(3) SECNAV 55121 (CNIC) Access Registration Form_fillable.pdf

PDF 2 MB Posted

Attached to
J-023 BACHELOR OFFICER QUARTERS-A, US NAVSUPPACT MCB, GUAM
Solicitation number
N62742-21-R-1334
Issued by

About this file

Written by GovTribe AI ·

This document contains details of a federal contract opportunity for the construction of a multi-story housing tower on Guam. The Naval Facilities Engineering Command seeks to award a fixed-price contract valued between $100-150 million for the design and construction of a Bachelor Officers Quarters to house single-occupancy units, common areas, and support spaces. The project will be funded through direct contributions from the Government of Japan. The North American Industry Classification System Code for this opportunity is 236116 for new multifamily housing projects. The solicitation is anticipated to be released on December 17, 2020 through the System for Award Management website. The contract completion period will be 760 calendar days. Evaluation criteria will include experience with similar new construction projects valued over $40 million as well as past safety performance. A site visit has been tentatively scheduled for January 12, 2021, with registration required by December 28, 2020.

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1 LAST NAME:

2 FIRST NAME:
3 MIDDLE NAME:
8 DATE OF BIRTH:
9 CITY OF BIRTH:
IO STATE OF BIRTH:
1 1 BIRTH COUNTRY:
15 DOCUMENT NUMBERD Social Security No:
16 ISSUED BY STATECOURTD Social Security No:
18 ISSUEDUnited States:
19 EXPIRESUnited States:
15 DOCUMENT NUMBERD State IDDrivers License:
16 ISSUED BY STATECOURTD State IDDrivers License:
18 ISSUEDUnited States_2:
19 EXPIRESUnited States_2:
15 DOCUMENT NUMBERD Passport No:
16 ISSUED BY STATECOURTD Passport No:
United StatesD Passport No:
18 ISSUEDD Passport No:
19 EXPIRESD Passport No:
15 DOCUMENT NUMBERD Certification Number and Petition Number:
16 ISSUED BY STATECOURTD Certification Number and Petition Number:
United StatesD Certification Number and Petition Number:
18 ISSUEDD Certification Number and Petition Number:
19 EXPIRESD Certification Number and Petition Number:
15 DOCUMENT NUMBERD Derived Parents Certification Number:
16 ISSUED BY STATECOURTD Derived Parents Certification Number:
18 ISSUEDUnited States_3:
19 EXPIRESUnited States_3:
15 DOCUMENT NUMBERD Alien Registration No:
16 ISSUED BY STATECOURTD Alien Registration No:
18 ISSUEDUnited States_4:
19 EXPIRESUnited States_4:
OTHER APPROVED IDENTITY SOURCE DOCUMENTS:
D:
D_2:
20 WEIGHT Pounds:
21 HEIGHT Inches:
24 HOME ADDRESS Include city state zip code:
HOME PHONE Include Area Code:
L tuNut NAMt: KIMBERLY DOBROWOLSKI, CI PROGRAM MGR, MCAG PWD
SPONSOR PHONE Include Area Code: 355-8029
Lti tIVHLU i tK NAMt ANU AUUKt Include citystateZip code:
tMtLU cK rnvc Include Area Code:
l urcKVISUK NAMt ANU AUU Include citystateZip code:
SUPERVISOR PHONE Include Area Code:
undefined:
29 Have you ever been convicted of a Felony DYES ONO Initial:
DATE:
Date of Entry:
Port of Entry:
Check Box1:
0:
0: Off
1: Off
2: Off
3: Off
4: Off
5: Off
1:
0: Off
1: Off
2: Off
3: Off
4: Off
5: Off
2:
0: Off
1: Off
2: Off
3: Off
4: Off
5: Off
3:
0: Off
1: Off
2: Off
3: Off
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5: Off
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3: Off
4: Off
5: Off
5:
0: Off
1: Off
5: Off
3:
0: Off
1: Off
2: Off
3: Off

4: Off

113 DUAL CITIZENSHIP DYES ONO CITIZENSHIP IF OTHER THAN US Country:
Check Box2:
0: Off
1: Off
2: Off
3: Off
4: Off
5: Off
6: Off
Check Box3: Off
Check Box4: Off
Check Box5:
0: Off
1: Off
2: Off
3: Off
4: Off
5: Off
Check Box7: Off
Check Box8: Off
initals:
Check Box6: Off

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