Attach 02 - 55 SFS NCIC Screening Pass Request.pdf

351 KB Posted

Attached to
Demolition Bldg. 404, Offutt AFB, NE
Solicitation number
FA460025B0001
Issued by

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The document is a 55 SFS Contractor/Vendor NCIC Screening & Pass Request Spreadsheet for a federal contract at Offutt Air Force Base. The spreadsheet is designed to collect personally identifying information for contractors requiring base access, with fields for full name, date of birth, driver's license, work schedule, and U.S. citizenship status. The specific contract (FA4600-25-B-0001) involves demolition of Building 404 at Offutt AFB, Nebraska, with a contract period spanning from 09 April 2025 to 09 April 2026. The solicitation is a 100% small business set-aside with a project magnitude between $1,000,000 and $5,000,000, using NAICS code 238910 with a size standard of $19M. A mandatory site visit is scheduled for 15 April 2025 at 2:00 PM CST, and contractors without base access must submit the completed screening spreadsheet to specified Air Force contacts by 09 April 2025 at 10:00 AM CST.

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Bid Abstract_Certified.pdf PDF
Attach 06 - Amend 01 Questions and Answers 8May25.pdf PDF
Attach 01 - Amend 04- Bid Opening and Submission Information.pdf PDF
Solicitation Amendment 004 - FA460025B00010004.pdf PDF
Solicitation Amendment 004 - FA460025B00010004 SF 30.pdf PDF
Attach 06 Questions and Answers 5May25.pdf PDF
Attach 01 - Amend 03- Bid Opening and Submission Information.pdf PDF
Attach 07 Building Materials Inspection_Haz Mat Report.pdf PDF
Solicitation Amendment 003 FA460025B00010003 SF 30.pdf PDF
Solicitation Amendment 003- FA460025B00010003.pdf PDF
Solicitation Amendment 02 - FA460025B00010002.pdf PDF
Solicitation Amendment 02 FA460025B00010002 SF 30.pdf PDF
Attach 01 - Amend 02- Bid Opening and Submission Information.pdf PDF
Site Visit Attendance Roster15Apr25.pdf PDF
Base Map.jpg JPG image
Attach 01 - Amend 01- Bid Opening and Submission Information.pdf PDF
Solicitation Amendment 01 - FA460025B00010001.pdf PDF
Solicitation Amendment 01 FA460025B00010001 SF 30.pdf PDF
Solicitation - FA460025B0001.pdf PDF
Attach 03 - DRAWINGS 12Apr22.pdf PDF
Attach 05 - Wage Determination NE20250059.txt TXT text file
Attach 04 - SPECIFICATIONS 12Apr22.pdf PDF
Attach 01 - Bid Opening and Submission Information.pdf PDF
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Full Name U.S. Citizen Last, First, MI Year Month Day Drivers License/ID # State SSAN Days Hrs Dates (MMDDYYY) Yes / No

Personally Identifying Information (PII) being collected by this form is authorized for collection under provisions of 10 U.S.C. 8013, Secretary of the Air Force, DoD 5200.2R, DoD Personnel Security Program; AFI 33-202, Computer Security, Information will be maintained by local

Security Forces Authority while access requirements exist. Information access is restricted to personnel responsible for contract administration, or otherwise needed in the performance of official DoD duties. Information will be properly disposed of when its required use has been concluded. Providing this information is voluntary; however, failure to provide all of the required data shown on the spreadsheet will result in denial of entry to the installation. This information is exempt from OMB licensing under provisions of AFI 33-324, Information Collections and

Reports Management Program; Controlling Internal, Public, and Interagency Air Force Collections, paragraphs 3.16.11 and 3.16.16.3.

55 SFS CONTRACTOR/VENDOR NCIC SCREENING & PASS REQUEST SPREADSHEET

Date of Birth

Offutt AFB Sponsoring Agency / Unit:

Base Sponsor's Name:

Base Sponsor's Phone #:

Request Date:

Work Schedule

Company Name:

Company Address:

Company Representative Name:

Company Representative Phone Number:

Contract#:

Contract Start/End Dates:

