Federal Acquisition Regulation: Prohibition on Contracting With Entities Using Certain Telecommunications and Video Surveillance Services or Equipment (AUG 2020)

The AIR Card® and SEA Card® participants are asked to respond regarding compliance of the requirement regarding covered technology. Fields marked with an * are required for completion. Merchant continued participation in the AIR Card® and SEA Card® program may be impacted until and unless all required data has been provided.

*** If you need to leave this form at any time, please use the "Save and Return" option at the bottom of this form to save your work. ***

Contact Information

Person Completing Form *

Phone Number *

Email *

Legal Company Name *

DBA: 🛈

Are you responsible for more than one business location participating in the US Government AIR Card® and/or SEA Card® programs? *

Yes

Merchant Information

Please download the Excel file found at this link (click here) to provide additional information for all of your locations participating in the AIR Card® or SEA Card® programs.

Once complete, save the file to your computer and then upload here. *

ICAO:

IATA:

KHI Merchant Number: * 🛈

*** If you need to research your standing with SAM.gov or have requested and are waiting on an update to your SAM.gov account, please:

1) Continue through the rest of the form to acknowledge and confirm below

2) Use the "Save and Return" feature at the bottom of the form

3) Once your SAM.gov account information is gathered, come back, update that information, and submit the completed form

Is your business registration currently active on SAM.gov? * 🛈

Yes

SAM.gov Registration Expiration Date: * 🛈 +

CAGE Code: * 🛈

D-U-N-S Number 🛈

NOTICE: Merchants participating in AIR Card® or SEA Card® programs should maintain active registration on SAM.gov. Please renew your membership at your earliest convenience.

Acknowledgement

I acknowledge that I have read and understand the government compliance memorandum related to Section 889 of the National Defense Authorization Act (NDAA).

*

I acknowledge

I understand that failure to comply with this agreement may result in exclusion from the United States Government AIR Card® and/or SEA Card® programs. I attest that my selection below is true and accurate.
*

I CONFIRM that Merchant does not currently utilize covered communications equipment.

I CANNOT CONFIRM that Merchant does not currently utilize covered communications equipment.

Please advise of date when Merchant will be in compliance with NDAA Section 889. * +

Authorized By

Signature Date:

Authorized Signatory Full Name * 🛈

Completed Form Delivery

Additional email address to receive copy of completed form (if needed):

Save & Return

Use an account to return to saved work.

AIR Card® Operations | 6450 Sprint Parkway | Overland Park, Kansas 66211
Phone: +1 (866) 308-3811 | Fax: +1 (913) 271-9358
merchant-support@aircardsys.com | www.khinc.com

SEA Card® Operations | 6450 Sprint Parkway | Overland Park, Kansas 66211
Phone: +1 (866) 308-5475 | Fax: +1 (913) 271-9358
merchant-support@seacardsys.com | www.khinc.com