ANNEX A - Vehicle Mounted Electromagnetic Support and Attack System RFI-Technical_Document_Access_Compliance_Certification_Form with instructions.pdf

NOTE: DOCUMENT WILL BE CUI//OPSEC WHEN COMPLETED

PLEASE MARK ACCORDINGLY

ANNEX A –

VEHICLE MOUNTED ELECTROMAGNETIC SUPPORT AND ATTACK SYSTEM

PRODUCT LEAD ELECTRONIC ATTACK

TECHNICAL DOCUMENTATION ACCESS COMPLIANCE CERTIFICATION

NOTE: DOCUMENT WILL BE CUI//OPSEC WHEN COMPLETED

PLEASE MARK ACCORDINGLY

THIS CERTIFICATION of COMPLIANCE is made effective the [_____] day of [________________,] [20__].

IN WITNESS TO:

The US Army, PEO IEW&S, PM EW&C, PL EA (the “Owner”)

FROM:

(the “Vendor”)

1. The Vendor certifies it will protect all technical data whose export is restricted by the Arms Export Control Act

(Title 22, USC, Sec 2751 et seq) or the Export Administration Act of 1979, as amended Title 50, USC, App 2401, et seq. in alignment with DoD Directive 5230.25.

2. The Vendor certifies it is a: (Select only the most applicable one) ☐ A U.S. Owned and Operated Business, ☐ Foreign Controlled U.S. Owned and Operated Business and can provided approved Special Security

Agreement (SSA) and Foreign Ownership Control or Influence (FOCI) Mitigation Plan or equivalent documentation, ☐ A Foreign Affiliated U.S. Owned and Operated Business that provided approved Special Security Agreement (SSA) and Foreign Ownership Control or Influence (FOCI) Mitigation Plan or equivalent documentation, ☐ U.S. subsidiary of a Foreign Business that provided approved Special Security Agreement (SSA) and Foreign Ownership Control or Influence (FOCI) Mitigation Plan or equivalent documentation, or

☐ Foreign Owned or Foreign Affiliated Business that provided approved Special Security Agreement (SSA) and Foreign Ownership Control or Influence (FOCI) Mitigation Plan or equivalent documentation.

3. The Vendor certifies ALL personnel to be given access to Product Lead Electronic Attack technical documentation are U.S. Citizens. Foreign Nationals are excluded from participation, all associated technical documentation shall NOT be SEEN or DISCUSSED with any non-U.S. Citizens.

4. The Vendor certifies that if it pursues access to classified information, ALL personnel to be given access to Product Lead Electronic Attack Classified technical documentation hold appropriate clearance levels; Social Security Numbers will be supplied so clearances can be validated.

5. The Vendor certifies it has signed a Non-Disclosure Agreement and will abide by the terms therein, a copy has been provided to Product Lead Electronic Attack.

6. Within one hundred eighty (180) calendar days of receipt of the technical documentation, the Vendor shall destroy all printed and electronic copies of the documentation provided by the Government and all derivative products, to include unclassified and classified information. The Vendor shall certify via letter to the Product Lead Electronic Attack that:

a. this destruction has been completed,

b. the method used for destruction (e.g., shredding or incineration of printed copies, purging of electronic media, wiping of storage), and

c. provide a complete list of the personnel that had accessed the technical documentation prior to destruction.

IN WITNESS WHEREOF, the Vendor certifies it complies with the herein stated requirements as of the date specific on page 1:

(the “Vendor”) (the “Vendor” CAGE code)

POC: [________________________] Address: [___________________________]

Signature/Date: [________________________] [___________________________]

Position: [________________________] [___________________________]