CUI Building Information Request Form

REQUEST FOR CONTROLLED UNCLASSIFIED INFORMATION (CUI) BUILDING

INFORMATION

The requester shall complete the information below and return the entire Request for CUI Building Information 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.
(The Offeror shall attach copy of business license or formation document.) UEI Number Verified by Government Representative at:
https://www.sam.gov/portal/public/SAM/#1

Yes: ___ No: ___

Offeror/bidder/contractor information and UEI number has been verified and release of CUI building information is approved by:

Jamie Potter
Contracting Officer

Date

DISPOSAL STATEMENT FOR CUI BUILDING INFORMATION

I hereby certify that all 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 that no unauthorized physical or electronic copies of such CUI building information were made or are being retained.