Att. 3 - Site Visit Response Form (BPM055983).pdf
PDF 592 KB Posted
- Solicitation number
- BPM055983
- Issued by
- Maryland
About this file
This is a Site Visit Response Form issued by the Maryland Department of Public Safety and Correctional Services (DPSCS) for the Satellite Television Programming Services solicitation (BPM055983) for Eastern Correctional Institution (ECI) and ECI Annex. The solicitation seeks a contractor to provide satellite television programming services, including furnishing, installation, operation, maintenance, replacement, and support of head-end equipment for both facilities under a five-year contract term. Bidders are required to complete and return the Site Visit Response Form by the RSVP deadline specified in the Key Information Summary Sheet, indicating whether their firm will attend the mandatory site visit. Attendees are limited in number as specified in the Invitation for Bid (IFB) and must complete both the Site Visit Response Form and a Security Clearance Form, which must be submitted to the Procurement Officer, Larquana Bryan, at Larquana.Bryan@maryland.gov.
In addition to the Site Visit Response Form, prospective bidders and their representatives must complete a Security Clearance Information Form prior to entry onto institutional property. This form requires personal information including full name, date of birth, race, sex, Social Security number, driver's license or state ID number, and address. All attendees seeking facility access must undergo a background clearance check conducted by ECI staff. Bidders must indicate any reasonable accommodations needed and may specify the number of representatives planning to attend, subject to IFB limitations. Both forms are confidential and must be returned by the stated RSVP deadline via email to the procurement contact.
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Text version
Attachment 3. Site Visit Response Form effective date: July 2024
Attachment 3. Site Visit Response Form (ECI and ECI - Annex)
Solicitation Title: Satellite Television Programming Services for ECI and ECI - Annex Solicitation #: BPM055983 Bidder/Offeror Name:____________________________________
See the Key Information Summary Sheet for the date and time for the Site Visit.
Please return this form by the due date noted for the RSVP, advising whether or not your firm plans to attend. If your firm intends to attend the site visit, please also complete the Security Clearance Form.
Both forms are due by the RSVP deadline. The completed forms should be returned via e-mail to the Procurement Officer at the contact information below:
Larquana Bryan
DPSCS
E-mail: Larquana.Bryan@maryland.gov
Please indicate:
________ Yes, the following representatives will be in attendance.
Attendees (Check the IFB for limits to the number of attendees allowed):
1.
2.
3.
________ No, we will not be in attendance.
Please specify whether any reasonable accommodations are requested :
Bidder: ______________________________________________________________________________ (Bidder Name Please Print or Type)
By: _________________________________________________________________________________ (Signature/Seal)
Printed Name: ________________________________________________________________________ (Printed Name)
Title: _______________________________________________________________________________ (Title)
Date: ______________________________________________________________________________ (Date)
CONFIDENTIAL
ST ATE OF MARYLAND
DEPARTMENT OF PUBLIC SAFETY AND CORRECTIONAL SERVICES
SECURITY CLEARANCE INFORMATION
Prior to any individual being permitted into/or on Institutional property, a security background clearance check must be completed.
The following information will be necessary to perform the security check:
1. Full Name: ____________________ _
2. Date of Birth:
(Month/Day/Ye a r - XX/XX/XXXX)
3. Race: ____________ .Sex: __________ _
4. Social Security#: ____________________ _
5. Driver's License/State ID#: ___________________ _ (Driver's License# - State of Issue)
6. Address:-- -------------- ---------------
7. City/State/Zip: __________________________ _
My electronic signature constitutes my authorization for the Staff of ECI to conduct a clearance on me for my personal entry into Eastern Correctional Institution.
Signature:--------------------------------
When this form is completed, please email back to:
larquana.bryan@maryland.gov
**This information is private and is used by the staff of ECI to clear an individual for entry into the facility.
Security Clearance Form Revised 7 .16.13 Page 1 11/8/2023
| Attachment 3.-Site Visit Form.pdf |
| Background Check Clearance FORM.pdf |
File details come from the government source that posted it. Updated .