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Home My WebLink AboutResolution - 2023-R0236 - Memorandum of Agreement with U.S. Customs and Border Protection - AirportResolution No. 2023-RO236 Item No. 6.16 May 9, 2023 RESOLUTION BE IT RESOLVED BY THE CITY COUNCIL OF THE CITY OF LUBBOCK: THAT the Mayor of the City of Lubbock is hereby authorized and directed to execute for and on behalf of the City of Lubbock, a Memorandum of Understanding by and between the City of Lubbock and U.S. Customs and Border Protection (CBP), to reimburse CBP for costs related to providing Communications and Information Technology (IT) equipment and services at the Lubbock Preston Smith International Airport, and related documents. Said Memorandum of Understanding is attached hereto and incorporated in this resolution as if fully set forth herein and shall be included in the minutes of the City Council. Passed by the City Council on APPROVED AS TO CONTENT: May 9, 2023 Kelly CaYnpbell, Executive Director of Aviation ccdocs/RESNOU—U.S. Customs April 11, 2023 Resolution No. 2023-RO236 A.7 US. Customs and F Border Protection �Gi,ro se� U. S. CUSTOMS AND BORDER PROTECTION (CBP) MEMORANDUM OF AGREEMENT TO REIMBURSE CBP This Memorandum of Agreement ("MOA") outlines the agreement between the below named Lubbock Preston Smith International Airport(LBB)/City of Lubbock (City or Sponsor) and CBP in regards to the sponsor's responsibility to reimburse CBP for costs related to providing communications and information technology (IT) equipment and services required at the below named location. The legal authority for CBP to enter into and require such an agreement is found at 8 U.S.C. §§ 1223-1224, 1356(a); 19 U.S.C. §§ 1459, 1461, 1499, 1524, 1644a; 8 C.F.R. Part 234; 19 C.F.R. Part 122. Airport Owner/Operator: Lubbock Preston Smith International Airvort(LBB)/City of Lubbock (Sponsor Location: Lubbock, Texas [AIRPORT OWNER/OPERATOR'Sl RESPONSIBILITIES Data and Cabling LBB is responsible for the procurement and installation of all data cabling and electrical components required for connectivity of systems and equipment, according to CBP Office of Information Technology (OIT) provided specifications. LBB is required to provide a two week advanced notice of all cable pulls to allow CBP to observe installation. Reimbursement of Equipment and Recurring Costs LBB agrees to reimburse CBP for all equipment and connectivity costs, including installation, maintenance, and recurring costs, at the Lubbock Preston Smith International Airport. Current estimated equipment costs total $81,700.39. The estimated annual recurring costs are $19,608.60. CBP OIT's Cost Estimate titled "LUB033A-OFO-23130C" is attached. LBB will be billed the actual costs for the equipment identified in CBP OIT's Cost Estimate CSO#LBB-033A-OFO-23130C, along with any outstanding reimbursements due from any previously executed agreement(s). Recurring out -year network circuit charges, and the cost of any necessary replacement equipment not covered under warranty, will also be billed to LBB. Equipment Upgrades Upgrades to CBP required equipment and connectivity may be required on a schedule determined by CBP (approximately every 3-5 years, as needed). LBB is responsible for the cost of required upgrades. CBP will provide LBB a minimum of 180 days advance notice of any required upgrades. Payment Process A copy of this signed agreement will be forwarded to the CBP National Finance Center (NFC). Upon receipt and installation of all equipment, the NFC will issue LBB a bill for the actual equipment costs not to exceed $81,700.39, as detailed in CBP OIT Cost Estimate, LBB-033A- OFO-23130C. The CBP NFC will bill LBB 90-days prior to the due date for recurring out -year network and connectivity charges owed, along with any sums owed for replacement equipment not covered by manufacturer warranties. Pursuant to 19 C.F.R. § 24.3a, any amounts due CBP under the terms of this agreement that are more than 30 days past -due will begin accruing interest charges based on U.S. Treasury borrowing rates and may ultimately be referred for collection. Accounts