Attachment 007 - Fillable Site Visit Visitor Application.pdf
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- Solicitation number
- 12805B24R0032
About this file
This document is an attachment related to a federal contract opportunity for Boiler Chiller and Fuel Oil System Upgrades at the National Agro and Bio Defense Facility in Manhattan, KS. The solicitation number is 12805B24R0032 and the closing date is June 27, 2024 at 10 AM Central Time. The attachment is a fillable Visitor Application form that must be completed and password-protected before emailing to the NBAF Sponsor to attend the mandatory site visit. The application collects attendee personal information such as name, citizenship, and company details. The Privacy Act statement outlines the purpose and handling of the collected information. Contractors must also complete a background check form and provide their own personal protective equipment for the site visit. Any amendment and documents related to this procurement will be available on sam.gov, and the contract will require the use of USDA BioPreferred Program products where available.
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Attachment 007 Site Visit Attendee Visitor Application Information
RFQ12805B24R0032
Name (Last, First, MI)
Previously issued PIV Access Card
(Yes or No) PIV card is not required for site visit attendance.
US Citizen (Yes/No)
If Not US Citizen Country of Birth
Company Name
Company Phone Number
Company Address
Once completed please e-mail this document to the NBAF Sponsor: justin.schlegel@usda.gov
For your personal security, please DO NOT send personally identifiable information (the information contained within this document) to any other e-mail address.
You should password protect and encrypt this form when returning it to NBAF and send the password in a separate email.
To password protect this document, follow the instructions below:
FOR PC: Select File tab, then select Protect Using Password; select Viewing; create a Password; reenter the Password to verify, then click on Apply.
FOR MAC: Select File tab, then select Export, and click on Encrypt; create a Password; reenter the
Password to verify, then click Save.
For your personal security this form will be destroyed immediately upon completion of access request process.
PRIVACY ACT STATEMENT The Privacy Act, 552a, requires that federal agencies inform individuals, at the time information is solicited from them, whether the disclosure is mandatory or voluntary, by what authority such information is solicited, and what uses will be made of the information. The collection of this information is authorized by EO 9397, 6 USC 341, 44 USC 3101, and EO 12958. Provision of the information concerning foreign visits is mandatory under the provisions of EO 12958. Failure to provide it may impact planned visits. Use of this information is for internal purposes to facilitate visitor processing.
Controlled// SP-SPIIWhen filled out, this document contains sensitive information exempt from mandatory disclosure under the Freedom of Information act, 5 U.S.C. 552 (b)(2). Do not release without prior approval by USDA.
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File details come from the government source that posted it. Updated .