6 Visitors Request Form For Access To CDC Campuses.docx
DOCX document 27 KB Posted
- Solicitation number
- 75D301-24-R-73077
About this file
This document is a Visitors Request Form for access to CDC campuses. It provides details on a requested construction site visit to Building 110 at the CDC's Chamblee campus on July 11, 2024 for the P20221008080 B110 Domestic Water Replacement project. The form includes the point of contact, purpose of visit, visitor information, and required visitor protocols such as needing an escort with a valid CDC ID badge and obtaining visitor badges during normal security office hours.
The related federal contract opportunity is a solicitation for Atlanta water line installation services, where the work involves replacing the existing copper water piping system and related components in Building 110 at the CDC's Chamblee campus. The full scope of work is detailed in the attached Statement of Work, Specifications, and Drawings. The solicitation number is 75D301-24-R-73077 and the work is being procured by the Department of Health and Human Services Centers for Disease Control and Prevention Office of Acquisition Services.
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Other files
| File | Type | Posted |
|---|---|---|
| 11 Pre-Bid RFI Log-P20221008080 08082024.xlsx | XLSX spreadsheet | |
| Amendment 00002 to 75D301-24-R-73077 signed.pdf | ||
| 13 Pre-Bid RFI Log-P20221008080 07262024.xlsx | XLSX spreadsheet | |
| 14 75D301-24-R-73077 Site Visit Notes.pdf | ||
| 12 Pre-Bid RFI Log-P20221008080 07242024.xlsx | XLSX spreadsheet | |
| A19 75D301-24-R-73077 Solicitation 07182024.pdf | ||
| 11 Pre-Bid RFI Log-P20221008080 07182024.xlsx | XLSX spreadsheet | |
| 10 TEMPLATE - Document Tracking Log.xls | XLS spreadsheet | |
| 9 EXHIBIT A breakdown example.xlsx | XLSX spreadsheet | |
| Amendment 00001 to 75D301-24-R-73077 signed.pdf | ||
| 75D301-24-R-73077 Solicitation.pdf | ||
| 4 Employee Non-Disclosure Agreement.docx | DOCX document | |
| 2 Davis Bacon WD GA20240305 03222024 rev 1.pdf | ||
| 6 Visitors Request Form For Access To CDC Campuses.docx | DOCX document | |
| 1 Statement of Work (SOW) P20221008080.pdf | ||
| 3 Contractors Non-Disclosure Agreement.docx | DOCX document | |
| 5 Past Performance Questionnaire.docx | DOCX document |
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Text version
VISITORS REQUEST FORM FOR ACCESS TO CDC CAMPUSES
| DATE OF REQUEST: |
| 07/09/2024 |
| PROJECT: |
| P20221008080 B110 Domestic Water Replacement - GACH0110 |
| OSSAM POINT OF CONTACT: |
| CARL SANDRA ULYSSE; 770-241-9722 |
PRIME CONTRACTOR POC & CELL:
CAMPUS, BUILDING(S) & FLOOR(S)
WHERE VISIT WILL TAKE PLACE:
Chamblee B110
| ENTRY POINT OF VISITOR: |
| FRONT DESK |
| PURPOSE OF VISIT: |
| CONSTRUCTION SITE VISIT |
| ESCORT NAME(S) AND CELL PHONE: |
| CARL SANDRA ULYSSE; 770-241-9722 |
| OAS CONTACT: |
| MICHAEL DAVIS (770) 488-2427 |
VISITOR
NAME AS SHOWN ON PHOTO ID and Driver’s License #
| US CITIZEN |
| VISITOR’S COMPANY |
NAME
CELL PHONE
IF AVAILABLE
| DATE OF VISIT |
| TIME AND DURATION OF VISIT |
| NO |
| YES |
X
| 07/11/2024 |
| 10:00 AM; approximately 1 hour |
X
| 07/11/2024 |
| 10:00 AM; approximately 1 hour |
X
| 07/11/2024 |
| 10:00 AM; approximately 1 hour |
X
| 07/11/2024 |
| 10:00 AM; approximately 1 hour |
X
| 07/11/2024 |
| 10:00 AM; approximately 1 hour |
| 07/11/2024 |
| 10:00 AM; approximately 1 hour |
| 07/11/2024 |
| 10:00 AM; approximately 1 hour |
| 07/11/2024 |
| 10:00 AM; approximately 1 hour |
| 07/11/2024 |
| 10:00 AM; approximately 1 hour |
| 07/11/2024 |
| 10:00 AM; approximately 1 hour |
PENALTIES FOR INACCURATE OR FALSE STATEMENTS
The US Criminal Code (title 18, section 1001) provides that knowingly falsifying or concealing a material fact is a felony which may result in fines of up to $10,000, and/or 5 years imprisonment or both.
EMPLOYEE INFORMATION ON THIS FORM PROVIDED TO THE GOVERNMENT PROJECT OFFICER BY THE PRIME CONTRACTOR
VISITORS:
· MUST BE ESCORTED BY PERSON(S) WITH VALID CDC ID BADGE AT ALL TIMES
· A PHOTO ID IS REQUIRED FOR VISITOR ADMISSION ON ALL GOVERNMENT PROPERTY
· VISITOR BADGES MUST BE OBTAINED DURING THE NORMAL OPERATING HOURS OF THE LOCAL SECURITY OFFICE. THE SECURITY OFFICE IS NOT OPEN ON WEEKENDS AND HOLIDAYS
· FOREIGN NATIONAL MUST COMPLETE AND TRANSMIT, THE REQUIRED FORM AT http://intranet.cdc.gov/od/aspo/security/foreign_visitor.htm and http://aops-mas-iis.od.cdc.gov/Policy/Doc/policy334.pdf A MINIMUM OF TEN WORKING DAYS BEFORE VISITING ANY CDC CAMPUS. Page 2 of 2
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