Supplier Cybersecurity Questionnaire

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REPRESENTATION AND CERTIFICATION OF COMPLIANCE WITH DFARS 252.204-7020 NIST SP 800-171 DoD Assessment Requirements

As of November 30, 2020, Department of Defense (DoD) contractors and subcontractors utilizing an information system (see DFARS 252.204-7012) to process, store or transmit Covered Defense Information or Controlled Unclassified Information must have a current DoD assessment posted in the Supplier Performance Risk System (SPRS) prior to award of any new DoD contract, subcontract, or purchase order. This requirement flows down to subcontractors and suppliers at all levels.

SEILER, therefore, is obligated to confirm that recipients of purchase orders subject to DFAR 252.204-7012 ("SUPPLIERS") are in compliance with this requirement.

Accordingly, SEILER requests that SUPPLIER represent and certify as to the following:

Question #1*

SUPPLER represents and certifies that:

SUPPLIER confirms that it only provides “Commercial Off-the-shelf” (COTS) items and is, therefore, exempt from the requirements of NIST SP 800-171.

SUPPLIER confirms a DoD NIST SP 800-171A Assessment score is posted in the DoD’s Supplier Performance Risk System (SPRS) for each covered contractor information system.

SUPPLIER confirms a DoD NIST SP 800-171A Assessment score will be posted in the DoD’s Supplier Performance Risk System (SPRS) for each covered contractor information system by the date entered in the 'Supplier Assessment Date' box below.

SUPPLIER, while subject to NIST SP 800-171, has not and does not plan to perform and post a DoD NIST SP 800-171A Assessment score in the DoD’s Supplier Performance Risk System (SPRS).

SUPPLIER Assesment Date*

SUPPLIER DoD NIST SP 800-171A Assessment Date is:

Certification

The undersigned, a person authorized to represent the SUPPLIER in this matter, herein certifies that the information provided is, to the best of their knowledge, complete and truthful and understands that SEILER intends to rely upon this information in representations that it makes to the United States Government regarding compliance with contractual requirements.

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Vendor ID

Supplier Name*

Name of Person Certifying*

Title of Person Certifying*

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