Payable Information Tax Identification Number: 756-00-0590 Bill To Representative: Jay Patel Phone Number: (806)775-3139 Email Address: ipatel(a-)mylubbock.us Address: 5401 N Martin L King Blvd Lubbock. TX 79403 Equipment Ownership CBP will retain possessory ownership of all equipment used in CBP operations until CBP vacates the premises. CBP will transfer the equipment reimbursed by LBB when CBP vacates the premises. Within two months (60-days) of installation and reimbursement, CBP OIT will deliver a list of serial numbers and/or other identification and warranty information for LBB reimbursed equipment to the point of contact listed below. Equipment Administrator: Jay Patel Email Address: ipatel _ mylubbock.us Phone Number: (806)775-3139 Ship to Address: 5401 N Martin L King Blvd Lubbock TX 79403 U.S. CUSTOMS AND BORDER PROTECTION (CBP) RESPONSIBILITIES Equipment Connectivity and Maintenance CBP OIT will be responsible for ordering and installing required circuit, data equipment, and connection(s) from LBB to the CBP National Data Center. CBP is also responsible for imaging, maintaining, and controlling all equipment listed in the attached CBP OIT Cost Estimate, CSO#HIA-008A-OFO-23097C. LBB will incur no CBP OIT charged service fees for any equipment maintenance/repair/replacement covered by CBP procured equipment warranties. Page 2 of 3 Data Ownership All data entered and or stored in any manner on the equipment covered by this MOA shall belong to the United States and is confidential and protect ed information. It is CBP's responsibility to properly remove data before possession of any equipment is transferred to LBB In the event data inadvertently remains on any equipment after transfer, LBB shall keep the information confidential and immediately notify CBP so that CBP can remove the data. AUTHORIZATION (TWO ORIGINALS WITH SIGNATURES ARE REQUIRED) Auth<)rized Re resentative The signatory to this MOA represents and warrants that he or she is a duly authorized representative of LBB, with full power and authority to enter into this MOA and to bind LBB with regard to all matters relating to this agreement. Agreement to these terms is attested by the signatures below. Kelly Campbell Email Address Executive Director of Aviation °RAUL H ORONA o�0 ' a M o0. wuma'w Raul H. Orona Email Address (Acting) Area Port Director, Dallas, Fort Worth Office of Field Operations, Houston Field Office U.S. Customs and Border Protection EXECUTED this 9th day of THE CITY L CK, CITY BY: Tray P ayor AT4EST: Cobftney Paz, j City Secfetary 4* 10,,2023 Date 4/ 1 I /2023 Date 12023. Date: May 9, 2023 Page 3 of 3 U.S. Customs and Border Protection Office of Information & Technology Cost Sign -Off Document* ("Actual costs will be derived from actual obligations) This is a Rough Order of Magnitude Estimate. Final costs will be determined once the network designs are completed Site Code: LUB033A (LUB033A-OFO-23130C) Site Name: Lubbock GAF Site Address: 6202 N Interstate 27, Lubbock, TX Date Prepared: 02/22/2023 Preparer: Tracey Marbury Equipment and Service Costs Data Equipment Costs (OCC-31) Line Item Description Qty Unit Cost Total 10 1 M LC -LC 9/125 OS2 Duplex Single -Mode PVC Fiber Optic Cable - Yellow 2 $50.00 $100.00 BRAND NAME or EQUIVALENT 20 3M LC -LC 9/125 OS2 Duplex Single -Mode PVC Fiber Optic Cable - Yellow 1 $45.00 $46.00 BRAND NAME or EQUIVALENT 30 Std Desktop - Slim Line Form Factor (1TB SSD, 32 GB RAM 3 $1,650.00 $4,950.00 40 Dell 24" Touch Monitor - P2418HT (BRAND NAME or EQUIVALENT) 1 1 $350.00 $350.00 50 LG 24" TAA IPS FHD Monitor and Built-in Speakers (BRAND NAME or 4 $225.00 $900.00 EQUIVALENT 60 Logitech C920e Pro WebCam w/5' Cable (BRAND NAME or 2 $150.00 $300.00 EQUIVALENT 70 Integrated Biometrics Kojak 10-Print Scanner w/Bracket (BRAND NAME or 1 $1,500.00 $1,500.00 EQUIVALENT 80 3M Passport Reader Model AT9000MK2 (BRAND NAME or EQUIVALENT) 2 $2,500.00 $5,000.00 90 SLIK Mini Pro V Tripod with 2-Way Pan/Tilt Head - Black (BRAND NAME 1 $30.00 $30.00 or EQUIVALENT 100 SnakeClamp Camera Mount Adapter (BRAND NAME or EQUIVALENT) 1 $20.00 $20.00 110 SnakeClamp 3" x 3" Mounting