Fillable Form 20220531: MILITARILY CRITICAL TECHNICAL DATA AGREEMENT (Washington Headquarters Services)

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Form 20220531: MILITARILY CRITICAL TECHNICAL DATA AGREEMENT (Washington Headquarters Services)

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PREVIOUS EDITION IS OBSOLETE.
DD FORM 2345, MAY 2019
MILITARILY CRITICAL TECHNICAL DATA AGREEMENT
(Please read Agency Disclosure Notice and Instructions on back
before completing this form.)
OMB No. 0704-0207
OMB approval expires
20220531
MAIL THE ORIGINAL, COMPLETED FORM AND A COPY OF YOUR COMPANY'S INCORPORATION CERTIFICATE, STATE/ PROVINCIAL
BUSINESS LICENSE, SALES TAX IDENTIFICATION FORM OR OTHER DOCUMENTATION WHICH VERIFIES THE LEGITIMACY OF THE
COMPANY TO:
U.S./CANADA JOINT CERTIFICATION OFFICE
DLA LOGISTICS INFORMATION SERVICE
FEDERAL CENTER, 74 WASHINGTON AVE., NORTH
BATTLE CREEK, MI USA 49037-3084
1. TYPE OF SUBMISSION (X one)
a. INITIAL SUBMISSION b. REVISION c. 5-YEAR RENEWAL
2. ENTERPRISE OR INDIVIDUAL DATA
(Referred to as a "certified contractor" upon acceptance of certification by the U.S./Canada - JCO)
a. NAME (Name of Enterprise or Individual)
c. NAME OF SUBSIDIARY/DIVISION/DEPARTMENT
d. CAGE CODE (Mandatory for Enterprise)
b. ADDRESS (Physical address, including P.O. Box if applicable)
3. DATA CUSTODIAN
a. NAME (See Instructions) b. TELEPHONE NUMBER (Primary Company Number preferred - include area code)
c. TITLE d. E-MAIL ADDRESS
4. DESCRIPTION OF RELEVANT BUSINESS ACTIVITY (Print or type)
5. AS A CONDITION OF RECEIVING MILITARILY CRITICAL TECHNICAL DATA, THE ENTERPRISE OR INDIVIDUAL CERTIFIES THAT:
a. CITIZENSHIP/RESIDENCY STATUS.
The individual designated by name in Item 3, who will act as custodian of the
militarily critical technical data on behalf of the contractor, is a citizen or person
admitted lawfully for permanent residence into:
(X (1) or (2))
(1) THE UNITED STATES (2) CANADA
b. The data are needed to bid or perform on a contract with any agency of the U.S.
Government or the Canadian Government or for other legitimate business activities
in which the contractor is engaged, or plans to engage.
c. They (1) acknowledge all responsibilities under applicable U.S. export control
laws and regulations (including the obligation, under certain circumstances, to obtain
an export license from the U.S. Government prior to the release of militarily critical
technical data within the United States) or applicable Canadian export control laws
and regulations, and (2) agree not to disseminate militarily critical technical data in a
manner that would violate applicable U.S. or Canadian export control laws and
regulations.
d. They will not provide access to militarily critical technical data to persons other
than their employees or eligible persons designated by the registrant to act on their
behalf unless such access is permitted by U.S. DoDD 5230.25, Canada's TDCR, or
by the U.S. or Canadian Government agency that provided the technical data.
e. No person employed by the enterprise or eligible persons designated by the
registrant to act on their behalf, who will have access to militarily critical technical
data, is disbarred, suspended, or otherwise ineligible to perform on U.S. or
Canadian Government contracts or has violated U.S. or contravened Canadian
export control laws or has had a certification revoked under the provisions of U.S.
DoDD 5230.25 or Canada's TDCR.
f. They are not themself debarred, suspended, or otherwise ineligible to perform on
U.S. or Canadian Government contracts, and have not violated U.S. or contravened
Canadian export control laws, and have not had a certification revoked under the
provisions of U.S. DoDD 5230.25 or Canada's TDCR.
6. CONTRACTOR CERTIFICATION
I certify that the information and certifications made by me are true, complete, and accurate to the best of my knowledge and belief and are made
in good faith. I understand that a knowing and willful false statement on this form can be punished by fine or imprisonment or both.
(For U.S. contractors see U.S. Code, Title 18, Section 1001 and for Canadian contractors see the Defense Production Act.)
a. TYPED NAME (LAST, First, Middle Initial)
b. TITLE
d. SIGNATURE (See instructions)
e. DATE
7. CERTIFICATION ACTION (For JCO Use Only)
a. CERTIFICATION ACCEPTED. This certification number, along with a
statement of intended data use, must be included with each request for
militarily critical technical data.
b. NUMBER c. EXPIRATION DATE
8. DOD OFFICIAL
a. TYPED NAME (LAST, First, Middle Initial)
b. TITLE
d. SIGNATURE (See instructions)
e. DATE
9. CANADIAN OFFICIAL
a. TYPED NAME (LAST, First, Middle Initial)
b. TITLE
d. SIGNATURE (See instructions)
e. DATE
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PREVIOUS EDITION IS OBSOLETE.
