QAX SF-6400 - Safeguard.pdf

QAX Standard Form 6400 31 August 2018 Page 1

CONTRACTOR CERTIFICATION TO SAFEGUARD TECHNICAL DATA AND ASSETS

PART A. REQUEST. The U.S. Air Force unit listed here requests the contractor make the certification below in order to be eligible to quote for work (or carry out work). This certification must be properly filed and accepted before any DoD activity is permitted to provide access to export-controlled technical data in accordance with DoD Directive 5230.25.

U.S. Air Force unit office symbol (typically MXG or MXS)

USAF employee to whom certification shall be returned

Mailing address E-mail address

Phone number Date needed by

PART B. REPLY. CONTRACTOR’S CERTIFICATION

This certification must be signed by a person authorized to make representations on behalf of the contractor1 and obligate the contractor legally as evident by that person’s title and position.

On behalf of the contractor, I certify the following:

1. I am authorized to make representations on behalf of the contractor and to legally obligate the contractor. Furthermore, I have knowledge of relevant organizational history, business practices, operations, legal matters, and personnel to make such representations.

2. All individuals who will receive or have access to export-controlled technical data and/or assets on behalf of the contractor are U.S. citizens or permanent residents (green card holders) admitted lawfully into the United States. Furthermore, these persons are located within the geographical boundaries of the United States (more specifically, within one of the fifty states).

3. All individuals who will receive or have access to technical data and/or assets shall sign a nondisclosure agreement (NDA) acceptable to the U.S. Air Force unit to whom this certification is made. All NDAs will be retained by the contractor in paper or electronic form for at least ten years after the work is completed. Retained NDAs will be legible and available for audit or inspection at any time. If not using a pre-approved NDA form, a copy of our NDA form is submitted with this bid.

4. Access to export-controlled technical data and/or are needed to bid or perform work required and authorized by the U.S. Air Force or for other legitimate business purposes in which the contractor is engaged or plans to engage. I understand further proof may be required to demonstrate a legitimate business purpose.

5. I acknowledge contractor responsibilities under U.S. export control laws and regulations (including the obligation, under certain circumstances, to obtain an export license prior to the

1 The term contractor shall be understood to include any entity that is not strictly a U.S. Government agency, including private businesses, companies, corporations, state or local government agencies, public or private colleges and universities, non-profit and not-for-profit enterprises, sole proprietorships, and individuals.

QAX Standard Form 6400 31 August 2018 Page 2 receipt or release of technical data and/or assets within the United States). The contractor agrees that it shall not disseminate any export-controlled technical data or allow access to export-controlled assets in a manner that would violate applicable export control laws and regulations.

6. I affirm that the contractor recognizes the authority of distribution statements on scientific and technical information and agrees to adhere to all distribution statements regarding the dissemination of this information.

7. The contractor will not provide access to any technical data and/or assets to persons or entities other than its employees without the express written permission of the U.S. Air Force to whom this certification was made. Moreover, access will be provided on a need-to-know basis.

8. To the best of my knowledge and belief, the contractor knows of no person employed by it, or acting on its behalf, who will have access to such data and/or assets that is debarred, suspended, or otherwise ineligible from performing work for U.S. Government agencies; has violated U.S.

export control laws; or has violated/inaccurately made a certification to any U.S. Government agency.

9. The contractor itself is not debarred, suspended, or otherwise determined ineligible by any U.S.

Government agency to perform work for U.S. Government agencies, has not been convicted of export control law violations, and has not been disqualified by any U.S. Government agency or prime defense contractor for a similar issue within the past ten years.

10. To the best of my knowledge, neither the contractor nor any of its employees are currently under investigation for export control law/regulation violations and have not been notified of a pending disqualification, denial, debarment, license suspension, license revocation, or similar adverse action by any U.S. Government agency.

11. I affirm that the contractor will notify the U.S. Air Force unit to whom this certification is made within two business days if the validity of any certification made hereon changes or the contractor has reason to believe it may change for a period of 24 months or the total length of any contract (to include all options), whichever is longer.

□ Check this box if the certification above cannot be made truthfully, and describe any issues and extenuating circumstances in the comment box below.

Signature of certifier

Date

Printed name and title/position of certifier

Comment

QAX Standard Form 6400 31 August 2018 Page 3

Vendors without a current Government contract: Send a blank NDA for review when you submit this form. If you have a Department of State Directorate of Trade Controls (International Traffic in Arms Regulations) and/or Department of Commerce Bureau of Industry and Security (Export Administration Regulations) license, submit evidence of licensure with this form.

□ Vendors without a current contract may check box at left to indicate they elect to use WR-ALC/QAX OF-1601 instead of submitting an NDA form for review.

NOTE THAT THE TERMS OF A SPECIFIC GOVERNMENT CONTRACT MAY MANDATE A

SPECIFIC NDA FORM. IF SO, THAT FORM MUST BE USED.

SECTION BELOW FOR U.S. GOVERNMENT USE ONLY

PART C. CERTIFICATION ACCEPTANCE DECISION

Certification status

□ Accepted □ Rejected

Reason if rejected

NDA status

□ Agreed to use QAX OF-1601

□ Other Government NDA used

□ Omitted from bid

□ Submitted not reviewed

□ Rejected

□ Accepted Signature of acceptance official Printed name, title, and rank/grade of acceptance official (must be GS-12/NH-III or higher)

Date of acceptance

Expiration date (24 months maximum)*

If this form is used in conjunction with a Government contract, certification will run with the length of the contract, including all option years.