Plate for Camera (BRAND NAME or 1 $20.00 $20.00 EQUIVALENT 120 SnakeClamp 9" Flex Arm for Camera, Chrome (BRAND NAME or 1 $20.00 $20.00 EQUIVALENT 130 APC P7V 7-Outlet 840 Joule Surge Suppressor (BRAND NAME or 4 $16.00 $64.00 EQUIVALENT 140 Cables To Go 7' Cat6 550MHz Blue Patch Cable; per Cable (BRAND 4 $10.00 $40.00 NAME or EQUIVALENT 150 Cables To Go 3' Cat6 550MHz Blue Patch Cable; per Cable (BRAND 4 $7.00 $28.00 NAME or EQUIVALENT 160 Patch Cable - 3ft - Cat6a Snagless Unshielded (UTP) Ethernet Network 4 $10.00 $40.00 Patch Cable - Yellow 170 Patch Cable - 14ft - Cat6a Snagless Unshielded (UTP) Ethernet Network 4 $16.00 $64.00 Patch Cable - Yellow 180 190 200 15% Cost Contingency for Equipment 1 $2,020.65 $2,020.65 Total Data Equipment Costs: $15 491.65 Network Equipment Costs (OCC-31) 210 Router (Up to 100 Mbps) 1 $10,008.00 $10,008.00 220 24-port Stackable Access Switch (with 12 mGig) 1 $15,236.00 $15,236.00 230 Cloud Managed Indoor AP 3 $2,024.00 $6,072.00 240 Cloud Managed Outdoor AP 1 $2,346.00 $2,346.00 250 1G Single Mode SFP 3 $775.00 $2,325.00 260 15% Cost Contingency for Equipment 1 $5,398.051 $5,398.05 Total Network Equipment Costs: $41,385.05 Voice Equipment Costs OCC-31 Line Item Description Qty Unit Cost Total 270 Crestron Flex 10 in. Video Desk Phone with Handset for Microsoft Teams Software TAA 3 $850.00 $2,550.00 280 Microsoft Teams License for GCC - Common Area Phone/Shared Device Annual Recurring Cost 3 $75.48 $226.44 290 Microsoft Teams Calling Plan - Domestic Only Annual Recurring Cost 3 $126.72 $380.16 300 310 15% Cost Contingency for Equipment 1 $473.49 $473.49 Total Voice Equipment Costs $3,630.09 BSDP Equipment Costs OCC-31 320 IThere are no BSDP costs associated with this request. I 1 $0.001 $0.00 330 15% Equipment Contingency Costs I 1 $0.001 $0.00 Total BSDP Equipment Costs: $0.00 Tactical Communication TACCOM Equipment Costs 0CC-31 : 340 IThere are no TAC COMM equipment costs associated with this request. 1 0 1 $0.001 $0.00 350 15% Cost Contingency for Equipment $0.001 $0.00 Total Communication Equipment Costs: $0.00 TOTAL EQUIPMENT C $60 606.79 Service Costs Circuit Costs (OCC-23) 360 Coba 100M ICP new Circuit Installation 0 $495.00 $495.00 370 Coba 100M ICP Annual Recurring Costs 12 $1,137.58 $13,650.96 380 Potential Estimated LEC Special Construction 1 $5,000.00 $5,000.00 390 15% Cost Contingency for Tax / USF 1 $2,047.64 $2,047.64 Total Circuit Costs: $21,193.60 BSDP Services Costs OCC-25 400 There are no BSDP Services costs associated with this request.. $0.00 $0.00 410 420 430 440 15% Service Costs Total BSDP Contract Services Costs: $0.00 TACCOM Service Costs (OCC-25) 450 IThere are no TACCOM Service costs associated with this request. 1 $0.001 $0.00 Total Tactical Communication Services Costs: $0.00 Government Travel (OCC-21) 460 IThere are no Travel costs associated with this request. $0.00 $0.00 Total Government Travel Costs: $0.00 TOTAL SERVICE COSTS: $21 193.60 TOTAL ESTIMATED INITIAL EQUIPMENT AND SERVICES COSTS $81,700.39 Out Year Recurring Service Costs Circuit Recurring Costs (OCC-23) 470 lCoba 100M ICP Annual Recurring Costs 1 12 1 $1,137.58 $13,650.96 480 15% Cost Contingency for Tax / USF 1 1 1 $2,047.641 $2,047.64 Total Recurring Circuit Costs: $15,698.60 Line Item Description sty Unit Cost Total Network Equipment Service Costs (OCC-25) 490 Router (Up to 100 Mbps) Maintenance Annual Recurring Costs 1 $1,290.00 $1,290.00 500 24-port Stackable Access Switch (with 12 mGig) Maintenance Annual Recurring Costs 1 $2,060.00 $2,060.00 510 Cloud Managed Indoor AP Maintenance Annual Recurring Costs 3 $140.00 $420.00 520 Cloud Managed Outdoor AP Maintenance Annual Recurring Costs 1 $140.00 $140.00 Total Recurring Network Service Costs: $3,910.00 BSDP Service Costs (OCC-25) 530 IThere are no BSDP O&M costs associated with this request. 1 1 $0.00 $0.00 Total Recurring BSDP Service Costs: $0.00 TACCOM Annual Operation and Maintenance Costs (OCC-25) 540 IThere are no TACCOM Service costs associated with this request. 