Attachment 005 - Fillable Site Visit Visitor Application.pdf
PDF 421 KB Posted
- Solicitation number
- 12805B24R0043
About this file
This document is a Fillable Site Visit Visitor Application for RFQ12805B24R0037. It collects information such as the visitor's name, whether they have a previously issued PIV access card, citizenship status, company details, and contact information. The form must be password-protected and encrypted before being emailed to the NBAF Sponsor. The Privacy Act Statement indicates the information is mandatory for planned visits and will be used internally to facilitate visitor processing.
The related federal contract opportunity is Solicitation Number 12805B24R0043 for Necropsy Coolers Cove Base Repairs in Manhattan, KS. It is a Solicitation with a site visit requirement, unless waived by the Contracting Officer. The solicitation documentation is available electronically at the Government Point of Entry (sam.gov). Inquiries must be submitted in writing to the Contracting Officer via email. The solicitation requires the use of biobased products from the USDA BioPreferred Program, where available.
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Text version
Attachment 005 Site Visit Attendee Visitor Application Information
RFQ12805B24R0037
Name (Last, First, MI)
Previously issued PIV Access Card
(Yes or No) PIV card is not required for site visit attendance.
US Citizen (Yes/No)
If Not US Citizen Country of Birth
Company Name
Company Phone Number
Company Address
Once completed please e-mail this document to the NBAF Sponsor:
Jonathan.Lagerquist@usda.gov
For your personal security, please DO NOT send personally identifiable information (the information contained within this document) to any other e-mail address.
You should password protect and encrypt this form when returning it to NBAF and send the password in a separate email.
To password protect this document, follow the instructions below:
FOR PC: Select File tab, then select Protect Using Password; select Viewing; create a Password; reenter the Password to verify, then click on Apply.
FOR MAC: Select File tab, then select Export, and click on Encrypt; create a Password; reenter the
Password to verify, then click Save.
For your personal security this form will be destroyed immediately upon completion of access request process.
PRIVACY ACT STATEMENT The Privacy Act, 552a, requires that federal agencies inform individuals, at the time information is solicited from them, whether the disclosure is mandatory or voluntary, by what authority such information is solicited, and what uses will be made of the information. The collection of this information is authorized by EO 9397, 6 USC 341, 44 USC 3101, and EO 12958. Provision of the information concerning foreign visits is mandatory under the provisions of EO 12958. Failure to provide it may impact planned visits. Use of this information is for internal purposes to facilitate visitor processing.
Controlled// SP-SPIIWhen filled out, this document contains sensitive information exempt from mandatory disclosure under the Freedom of Information act, 5 U.S.C. 552 (b)(2). Do not release without prior approval by USDA.
Chris.C.Turner Highlight
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File details come from the government source that posted it. Updated .