Contractor_Clearance_Form-KM.pdf

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Attached to
Confirm Pre-prposal Conference Date & provide required contractor clearance forms Federal contract opportunity
Solicitation number
47PD0317R0020
Issued by
General Services Administration Public Buildings Service Region 3

About this file

From the source

This form is for contractors to be able to access the facilities. It is required to be completed and submitted by 2:00 PM EST on 7 September 2017. One form is required for each individual attending the 14 September 2017 pre-proposal conference. Due to space limitations, only 2 individuals per contractor will be authorized access. Please submit via email to jeffrey.gibson@gsa.gov

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United States Marshals Service

Eastern District of Virginia

CCOONNTTRRAACCTTOORR SSEECCUURRIITTYY CCLLEEAARRAANNCCEE RREEQQUUEESSTT FFOORRMM

Any building tenant scheduling contractor services to be performed inside U.S. Courthouse space must complete this form in its entirety and submit to the local U.S. Marshals Service office a minimum of twenty-four (24) hours in advance of the contractor start date.

GSA / U.S. Courthouse Tenant Contact Information

Requesting Agency:

Requestor (Name):

Office Telephone Number: Mobile Phone:

Contractor / Vendor Information

Full Name (Last, First,Middle): Gender: Male Female

Date of Birth (mm/dd/yyyy): Soc. Sec. Number:

Place of Birth:

Current Home Address:

City: State: Zip Code:

Race:

Company Name:

*Contractor/Vendor must be escorted at all times in non-public areas of the courthouse*

Results of Inquiry

Pass: Fail:

US Courthouse Tenant

/ GSA

Approver Signature:

GSA US Courthouse Tenant Contact Information 2: Kate Melville
undefined:
undefined_2: 202-870-8270
Gender: Off
Contractor Vendor Information 1:
Contractor Vendor Information 2:
Soc Sec Number:
Current Home Address:
undefined_3:
State:
Zip Code:
undefined_4:
undefined_5:
Company Name:
undefined_6:
undefined_7:
undefined_8:
asfd: GSA

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