Sponsoring Unit Security Manager or Commander Signature Block/Signature

Offutt AFB Sponsoring Agency Unit: 55 CES
Company Name: Company
Base Sponsors Name: (Filled in by sponsoring agency)
Company Address: Address
Base Sponsors Phone: (Filled in by base sponsor)
Company Representative Name: Name
Request Date: (Filled in by base sponsor)
Last First MIRow1: Name
YearRow1: 19XX
MonthRow1: MAY
DayRow1: XX
Drivers LicenseID Row1:
StateRow1:
SSANRow1: xxx-xx-xxxx
DaysRow1: N/A
HrsRow1: N/A
Dates MMDDYYYRow1: N/A
Yes NoRow1:
Last First MIRow2:
YearRow2:
MonthRow2:
DayRow2:
Drivers LicenseID Row2:
StateRow2:
SSANRow2:
DaysRow2: N/A
HrsRow2: N/A
Dates MMDDYYYRow2: N/A
Yes NoRow2:
Last First MIRow3:
YearRow3:
MonthRow3:
DayRow3:
Drivers LicenseID Row3:
StateRow3:
SSANRow3:
DaysRow3: N/A
HrsRow3: N/A
Dates MMDDYYYRow3: N/A
Yes NoRow3:
Last First MIRow4:
YearRow4:
MonthRow4:
DayRow4:
Drivers LicenseID Row4:
StateRow4:
SSANRow4:
DaysRow4: N/A
HrsRow4: N/A
Dates MMDDYYYRow4: N/A
Yes NoRow4:
Last First MIRow5:
YearRow5:
MonthRow5:
DayRow5:
Drivers LicenseID Row5:
StateRow5:
SSANRow5:
DaysRow5: N/A
HrsRow5: N/A
Dates MMDDYYYRow5: N/A
Yes NoRow5:
Last First MIRow6:
YearRow6:
MonthRow6:
DayRow6:
Drivers LicenseID Row6:
StateRow6:
SSANRow6:
DaysRow6: N/A
HrsRow6: N/A
Dates MMDDYYYRow6: N/A
Yes NoRow6:
Last First MIRow7:
YearRow7:
MonthRow7:
DayRow7:
Drivers LicenseID Row7:
StateRow7:
SSANRow7:
DaysRow7: N/A
HrsRow7: N/A
Dates MMDDYYYRow7: N/A
Yes NoRow7:
Last First MIRow8:
YearRow8:
MonthRow8:
DayRow8:
Drivers LicenseID Row8:
StateRow8:
SSANRow8:
DaysRow8: N/A
HrsRow8: N/A
Dates MMDDYYYRow8: N/A
Yes NoRow8:
Last First MIRow9:
YearRow9:
MonthRow9:
DayRow9:
Drivers LicenseID Row9:
StateRow9:
SSANRow9:
DaysRow9: N/A
HrsRow9: N/A
Dates MMDDYYYRow9: N/A
Yes NoRow9:
Last First MIRow10:
YearRow10:
MonthRow10:
DayRow10:
Drivers LicenseID Row10:
StateRow10:
SSANRow10:
DaysRow10: N/A
HrsRow10: N/A
Dates MMDDYYYRow10: N/A
Yes NoRow10:
Last First MIRow11:
YearRow11:
MonthRow11:
DayRow11:
Drivers LicenseID Row11:
StateRow11:
SSANRow11:
DaysRow11: N/A
HrsRow11: N/A
Dates MMDDYYYRow11: N/A
Yes NoRow11:
Last First MIRow12:
YearRow12:
MonthRow12:
DayRow12:
Drivers LicenseID Row12:
StateRow12:
SSANRow12:
DaysRow12: N/A
HrsRow12: N/A
Dates MMDDYYYRow12: N/A
Yes NoRow12:
Last First MIRow13:
YearRow13:
MonthRow13:
DayRow13:
Drivers LicenseID Row13:
StateRow13:
SSANRow13:
DaysRow13: N/A
HrsRow13: N/A
Dates MMDDYYYRow13: N/A
Yes NoRow13:
Last First MIRow14:
YearRow14:
MonthRow14:
DayRow14:
Drivers LicenseID Row14:
StateRow14:
SSANRow14:
DaysRow14: N/A
HrsRow14: N/A
Dates MMDDYYYRow14: N/A
Yes NoRow14:
Last First MIRow15:
YearRow15:
MonthRow15:
DayRow15:
Drivers LicenseID Row15:
StateRow15:
SSANRow15:
DaysRow15: N/A
HrsRow15: N/A
Dates MMDDYYYRow15: N/A
Yes NoRow15:
Last First MIRow16:
YearRow16:
MonthRow16:
DayRow16:
Drivers LicenseID Row16:
StateRow16:
SSANRow16:
DaysRow16: N/A
HrsRow16: N/A
Dates MMDDYYYRow16: N/A
Yes NoRow16:
Last First MIRow17:
YearRow17:
MonthRow17:
DayRow17:
Drivers LicenseID Row17:
StateRow17:
SSANRow17:
DaysRow17: N/A
HrsRow17: N/A
Dates MMDDYYYRow17: N/A
Yes NoRow17:
Last First MIRow18:
YearRow18:
MonthRow18:
DayRow18:
Drivers LicenseID Row18:
StateRow18:
SSANRow18:
DaysRow18: N/A
HrsRow18: N/A
Dates MMDDYYYRow18: N/A
Yes NoRow18:
Last First MIRow19:
YearRow19:
MonthRow19:
DayRow19:
Drivers LicenseID Row19:
StateRow19:
SSANRow19:
DaysRow19: N/A
HrsRow19: N/A
Dates MMDDYYYRow19: N/A
Yes NoRow19:
Last First MIRow20:
YearRow20:
MonthRow20:
DayRow20:
Drivers LicenseID Row20:
StateRow20:
SSANRow20:
DaysRow20: N/A
HrsRow20: N/A
Dates MMDDYYYRow20: N/A
Yes NoRow20:
Contract #: FA4600-25-B-0001
Contract End Date: 09 April 2025 / 09 April 2025
Company Phone #:

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