1 0 1 $0.001 $0.00 Total Recurring TACCOM Service Costs: $0.00 TOTAL ANNUAL RECURRING COSTS $19,608.60 NOTE: The OIT Cost Sign -Off Document and the associated estimated costs listed above expires 90 days from the above Date Prepared or at the end of the Governments current fiscal year, whichever comes first. After such time, a new OIT Cost Sign -Off Document is required. Acceptance By signing below, I accept any and all costs associated with the purchase and installation of equipment itemized above. Authority Signature: Date: Authority Printed Name: Phone/Em I Address: 0 W. • -1-16 • t 31 W • u OIT REFERENCE Number: L 033A-OFO-23130C Document Expiration Date: 05/31/2023 •��s OMB APPROVAL NO. 1651-0064 D DEPARTMENT OF HOMELAND SECURITY EXPIRATION DATE 12-31-2020 U.S. Customs and Border Protection 4ND 5 CREATE/UPDATE IMPORTER IDENTITY FORM 19 CFR 24.5 As the importer, consignee, or other party listed in block 1, you are responsible for the validity of the information provided in this document. Any Customs Broker or third party who is submitting the information on your behalf is only obligated to convey this information to Customs and Border Protection (CBP). PRIVACY ACT STATEMENT: Pursuant to 5 U S C. § 552a(e)(3), this Privacy Act Statement serves to inform you of why DHS is requesting the information on this form. AUTHORITY: The U.S. Customs and Border Protection (CBP) is authorized to collect the information requested on this form pursuant to Title 19 of the Code of Federal Regulations (19 CFR §24.5 Filing Identification Number and 149.3 Data Elements). CBP has the authority to collect Social Security numbers (SSN) under Executive Order (E.O.) 9397, as amended by E.O. 13478 (Pursuant to 31 U.S.C. §7701(c), 26 U.S.C. §6109(d), 19 C.F R. §24.5 and §149.3) PURPOSE: CBP is requesting this information to collect and maintain records on all commercial goods imported into the United States, along with carrier, broker. importer, and other ACE-ITDS Portal user account and manifest information. CBP will use this information to track, control, and process all commercial goods imported into the United States. This facilitates the flow of legitimate shipments, and assists the Department of Homeland (DHS)/CBP in targeting illicit goods. ROUTINE USES: The information requested on this form may be shared externally, as a "routine use" with appropriate federal, state, local, tribal, or foreign governmental agencies, or multilateral governmental organizations, to assist DHS in investigating or prosecuting the violations of, or for enforcing or implementing, a statute. rule. regulation, order, license, or treaty or when DHS determines that the information would assist in the enforcement of civil or criminal laws. A complete list of the routine uses can be found in the system of records notice associated with this form, ' DHSICBP-001 Import Information System." The Department's full list of system of records notices can be found on the Department's website at https:Jlwww.dhsgovlsxstem-records-notices-sorns. CONSEQUENCES OF FAILURE TO PROVIDE INFORMATION: Providing this information to is voluntary. However, failure to provide the information will result in the denial of a CBP-assigned importer number/importer of record identification (ID) number, and inability to pay import related duties, taxes, and fees related to an entry of imported goods. Individuals who do not provide this information may be required to use a separate party for transactions, which may affect or delay the importation of shipments in international trade. PAPERWORK REDUCTION ACT STATEMENT: An agency may not conduct or sponsor an information collection and a person is not required to respond to this information unless it displays a current valid OMB control number and an expiration date. The control number for this collection is 1651-0064. The estimated average time to complete this application is 45 minutes. The obligation to respond is required to obtain a benefit. If you have any comments regarding the burden estimate you can write to U.S. Customs and Border Protection, Office of International Trade, Regulations and Rulings, 90 K Street NE, Washington DC 20229-1177. TYPE OF ACTION (Mark all applicable): ❑x Notification of