Vendor-Self-Validation-Form.docx
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- Attached to
- Modular Open Systems Approach (MOSA) for Department of War Consortium Manager and Marketplace
- Solicitation number
- W900KK26RMOSA
About this file
This is a Vendor Self-Validation Form for contractors requiring access to classified and Controlled Unclassified Information (CUI) technical data packages on FAR-based contracts or Other Transaction Agreements (OTA).
The form requires contractors to provide company registration and clearance information, including legal name, CAGE code, Unique Entity Identifier, and System for Award Management (SAM) database registration status. Contractors must disclose whether their organization holds a Defense Counterintelligence and Security Agency (DCSA) approved Facility Clearance at the SECRET or TOP SECRET level and whether they possess classified material at either level. The form also requires disclosure of foreign ownership status, including whether the organization is foreign-owned, under Foreign Owned, Controlled, or Influenced (FOCI) status, or engaged in merger or acquisition discussions with foreign or FOCI entities. Contractors must provide detailed information on any foreign-owned entities involved with their organization, including company name, CAGE code, and country of origin. Completion of the form constitutes certification that all provided information is accurate and current, with signature and date required. When completed, the form must be marked as CUI in both the header and footer.
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Other files
| File | Type | Posted |
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| Vendor Questions Form.xlsx | XLSX spreadsheet | |
| Data Rights.docx | DOCX document | |
| RFS - MOSA Consortium Manager and Marketplace.docx | DOCX document | |
| Telecommunication-Representation.docx | DOCX document |
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Text version
FACILITY SECURITY CLEARANCE VALIDATION OF CONTRACTORS
Requiring Access to Classified, CUI Technical Data Packages
To facilitate the security validation procedures required to support your participation on FAR base contracts or OTA agreements, please provide the following information and certify (sign) and date your responses.
1. Company / Organization Full legal Name:
2. Company / Organization Cage Code:
3. Unique Entity Identifier
4. Is your organization registered in the System for Award Management (SAM) database (Yes or No)? If yes, include registration valid through date.
5. If you answered “No” to question #3, please provide information regarding any previous government contracts or government work your organization has performed.
6. Does your company / organization have a DCSA approved Facility Clearance (FCL) (Yes or No)? If you answer “Yes,” List the level of your FCL (SECRET or TOP SECRET)
5a. Possessing (Yes or No), If you answer “Yes,” List the level of possessing (SECRET or Top Secret)
7. Is your company / organization (or your subcontractors) foreign owned or under USA Foreign Owned, Controlled, or Influenced (FOCI) status (Yes or No)?
8. Is your company / organization in merger and/or purchasing discussions with a foreign company or a USA FOCI company (Yes or No)? No
9. If you answered “Yes” to question #6 or #7, please provide the following information on each foreign owned or under USA FOCI company.
a. Full Company Name:
b. Cage Code:
c. Identify Country or Origin:
I certify the information I have provided on behalf of my organization is accurate and up to date.
Printed Name Signature Date
WHEN FILLED IN, MARK CUI IN THE TOP HEADER AND BOTTOM FOOTER!
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