Joint Service Provider - EPIC

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Joint Service Provider

GSA/DoD Designated Agency Representative (DAR) Appointment Form

Washington lnteragency Telecommunications 3

In compliance with the GSA contract agreement, a DARA has been appointed. DoD has assigned a DARA (Designated Agency Representative Administrator) to facilitate all appointments of DAR(s). The DARA assigned to you is Jonathan Barb. He is the only official with signature authority to assign DARs as agents to place service orders against the WITS 3 contract. If you have questions call the JSP Service Desk at 703-571-4JSP (4577). This supersedes all previous signature authority notification .

DARs cannot be contractors. As a DAR for your organization, you are responsible to the Agency you represent; in accordance with the WITS 3 contract, your Agency policy and procedures, the Federal Acquisition Regulation (FAR) and applicable anti-deficiency laws. You cannot delegate this responsibility to others . This appointment does not include the right to modify the contract, or any of its terms and conditions , as only the GSA Contracting Officer may make contract modifications . If you have any questions related to your roles and responsibilities as outlined in this letter, please contact the JSP Service Desk at 703-571-4JSP (4577) .

Before authorizing orders directly through Service@once and Level 3's ordering system , Verizon 's and Level 3's automated ordering and provisioning system for use by federal agencies, you must attend the three-day Service@once training course provided by Verizon and Level 3's training. If you have not completed Service@once training for Verizon, you may place orders by completing a Service Order Request Form available online at: http://ita.army .mil/CustomerForms .aspx . Be sure to fax the completed form to the appropriate Verizon number for processing. Faxed orders are available for authorization in Service@once, but there is a $25 service-order processing fee. Level 3 training will be available . For training and access please email at [email protected]

Consider the following in carrying out your responsibilities as a DAR:

• Be familiar with the terms and conditions of the referenced Contract.

• Ensure that a valid obliqatinq document is in place before placinq a service order • Ensure funds are available on the obliqatinq document to fund the service order • Verify that the service order requirements are consistent with the scope of the Fair

Opportunity Decision/Number referenced in the service order • Keep current on contractual service ordering procedures .

• Meet all appropriate contract automated system security safeguards, such as access to orderinq and billinq svstems .

• Comply with all appropriate Agency standards of conduct.

Promptly notify the JSP Service Desk at 703-571-4JSP (4577) shou ld you no longer be in the role to perform the functions of a DAR, or be separated from your current employment/Government service . Your appointment shall terminate upon notification from your agency or the date you separate from your current employment/Government service, whichever is first. Contact the JSP Service Desk regarding any issues or concerns you may have in your relationship with the contractor .

s that you accept and understand the responsibilities and limitations

1of 2


Joint Service Provider

WITS3 Designated Agency Representative (DAR) Form

If you need to change or add the Designated Agency Representative (DAR) for your agency , please comp lete this form and return to the JSP Service Desk : osd.pen tagon .jsp.mbx.jsp-service -desk@ma il.mil

Please contact the JSP Service Desk at 703-571-4JSP (4577) with any questions.

Please Check One:

~ DAR New D DAR Remove 0 DAR Profile Update

Billing Account Code {BAC): _______________________ _

(List all that apply or use attachment if needed)

Billing Agency Name: National Security Commission on Artificial Intelligence

Name of DAR: Michael L Gable

Remove this DAR:_ . ___________________________ _

Address: --{l;)JlD-,------------------Title: Chief of Staff

Telephone Number:------- Fax Number: ___ _____ _ __ _

(Agency Authorizing Official Signature)

• All names should match the name that Is used on the person's Common Access Card (CAC)

2of 2


DoD WITS3 Application Form for New Customers

WITS 3 Establishing a BAC for New Customers

Please provide the information requested on the following two pages in order to become a WITS 3 customer. E-mail the completed form to the following address. Otherwise, please contact the JSP Help Desk at 703 -571-4577 or [email protected] with any questions.