identification number ❑ Change of name* ❑ Change of address* 1. NAME AND IDENTIFICATION NUMBER '1A. Importer/Business/Private Party Name 1B. Internal Revenue Service (IRS) number/Social Security Number (SSN): City of Lubbock, Texas 756-00-0590 1C. ❑ DIV ❑ AKA ❑ DBA 1D. DIV/AKA/DBA Name: *1 E. ❑ I wish to be assigned a CBP Number. Check here if requesting a CBP-assigned number and indicate reason(s). Check all reasons that apply. ❑ I have a SSN, but wish to use a ❑ I have no Social ❑ I have no IRS ❑ I have not applied for ❑ I am not a CBP-Assigned Number on all my Security Number Number an IRS number or SSN U.S. Resident entry documents 1F. CBP-Assigned Number: 1G. Type of Company: ❑ Corporation ❑ Partnership ❑ LLC ❑ Sole Proprietorship ❑ Individual ❑ U.S. Government ❑x State/Local Government ❑ Foreign Government 1 H. If you are an importer, how many entries do you plan on filing in a year? Please select from the following: ❑ 1-4 per year ❑ 5-24 per year ❑ 25 or more per year ❑ infrequent personal shipments, or ❑ I do not intend to import. 11. How will the identification number be utilized? Please select all options that will apply: ❑ Importer of Record ❑ Consignee/Ultimate Consignee ❑ Drawback Claimant ❑ Refunds/Bills, or ❑ Other 1J. Program Code 1: 1K Program Code 2 1L. Program Code 3. 1M. Program Code 4 CBP Form 5106 (6/19) Page 1 of 3 2. ADDRESS INFORMATION 2A. MAILING ADDRESS (Each street address line can be no more than 32 characters) -Street Address 1: 1314 Avenue K *City: Lubbock 'State/Province Texas Street Address 2: Zip Code: 79401 Country ISO Code: *Is the address in 2A, a ❑ Residence ❑ Corporate Office ❑ Warehouse ❑ Retail Location ❑x Office Building ❑ Business Service Center ❑ Post Office Box or ❑ Other - Explain: 2B. PHYSICAL LOCATION ADDRESS (Required only if different than mailing address. 32 character limit applies to street address line) "Street Address 1: *City: *State/Province: ----Please Select --- Street Address 2: Zip Code: Country ISO Code: *Is the address in 2B, a ❑ Residence ❑ Corporate Office ❑ Warehouse ❑ Retail Location ❑ Office Building or ❑ Other -Explain: 2C. *Phone number. (806)775-3131 Extension: r 2D. Fax number. (806)775-3133 2E. 'Email address: kcampbell@mylubbock.us 2F. Website: 3. COMPANY INFORMATION 3A. Provide a brief business description: 31B. Provide the 6-digit North American Industry Classification System (NAICS) code for this business: 3C. Provide the D-U-N-S Number for the Importer: 3D. If you are also a broker/self-filer, supply the filer code that will be used when conducting business with CBP: 3E. Year established: 3F. List the names and Internal Revenue Service (IRS) employer identification, Social Security or CBP-assigned numbers for current or previous related business entities. Related Business Name of Business Entities IRS/SSN/CBP-Assigned Number ❑ Current ❑ Previous ❑ Current ❑ Previous ❑ Current ❑ Previous 3G. Primary Banking Institution: _ (Name) ----Please Select --- (Bank Routing Number) (City) (State) (Country ISO Code) 3H. Certificate or Articles of Incorporation - (Locater I.D.) 31. Certificate or Articles of Incorporation - (Reference Number) 3J. Business Structure/Beneficial Owner/Company Officers - The officers listed in this section must have importing and financial business knowledge of the company listed in section 1 of this form and must have legal authority to make decisions on behalf of the company listed in section 1. Elements designated below with an asterisk are optional data fields. Company Position Title: Director of Aviat: Name (Last, First, Middle Initial) ampbell, Kelly, Direct Phone Number. (806)775-3131 Extension: Direct Email: ikcampbellftylubbock.us CBP Form 5106 (6/19) Page 2 of 3 Social Security Number: Passport Number: Country of Issuance: ---Flp.se :ele ^t---- Passport Expiration Date: Passport Type: ❑ Regular ❑ Official ❑ Diplomatic ❑ Passport Card Company Position Title: Name (Last, First, Middle Initial): Direct Phone Number: Extension: Direct Email: Social Security Number: Passport Number: Country of Issuance: Passport Expiration Date: 'PassportType: ❑ Regular ❑ Official ❑ Diplomatic ❑ Passport Card Company Position Title: Name (Last, First, Middle Initial): Direct Phone Number: Extension: Direct Email: Social Security Number: Passport Number: Country of Issuance: ---PlP33p- .:Nlp'r--- Passport Expiration Date: Passport Type: ❑ Regular ❑ Official ❑ Diplomatic ❑ Passport Card Company Position Title: Name (Last, First, Middle Initial): Direct Phone Number: Extension: Direct Email: Social Security Number: Passport Number: Country of Issuance: ---Please Select --- Passport Expiration Date: Passport Type: ❑ Regular ❑ Official ❑ Diplomatic ❑ Passport Card 4. CERTIFICATION By my signature below, I certify that, to the best of my knowledge and belief, all of the information included in this document is true, correct, and provided in good faith. I understand that if I make an intentional false statement, or commit deception or fraud in this 5106 document, I may be fined or imprisoned (18 U.S.C. § 1001). 'Printed or Typed Full Name and Title: `Signature. Kely Campbell Director of Aviation Telephone Number: (806)775-3131 +Date: 04/10/2023 Broker Name: Telephone Number: CBP Form 5106 (6/19) Page 3 of 3 Country ISO Code - For a U.S. mailing address, leave blank. For any foreign mailing address, including Canada and Mexico, insert a 2-character alphabetic International Standards Organization (ISO) Code representing the country. Type of Address - Check the box that describes this address. 2B - PHYSICAL LOCATION ADDRESS - Please provide the address that is associated with the business or the individual. This address cannot be a P.O. Box, Business Service Center, etc. The address associated with the business can be the principal's home address The Physical Location Address does not need to be provided on the form if it is the same as the mailing address Street Address 1- If the place of business is the same as the mailing address, leave blank. If different from the mailing address, insert the company's business address in this space. A second address representing the company's place of business is to be provided if the mailing address is a post office box or drawer. This line can be no more than 32 characters long Street Address 2 - If applicable, this block must always be completed with the apartment, suite, floor, and/or room number. This line can be no more than 32 characters long City - Insert the city name for the business address. State/Province - For a U.S. address, insert a 2-character alphabetic U.S. state postal code. For a Canadian address. insert a 2-character alphabetic code representing the province of the importer's business address. Zip Code - For a U.S. business address, insert a 5 or 9-digit numeric ZIP code as established by the U.S. Postal Service For a Canadian address, insert a Canadian postal routing code. For a Mexican address, leave blank. For all other foreign addresses, a postal routing code may be inserted. Country ISO Code - For a U.S. address, leave blank. For any foreign address, including Canada and Mexico, insert a 2-character alphabetic ISO code representing the country. Type of Address - Check the box which describes this address. 2C - Phone Number - The phone number and extension. 2D - Fax Number - The fax number. 2E - E-mail Address - The e-mail. 2F - Website - The website. SECTION 3 - COMPANY INFORMATION In most cases the data elements in this section are optional. However. if the "I have an SSN. but wish to use a CBP-Assigned Number on all my entry documents' option was selected in Block 1 E you must provide your "Company Position Title". name and SSN in Block 3J The absence of this information will affect CBP's ability to fully understand the level of risk on subsequent transactions and could result in the delay of cargo release or the processing of a refund. 3A - Provide a brief description of your business. 3B - Complete this field if you know the North American Industry Classification System (NAICS) code as defined by the Department of Commerce. Provide your 6-digit NAICS code. 3C - If available, provide the Dun & Bradstreet Number for the name that was presented in section 1. 