ATT 4 PSIP FORM.pdf
PDF 30 KB Posted
- Attached to
- Professional Services (Dentist & Nurse Practitioner) Federal contract opportunity
- Solicitation number
- W9127P21R0002
- Issued by
- Department of the Army National Guard
About this file
This document contains a federal contract solicitation and required forms for a professional services opportunity. The U.S. Army National Guard is seeking part-time professional services from a dentist and nurse practitioner, with performance taking place at a location in Estate Bethlehem, St. Croix, USVI from September 2021 through September 2026. The solicitation is set aside 100% for small businesses with a size standard of $8 million. Responses are due by September 7, 2021. The award will be a firm-fixed price contract for the base year plus four option years. Interested offerors must include completed representations and certifications with their responses.
View the file
Other files for this federal contract opportunity
| File | Type | Posted |
|---|---|---|
| 21R0002 Q-A_V2.pdf | ||
| 21R002 Q-A_V1 Prof SVS.pdf | ||
| W9127P21R0002 RFP Prof Svcs Amend 1.pdf | ||
| ATT 1_SCA WD 2015-5715.pdf | ||
| W9127P21R0002 RFP Prof Svcs FINAL.pdf | ||
| ATT2_PPQSol.pdf | ||
| ATT3_Price Model.xlsx | XLSX spreadsheet |
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Text version
PSIP Required Information Worksheet
Personal Information:
SSN: _______________ (Only provide if Security Manager doesn’t have on file) Birth Date: ________________ (MM/DD/YYYY)
Rank/Prefix (SSG, SGT, Dr., Ms., Mrs., Mr.): ________ Last Name: ___________________ First Name: ____________ Middle Name: _________ Initial Only / No Middle Name (Type NMN) Postfix/Suffix (i.e.: II, III, Jr.): ______
Country of Birth: _________________ State of Birth: __________________ City of Birth: ___________________________
Investigation Information:
Role: Military / Civilian / Contractor (Circle the role that applies to you) Clearance Required: Secret / Top Secret /Suitability / PRP / None (Background Investigation) IT Level: I / II / III / None (Hint: Normal users are “III”)
Periodic Reinvestigation: Yes /No Reason for Investigation:_____________________________________________ Branch of Service: ARMY NATIONAL GUARD Expedite Request? Yes / No Justification: _______________________________________________________
Subject Contact Information:
Email Address (AKO preferred): _____________________________________ Secondary Email Address (Mandatory): _______________________________
Primary Phone: _________________ Comm / DSN / Overseas Secondary Phone: ________________ Comm / DSN / Overseas
Organization/Unit Name: VIRGIN ISLANDS ARMY NATIONAL GUARD Organization/Unit UIC: W7P4AA
Supervisor’s Contact Information:
Rank/Prefix: ______ First Name: ______________________ Last Name: ___________________ Title: ____________________________
E-mail Address: __________________________________________________ Phone: _________________ Comm / DSN / Overseas
| SSN: |
| Birth Date: |
| RankPrefix SSG SGT Dr Ms Mrs Mr: |
| Last Name: |
| First Name: |
| Middle Name: |
| PostfixSuffix ie II III Jr: |
| Country of Birth: |
| State of Birth: |
| City of Birth: |
| Reason for Investigation: |
| Justification: |
| Email Address AKO preferred: |
| Secondary Email Address Mandatory: |
| Primary Phone: |
| Secondary Phone: |
| RankPrefix: |
| First Name_2: |
| Last Name_2: |
| Title: |
| Email Address: |
| Phone: |
File details come from the government source that posted it. Updated .