Att 1a_Vendor-Self-Vetting-Form.pdf
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- Solicitation number
- W900KK-24-R-9001
About this file
This document includes a vendor self-vetting form and a request for solutions for an advanced electrochromic manufacturing prototype project. The self-vetting form requests information from vendors such as organization name, CAGE code, SAM registration status, facility clearance level, foreign ownership status, and merger or acquisition information. The request for solutions is seeking proposals from vendors for an Other Transaction Authority agreement to develop prototypes of single-piece electronically dimmable eyewear with mature electrochromic technology and demonstrate US-based manufacturing capabilities and processes. Questions are due by the specified closing date and the government intends to competitively award one agreement. The agencies involved are the Industrial Base Analysis and Sustainment program, Program Executive Office for Simulation, Training, and Instrumentation, and Army Contracting Command-Orlando.
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SECURITY VETTING FOR CONTRACTORS
To facilitate the security vetting procedures required to support your participation on FAR base contract or OTA agreement, please provide the following information and certify (sign) and date your responses.
1. Full Organization Name:
2. Organization Cage Code:
3. Is your organization registered in the System for Award Management (SAM) database
(Yes or No)? Yes No
4. If you answered “No” to question #3, please provide information regarding any previous contracts or government work your organization has performed.
5. Does your organization have an active Facilities 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)
6. Is your organization (or your subcontractors) foreign owned or under USA Foreign
Owned, Controlled, or Influenced (FOCI) status (Yes or No)? Yes No
7. Is your organization in merger and/or purchasing discussions with a foreign company or a
USA FOCI company (Yes or No)? Yes No
8. 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
File details come from the government source that posted it. Updated .