Custodian_Agreement_Form.pdf

I, _________________________________ certify that I have a comprehensive understanding of the meaning of and the handling designation "DoD Unclassified Controlled Nuclear Information (UCNI)" on the documents I am requesting and will comply with all requirements for protection of DoD UCNI documents identified in

5210.83 Department of Defense - DoD UCNI and AR 380-5 Army Regulation policy for safeguarding protected information. I understand that DoD UCNI is a document designation with an "unclassified" classification. This designation for the provided material is information or material which, although unclassified, is not appropriate for public release in accordance with DoD Directives and Regulations..

I also attest to my understanding that the DVD, any copies generated from that DVD and the Chain of Custody Log, referenced below shall be returned to the Omaha District Corps of Engineers, Contracting Division no later than 60 days after notification of award. The awardee is permitted to retain their respective copy until further notification.

I agree to maintain a Chain of Custody Log to record all access to the DVD and all copies generated. All printing of hardcopies or duplicate DVD's from the DVD provided must be logged. The log shall be maintained in ink. No white-out corrections allowed on this log. The log shall record who has physical control of these items at any time. The log shall identify the document reproduced (i.e. plans, specifications, sheets, or sections), how many copies were made, and where they were sent, including the name of the company it was sent to as well as the specific person at that company. A Chain of Custody Log will be provided to your company along with the DVD and instructions on the use of the DVD.

Any copies sent to another entity, sub-contractor, vendor or to any person acting on their behalf shall be logged and all copies in those corporations shall be safeguarded in the same manner, including logging who has physical control of that document and any copies made. The person receiving that document shall likewise maintain a chain of custody log.

The signature below certifies that the information herein is correct and factual and that I agree to all terms stated herein with regards to the safekeeping of the DVD and all information contained on the DVD which I am requesting.

Signed By: ________________________________________ DATE: __________

Notarized By: ________________________________________ DATE: __________

Any misrepresentations or falsifications in the information provided or the release of information on the DVD provided may be prosecuted in accordance with U.S. Code, Title 18, Section 1001.

CUSTODIAN AGREEMENT FORM

FOR

SOLICITATION DOCUMENTS

Corporation Name

Name of Custodian

Custodian’s EMail Address

Custodian’s Phone Number

Duns & Bradstreet Number

Title of Custodian

Mailing Address (Note – PO Boxes are not acceptable)

City State Zip Code