Attachment 06 - NCIC Screening and Pass Request - 6.24.25.pdf

PDF 205 KB Posted

Attached to
Water Pump and Motor Replacement and Refurbishment Federal contract opportunity
Solicitation number
FA460025Q0057
Issued by
Department of the Air Force Air Combat Command

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Written by GovTribe AI ·

The document is a 55 SFS Contractor/Vendor NCIC Screening & Pass Request Spreadsheet for accessing Offutt Air Force Base. It is a multi-page form designed to collect personal identifying information for contractors and vendors who require base entry, including full name, date of birth, driver's license/ID number, work schedule, and citizenship. The form requires completion by the base sponsor and company representative, with a specific note that all listed personnel must present a REAL ID ACT compliant photo identification at the Visitor Control Center. Additional pages provide space for extended personnel listings, with a signature block for Unit Commander or Security Manager and a separate block for 55 WG/IP approval for non-U.S. visitors. The form is associated with a water pump and motor replacement solicitation (FA460025Q0057) for the Department of the Air Force Air Combat Command, which requires submission of this screening form for site visit attendance.

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File Type Posted
Amendment 0003 Attachment 01 - FAR 52.212-1 - Addendum - 7.1.25.pdf PDF
Amendment 0003 Solicitation - FA460025Q0057.pdf PDF
Amendment 0003 Attachment 08 - Questions and Answers - 7.1.25.pdf PDF
Amendment 0002 Attachment 01 - FAR 52.212-1 - Addendum - 6.30.25.pdf PDF
Attachment 07 - Photos - 6.26.25.pdf PDF
Attachment 08 - Questions and Answers - 6.26.25.pdf PDF
Attachment 01 - FAR 52.212-1 - Addendum - 6.24.25.pdf PDF
Attachment 04 - PWS B185 Tower Pump Replace - 6.24.25.pdf PDF
Solicitation - FA460025Q0057.pdf PDF
Attachment 02 - FAR 52.212-2 - Addendum - 6.24.25.pdf PDF
Attachment 05 - SCA WD - SARPY NE - 2015-5005 - REV 25 - 6.24.25.pdf PDF
Attachment 03 - Pump - Clauses Attachment - 6.24.25.pdf PDF
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Contract#:

Contract Start/End Dates: Unit Commander or Security Manager Sig Block

Full Name Country of Last, First, MI Year Month Day Drivers License/ID # State SSAN Days Hrs Start Date - End Date (MMDDYYYY) Citizenship

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:

NOTE:

Security Manager will ensure all listed personnel are briefed that they must present a REAL ID ACT compliant drivers license, or state ID, or an approved alternate form of photo identification upon arrival at Offutt AFB Visitor Control Center.

Contract Start/End Dates: Unit Commander or Security Manager Sig Block 55 WG/IP Sig Block - Needed For Non U.S. Visitors

Contract Start/End Dates: Unit Commander or Security Manager Sig Block 55 WG/IP Sig Block - Needed For Non U.S. Visitors

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