Atch 6 - Employee Info.docx
DOCX document 16 KB Posted
- Attached to
- Black Hills National Forest HVAC Maintenance
- Solicitation number
- 1240LP22Q0032
About this file
This document contains a federal contract opportunity solicitation for HVAC maintenance and repair services on the Black Hills National Forest. The solicitation seeks a contractor to provide multiple year HVAC maintenance and urgent repair services at 15 locations, as well as install a heat pump and furnace at one dwelling. The requirement is a total small business set-aside with a NAICS code of 238220 and size standard of $16.5 million. Interested vendors must be registered in the System for Award Management and able to submit electronic invoices via the Invoice Processing Platform. The solicitation will be awarded using simplified acquisition procedures considering past performance, technical capability, and price. Responses are due by email to the contracting officer by the date specified in the solicitation attachments.
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Text version
Contract Employee Information Back Ground Check and Linc Pass Information
The Federal Government has determined by agency Risk Assessment that a performing contract employee on your contract requires a LincPass. The information collected on this Personal Identity Information (PII) sheet is required for LincPass sponsorship. This information is to be collected and transmitted in accordance with The Privacy Act of 1974. For details on the Privacy Act of 1974, visit this website: http://www.usdoj.gov/oip/privstat.htm.
Instructions: Enter the information below for the applicant. Enter the applicant's complete name and address as it appears on their government-issued ID, such as a driver’s license or passport. If the information doesn’t match, the non-employee will encounter problems during the enrollment process and may have to reapply.
| Company Name You Work For |
| Contract Number You are Working Under |
| Name of Contracting Officer on Contract |
| Existing Background Investigation? Yes/No/Don’t Know. If yes, enter the agency that conducted the investigation (e.g. USDA, Treasury, Energy, etc). |
| |_| Yes |
|_| No |_| Don’t know
| Social Security Number |
| Name: First, Middle (if any), Last, Suffix (if any). |
| First |
Middle Last Suffix
| Date of Birth (mm/dd/yyyy) |
| / / |
MM/DD/YYYY
| Gender |
| |_| Female |
|_| Male
Email Address This is required for enrollment notification. If the applicant does not have a business email address, enter the address of the person who will manage enrollment activities, e.g. Security Officer or Supervisor.
|_| Business |_| Home
| Country of Citizenship |
| |_| USA |
|_| Other:
| Non-Employee Type: Contractor, Volunteer, Intern, Fellow, or Affiliate |
| |X| Contract Employee |
| Phone number |
| ( ) - |
|_| Business |_| Home |_| Cell
Federal Emergency Response Official: Yes/No. If yes, explain the applicant’s designation, e.g., “Continuity Coordinator.”
Note: This only applies to an Agency-identified person serving in an Emergency Response Official capacity. Contact your Security Officer for more information.
|X| No
| Place of Birth: City/State. If outside U.S., enter City/Country. |
| City: State: |
|_|USA |_| Other
| *Home Address: Enter the address as it appears on your government-issued ID. |
| Work Address: |
File details come from the government source that posted it. Updated .