________________________________________

c. CAGE CODE and UEID ___________________________________

d. Point of Contact _____________________________________________________

e. Telephone No _______________________________________________________

f. E-mail Address ______________________________________________________

2. My interest in this project is as a (please check one):

a. a. [ ] Prime Contractor

b. b. [ ] Joint Venture Participant

c. c. [ ] Other (please specify) ___________________________________________

3. I, the undersigned, agree that I will safeguard this information in accordance with the following distribution restriction statement:

RESTRICTED DISTRIBUTION AGREEMENT

Distribution authorized to legitimate bidders only, contains technical or operation information.

THESE RESTRICTED ACCESS DOCUMENTS MAY NOT BE DUPLICATED NOR IS ANY SECONDARY DISTRIBUTION OF DOCUMENTS AUTHORIZED. ANY AND ALL FIRMS WISHING TO VIEW ANY PART OF THESE DOCUMENTS MUST REGISTER WITH FEDBIZOPS, COMPLETE AND SIGN THIS FORM, AND HAVE THEIR REQUEST APPROVED BY THE GOVERNMENT. DATA SHALL BE KEPT IN A LOCKED DESK, LOCKED FILING CABINET, OR LOCKED ROOM WHEN NOT IN USE. UPON TERMINATION OF USE, THE HARDCOPY PRINTS AND ANY ELECTRONIC MEDIA SHALL BE DESTROYED BY SHREDDING THE PRINTS AND FORMATTING THE ELECTRONIC MEDIA. UPON TERMINATION OF USE, ALL MEDIA SHALL BE REMOVED FROM ANY COMPUTERS.

DO NOT COPY, SCAN OR POST ANY PART OF THESE BIDDING DOCUMENTS ON THE INTERNET.

Printed Name:____________________________ Signature:______________________________________

*Completed form may be e-mailed to Jenel A. Charles at CharlesJA6@state.gov.

Restricted Access Request Page 1

SBU - CONTRACTING AND ACQUISITIONS

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