Form in .pdf format - UCAR Finance & Administration

Logistics OperationsInternational ShippingQuestionnairePrior to all shipments through Logistics Operations, please complete this form tothe best of your ability. If you have any questions or need assistance? Call or emailKerry Slaven x 1151 slaven@ucar.edu or Joseph Lujan x 8219 jlujan@ucar.eduYour name Extension EmailWhat account key will you associate with your shipment?**Note: You will be responsible to authorize for payment of all freight invoicesassociated with this shipment.Invoices should be sent to: (check one)____ Your attention____ Division Administrator ___________________________ NameInternational includes Canada and MexicoIn order to ensure export compliance, as some exports may require a license,Logistics Operations requires lengthy information from you prior to shipping.Remember, No Exports to embargoed nations, it is illegal!***Cuba, Iran, Iraq, North Korea, Rwanda, and SyriaWho are you shipping to?List Contact Name, Institution, Address, Phone NumberWhat is the purpose of this shipment?What date do you need delivery?What are you shipping?Number of pieces?Please list for each piece:1. Dimensions?2. Approximate weight?

Are there any special handling/packaging requirements for sensitive or expensiveitems?Will any special equipment be needed for loading/unloading (i.e. crane, barge,exclusive trailer, forklift etc.)Do you have a written agreement with the destination country concerning duties,fees and taxes? If there is not an agreement in place prior to shipping,UCAR/NCAR/UCP is responsible for payment.Are you providing any services to the end user? If so, please explain.Please give a detailed description of your shipment’s contents (Identify all computerhardware, software, equipment, data or services that may be provided.)Who will use and/or see the technology associated with this?Is the end user a (check all that apply)a. ____ UCAR/NCAR/UCP employee?b. ____ U.S. citizen or institution?c. ____ Other nationality? (please list)Is the Receiver or end user (if different) a military entity, affiliated with a militaryentity or engaged in military-related activities?How long will the shipment be out of the U.S.? (check one)a. ____ Temporarily (less than one year, and returning to the U.S.)b. ____ PermanentlyWhat is the value of this shipment?

What is the Country of Origin of each piece?Do you have a manufacturer provided Export Commodity Control Number(ECCN)? If not, Logistics Operations or UCAR Office of General Council can makea determination.Do you have the technical specifications of your piece(s) available?(If so, please include with shipment.)What other technology/equipment will be used in conjunction with this item?Is this the ultimate destination?Will the technology be shared, sent or re-exported to anywhere with anyone else?Will the shipment be used for any military purpose?Has an export of any like items to this end user already been approved by anyexport license or Technical Assistance Agreements (TAA) obtained by the UCAROffice of General Counsel or Logistics Operations?If so, what is the license number or TAA number?If exporting computer hardware, please provide the following information:Type of equipment:Vendor:Model:Processor speed:APP (Adjusted Peak Performance): check one____ < 0.75 Weighted Teraflops____ > 0.75 Weighted TeraflopsHow many of these items, if any, have you shipped to this end user in the past?

List any software incorporated in this system?Is the exported software (check one)a. ____ a commercial, off-the-shelf itemb. ____ developed by UCAR/NCAR/UCPc. ____ developed by an entity other than UCAR/NCAR/UCP.Does any of the above-listed software use or include encryption? Please explain.Are there any hazardous materials?