Soliciation Attachment 04 - Request for Controlled Unclassified Information (CUI).pdf
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- Solicitation number
- 47PJ0025R0059
About this file
This document is a Request for Controlled Unclassified Information (CUI) for Solicitation/Contract Number 47PJ0025R0059. The document contains two primary sections: a Request for CUI form and a Disposal Statement for Sensitive but Unclassified Building Information. The Request for CUI form requires potential offerors to complete company details, including company name, individual name and title, signature, date, UEI number, and Employer ID/Federal Tax ID number. The form requires the offeror to attach a business license or formation document and acknowledges the responsibility to safeguard and properly handle the CUI building information.
The second section is a Disposal Statement to be submitted upon project completion, where the information holder must certify the destruction of all CUI building information through methods like burning, shredding paper copies, physically destroying computer diskettes, or permanently deleting electronic files. The statement requires the individual to confirm that no unauthorized physical or electronic copies of the CUI building information were made or retained. The document is signed by Shannon Sweeney, who is identified as the Contracting Officer, and provides a mechanism for tracking and securing sensitive building information throughout the contract lifecycle.
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Text version
REQUEST FOR CONTROLLED UNCLASSIFIED INFORMATION (CUI)
Solicitation/Contract Number 47PJ0025R0059
The requester shall complete the information below and return the entire Request for Controlled
Unclassified Information (CUI) document to the Contracting Officer or Contract Specialist. By signature below, the requestor of CUI building information acknowledges the requirement to maintain controls, as stated herein, to safeguard the information, and shall return or destroy the
CUI building information as required by this Agreement. The undersigned acknowledges that the requester shall abide by this Agreement and shall only disseminate CUI building information to other authorized users under the conditions set forth herein.
OFFEROR SHALL COMPLETE AND SUBMIT ALL REQUIRED INFORMATION AS
FOLLOWS:
Company Name: _____________________________________________________
Name of Individual and Title: ____________________________________________
Signature: ___________________________________________________
Date: _______________________________________________________
(The Offeror shall attach copy of business license or formation document.)
UEI Number: _________________________________________
UEI Number Verified by Government Representative at:
https://www.sam.gov/portal/public/SAM/#1 Yes: ___ No: ___
Employer ID Number/Federal Tax ID Number _______________________________
Offeror/bidder/contractor information and DUNS number has been verified and release of CUI building information is approved by:
Date
Shannon Sweeney
Contracting Officer https://www.sam.gov/portal/public/SAM/#1
This statement shall be submitted by the holder of SBU building information when information is disposed of in accordance with the Request for Sensitive but Unclassified
Building Information upon completion of the Project.
DISPOSAL STATEMENT FOR SENSITIVE BUT UNCLASSIFIED BUILDING
INFORMATION
Solicitation/Contract Number ________________________________________
I hereby certify that all Controlled Unclassified Information (CUI) building information relative to the referenced solicitation/contract not previously returned to the Government has been destroyed or disposed of by burning or shredding paper copies, physically destroying computer diskettes or permanently deleting/removing/erasing electronic files from computers.
I also certify the no unauthorized physical or electronic copies of such CUI building information were made or are being retained.
Company Name: ______________________________________________
Name of Individual: ____________________________________________
Signature: ___________________________________________________
Title: _______________________________________________________
Date: _________________
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