3D - If you are an importer who is a self -filer and are using your own filer code, or a broker who also has maintained an identification number, provide the filer code that you will be using to conduct business with CBP. 3E - Indicate the year in which your company was established. 3F - Related Businesses Information - List the name and IRS employer identification number. Social Security Number or CBP-Assigned Number for each related business and indicate if it is a current or previous related business. 3G - Indicate the primary banking information for the company that is listed in 1 B. 3H - Certificate or Articles of Incorporation - Provide the 2-digit State or insert a 2-character alphabetic ISO Code representing the country in which the articles of incorporation for the business were filed. (as applicable) 31- Certificate or Articles of Incorporation - Provide the file, reference, entity, issuance or unique identifying number for the certificate or articles of incorporation or the foreign articles of incorporation. (as applicable) 3J - Business Structure/Beneficial Owner/Company Officer - The Beneficial Owner is any individual or group of individuals that, either directly or indirectly, has the power to vote or influence the transaction decisions regarding a specific security or one who has the benefits of ownership of a Security (finance) or property and yet does not nominally own the asset itself. Beneficial Owner/ Company Officers must have importing and financial business knowledge of the company listed in section 1 and the legal authority to make decisions on behalf of the company listed in section 1 with respect to that knowledge. Please note that in most instances the SSN or "Passport Number", "Country of Issuance", "Passport Expiration Date", and "Passport Type", in the absence of an SSN, are optional in this block. However, if the "I have an SSN. but Hush to use a CBP-Assigned Number on all my entry documents" option is selected in Block 1 E your -'Company Position Title", name. and SSN must be provided in this block CBP Form 5106 (6/19) Instructions Page 2 of 2 INSTRUCTIONS TYPE OF ACTION Notification of Identification Number - Check this box if this is your first request for services with CBP, or if your current Importer Number is inactive and you wish to activate this number. Change Name - Check this box if the Importer Number is on file but there is a change in the name. Change of Address - Check this box if the Importer Number is on file but there is a change in the address. For updates involving changes to an existing IOR other than a "Change of Name" and "Change of Address", the "TYPE OF ACTION" should be left blank. NOTE - If a "Change of Address" and/or "Change of Name"is requested for an importer or other party that has an active bond on file with CBP, then name and/or address rider must accompany this change document, unless the rider is otherwise not required for the bond pursuant to a CBP test announced in the Federal Register, such as CBP's eBond Test Program, or otherwise not required by CBP's regulations. SECTION 1 - NAME AND IDENTIFICATION NUMBER 1A - Importer/Business/Private Name - Please indicate the name of the company or individual who will be importing or seeking service or payment. If you are submitting this document as a consignee to the import transaction, sections 1 and 2 must be filled out completely. 1 B - IRS/SSN - Complete this block if you are assigned an Internal Revenue Service (IRS) employer identification number or Social Security Number (SSN). If neither an IRS employer identification number nor a Social Security Number (SSN) has been assigned, the word "NONE" shall be written in 1 B. The SSN should belong to the principal or owner of the company. 1C - DIV/AKA/DBA - Complete this block if an importer is a division of another company (DIV), is also known under another name (AKA), or conducts business under another name (DBA). 