DD FORM 2345, MAY 2019
INSTRUCTIONS FOR COMPLETING DD FORM 2345
AGENCY DISCLOSURE NOTICE
The public reporting burden for this collection of information, 0704-0207, is estimated to average 20 minutes per response, including the time for reviewing
instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send
comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing the burden, to the Department
of Defense, Washington Headquarters Services, at whs.mc-alex.esd.mbx.dd-dod-information-collections@mail.mil. Respondents should be aware that
notwithstanding any other provision of law, no person shall be subject to any penalty for failing to comply with a collection of information if it does not display a
currently valid OMB control number.
SPECIFIC INSTRUCTIONS
1. Mark only one box. Mark "REVISION" (of a previously accepted
submission) to show revised information, such as addresses or
business description. Mark "5-YEAR RENEWAL" in response to a
renewal notice from U.S./Canada - JCO. When either the
"REVISION" OR "5-YEAR RENEWAL" box is marked, enter your
current Certification Number in Item 7.b.
2.a. For an enterprise, show full name of corporate parent; or
institution. For an individual, show full name (LAST, First, Middle
Initial).
b. Enter the physical mailing address of the enterprise or
individual making the certification. If a P.O. Box is used for mailing
purposes, include street address as well.
c. Each corporate subsidiary or division that is to receive militarily
critical technical data must be certified separately, each with a
unique CAGE Code. If not applicable, so state.
3. Show the name, business telephone number (including area
code - general company number preferred), title of the individual
and their e-mail address who will receive militarily critical technical
data and be responsible for its further dissemination.
4. Describe the business activity of the entity identified in Item 2 in
sufficient detail for the U.S. or Canadian Government agency
controlling the data to determine whether the militarily critical
technical data that you may request from time to time are
reasonably related to your stated business activity. For example,
state that you design and construct high-pressure, high volume
hydraulic pumps for use in connection with aircraft control surfaces;
do not state simply "hydraulic pumps." Provide concise statements
within the space provided.
5. If certifications 5.e. and 5.f. cannot be made, provide (on a
separate sheet) a description of any extenuating circumstances that
may give sufficient reason to accept your certification.
5.a. If the location of the entity identified in Item 2.a. is in the United
States, the individual named in Item 3 must be a U.S. citizen or a
person admitted lawfully for permanent residence into the United
States. If the location of the entity is in Canada, the individual
named in Item 3 may be either a Canadian or U.S. citizen or a
person admitted lawfully for permanent residence into Canada.
6. If Item 2 identifies an individual, that individual must sign. If Item
2 identifies an institution or a corporate entity, a person who
can legally obligate the enterprise to a contract must sign.
Digital signatures are NOT acceptable.
7. CERTIFICATION ACTION.
a. ACCEPTED. The U.S./Canada - JCO has assigned the
enterprise or individual identified in Item 2.a., a Certification Number
which will identify the individual or enterprise as a "certified
contractor" as defined in U.S. DoDD 5230.25 or Canada's TDCR.
The acceptance is valid for a period of five years from the
acceptance date unless sooner revoked under the provisions of
U.S. DoDD 5230.25 or Canada's TDCR. If at any time a certified
contractor is unable to adhere to the conditions under which a
certification was accepted, the contractor's certification is
considered void, and the contractor will either submit a revised
certification or surrender all militarily critical technical data obtained
under this agreement to the data controlling offices specified on the
documents.
b. NUMBER. Certification Number (assigned by the JCO).
c. EXPIRATION DATE. Date Certification Number will expire
(assigned by the JCO).
LEGEND:
DoD = Department of Defense
DoDD = Department of Defense Directive
U.S./Canada - JCO = United States/Canada Joint Certification Office
TDCR = Technical Data Control Regulations
Militarily Critical Technical Data = Unclassified technical data as governed by U.S. DoDD 5230.25 or Canada's TDCR.
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Form 20220531: MILITARILY CRITICAL TECHNICAL DATA AGREEMENT (Washington Headquarters Services)

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Completed 5 January 2022

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