BILLING ACCOUNT INFORMATION

BILLING ACCOUNT CODE(s) (BAC): ________________ _

1. Billing Agency

Billing Agency Address: ___ __

Room Number/Floor: ___ _

City/State/Zip: _____ _

2. Points of Contact/Agency Budget Officer:

Name: ____ M"""'i...,_ch ___ a=e'-'-1-=L__,G'-"a=b=le,__ ____________________ _

Telephone Number/E-mail address/fax: --l(DJO-•i-------------Name: __ Y'--'-11'--'B=a=jr=a=kt=a"-'ri ______________________ _

Telephone Number/E-mail address/fax: ----tm1m•----------Name: ----------------------------Telephone Number/E-mail address/fax: -- ------- - -------

3. Designated Agency Representative (DAR):

Name: Michael L Gable

_ Telepho~ax:

Signature: ,....--..._ c:::>-

Special Instructions: _______________________ _

Have you attended Service@once Training*? D Yes J¼I No (*If no, please contact the JSP Help Desk at:

703-5 71-4577 to register to attend an upcoming session)

1


U.S. Dept. of Defense JSP

GSA Form 019 Memorandum for General Services Administration (GSA)

National Capital Region Federal Acquisition Service Network Service Div ision

SUBJECT: Estab lishment/Change of WITS 3 Accounting Data for Contract GS11 TO8BJD6001

The following information is submitted for the establishment/modification of WITS 3 Account

Please e-mail this completed form for GSA Billing to JSP <~~~~~~~~

A. Billing Agency Name: -·- - ... ,. .,,, ....... -Billing Address: (b) (6)

B. Budget/Certifying Officer Phone: tlgW- 1--------------- -. Fax:

e-mail address:

-OR-

Designated Agency Representative (DAR) Phone:

Fax:

e-mail address:

C. Agency Bureau Code: (check one)

(b) (6)

------- -~----------- -

----------- ----------

0 NAVY-1700 ; 0 ARMY - 2100; 0 AIR FORCE - 5700; 0 DoD - 9700; 0 USMC -1730;

0 NAF Agency = 9700; 0 ACOE - (9600) (9900); 0 DOJ = 1500; [g] Other - ------Agency Bureau and Agency Bureau Code, i.e. 1705 _____ _

D. Line of Accounting /Fund Citation Code:

-AND BOTH- Treasury Account Symbol:

_& IPAC (Agency Location Code):

E. Billing Account Code(s) (BACs) [ Added by JSP ]

F. Pay Office DFAS Field Site (OPLOC)

2765-48-2765XX/19D


• U.S. Dept. of Defense JSP

DoD Activity Addressing Directory (DODAAD) is located in the funds cite ; contact the certifying budget officer for more information and also for proper code visit http://www.dod.mil/dfas.

OPLOC:

DODAAD: --------,<-----/¾.------++-~-++-+-tl-~---Signature of DAR: -~-......__ ..... ~'--"""__. .. lr-~--=-----=--w.::==---Date: 31 L\ \ :to\ 1,


• U.S. Army Information Technology Agency /TA

JSP Agency Information Sheet

Please send your completed Agency Information Sheet to usarmy.pentagon.hgda-ita -ops.mbx .customercare-center@ma il.mil. You will receive an email notification from the JSP Service Desk after your request has been processed.

1. Agency Name: (no acronyms)

Address:

National Security Commission on Artificial Intelligence

(b) (6) Location Group: (if known)

2. Primary TSCO Name :

Phone:

Michael L Gable [lDJGJ ___ _______ _

Fax: n/a

E-mail: (b) (6) "' :

3. Alternate TSCO Name:

Phone: -rm-,-w-------- - - ---- -----Fax:

E-mail: (m1QJ- >---- --------

4. Primary DAR Name:

Phone:

Michael L Gable tm•m•-----------Fax:

E-mail: (b) (6) YII Bajraktari

5. Alternate DAR Name:

Phone:

Fax:

E-mail: (b) (6)

4. Budget Officer Name: Michael L Gable Phone: [G>lffl-~- - ------------Fax:

E-mail: (b) (6)


U.S. Army Information Technology Agency /TA

5. BAC (if applicable) Independent Commission contracting support services through DoD

6. Justification for .BAC: (DISA and WHS). BAC allows billing and payment for services .

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