1 D - Complete this block only if Block 1 C is used. 1 E - Request CBP-Assigned Number - Complete this block if you have neither an IRS employer identification number nor a SSN and you require a CBP-assigned number, or, you choose to use a CBP-assigned number in lieu of your SSN. If you have an IRS employer identification number at the time you submit this form that number will automatically become your importer identification number and no CBP-assigned number will be issued. PLEASE NOTE: A CBP-assigned number is for CBP use only and does not replace listing a SSN or IRS employer identification number on this form. If you have elected to request a CBP-Assigned Number in lieu of your SSN. you must provide your "Company Position Title' name and SSN in Block 3J of this form. If you have elected to request a CBP Assigned Number in lieu of your SSN, you must provide your SSN in section 3J of this form. In general, a CBP- assigned number will be issued to foreign businesses or individuals, provided no IRS employer identification number or SSN exists for the requester. A requester can choose to keep using the CBP-assigned number even if the individual subsequently acquires a SSN. If block 1 E is completed, CBP will issue an assigned number and inform the requester. This identification number will be used for all future CBP transactions when an identification number is required. If an IRS employer identification number, a Social Security Number, or both, are obtained after an identification number has been assigned by CBP, a new CBP Form 5106 form shall not be filed unless requested by CBP. IF - CBP-Assigned Number - Complete this block if you have already been assigned a CBP-Assigned Number, and there is a requested change in Block 'Type of Action". I - Type of Company- Please select the description that accurately describes your company. A Limited Liability Company (LLC) is not a corporation; it is a legal form of company that provides limited liability to its owners. 1 H - Provide an estimate of the number of entries that will be imported into the U.S. in one year, if you are an importer of record. 11 - Check the boxes which will indicate how the name and identification number will be utilized. If the role of the party is not listed, you can select "Other" and then list the specific role for the party. (ex., Transportation carrier, Licensed Customs Brokerage Firm, Container Freight Station, Commercial Warehouse/Foreign Trade Zone Operator, Container Examination Station or Deliver to Party). 1J thru 1M - If you are currently an active participant in a CBP Partnership Program(s), please provide the program code in Block 1J thru Block 1M of the revised CBP Form 5106 and the information that is contained in Section 3 of the revised CBP Form will not be required. (ex., Customs Trade Partnership Against Terrorism - CTPAT, Importer Self -Assessment - ISA) SECTION 2 - ADDRESS INFORMATION 2A - MAILING ADDRESS (Mailing Address for the named business entity or individual referenced in section 1) Street Address 1 - This block must always be completed. It may or may not be the physical location. Insert a post office box number or a street number representing the first line of the mailing address. For a U.S. or Canadian mailing address, additional mailing address information may be inserted. If a P.O. Box number is given for the mailing address, a second address (physical location) must be provided in 2B. This line can be no more than 32 characters long. Street Address 2 - If applicable, this block must always be completed with the apartment, suite, floor, and/or room number. This line can be no more than 32 characters long City - Insert the city name of the importer's mailing address. State/Province - - For a U.S., Canadian, or Mexican mailing address, a 2-character alphabetic code representing the state/province must be provided. All other foreign addresses must either enter a 2-character alphabetic code or, if one does not exist, "FN" in the "State/Province" block. Zip Code - For a U.S. mailing address, insert a 5 or 9-digit numeric ZIP code as established by the U.S. Postal Service. For a Canadian mailing address, insert a Canadian postal routing code. For a Mexican mailing address, leave blank. For all other foreign mailing addresses, a postal routing code may be inserted. CBP Form 5106 (6/19) Instructions Page 1 of 2