RAR Form Tallinn.docx

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Local Guard Services – U. S. Embassy in Estonia
Solicitation number
19AQMM24R0011
Issued by

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This document is a restricted access request form for a local guard services solicitation issued by the U.S. Department of State Office of Acquisition Management. Interested parties must complete the form providing company information and agreeing to distribution restrictions to receive access to the restricted solicitation documents for providing local guard services at the U.S. Embassy in Estonia. The solicitation number is 19AQMM24R0011 and seeks to award a contract for local guard services at the embassy location. Respondents must be registered in SAM.gov and the completed form is to be emailed to the identified contracting officer and contract specialist.

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U.S. Embassy in Tallinn, Estonia– Local Guard Program Restricted Access Request

RESTRICTED ACCESS REQUEST - LOCAL GUARD PROGRAM

U.S. Embassy in Tallinn, Estonia

19AQMM24R0011

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. UEI ______________________________________________________

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 SAM.GOV, 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 emailed to Eric Modrak (Contracting Officer) at ModrakER@state.gov and Sarah Gregory (Contract Specialist) at gregoryse2@state.gov Restricted Access Request Page 1

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