ATTACHMENT 07 - ARW Form 11 Visitor Access.pdf

PDF 249 KB Posted Apr 19, 2021

Attached to: Renovate Squadron Operations Building 522, 128th Air Refueling Wing, Milwaukee, WI
Solicitation number: W50S9G-21-R-0001
Issued by: Department of the Army Wisconsin Army National Guard

About this file

Written by GovTribe AI · Dec 27, 2023

This document contains details of a federal contract opportunity for renovation work at a military facility. The North American Industry Classification Code for this project is 236220 for commercial and institutional building construction. The project magnitude is above $10 million. Interested offerors should attend a pre-proposal conference on April 28, 2021 and submit bids in accordance with FAR Clause 52.228-1, including a bid bond. Funds are anticipated but not presently available, with an expected award date before September 30, 2021. The award will be made based on best value determination of criteria in the solicitation. The work involves renovating Squadron Operations Building 522 at the 128th Air Refueling Wing in Milwaukee, Wisconsin, which is overseen by the Department of the Army Wisconsin Army National Guard.

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AUTHORITY: Privacy Act of 1974 (5 USC Section 522(A)(7)) 41 USC Section 423, 5CFS Section 2635.602, AR 340-21 Title 10 and 37 USC.

ROUTINE USE(S): To authorize access to DoD facilities. Information may be reported to federal, state, and local law enforcement agencies with jurisdictional interests.

DISCLOSURE: Voluntary. Failure to provide requested information will result in denial of access to DoD facilities.

√ LEGAL LAST NAME

FULL FIRST

NAME

FULL MIDDLE

NAME

DATE OF

BIRTH

ISSUING

STATE OF ID

MILITARY

ID √ RANK/NOTES:

Doe John Michael 5/5/1965 WI

Smith Jane Ann X Major

128th Air Refueling Wing - VISITOR ACCESS REQUEST

PRIVACY ACT STATEMENT

PRINCIPLE PURPOSE: To enable military security and/or law enforcement personnel to conduct citizenship and criminal background investigations for civilians requesting access to DoD facilities.

Date:

ARW Form 11, 27 Jan 2015

SUBJECT TO THE PRIVACY ACT OF 1974

Properly dispose of this document after use AUTHENTICATED BY (SFS E6 or Higher):_____________

AUTHORITY: Privacy Act of 1974 (5 USC Section 522(A)(7)) 41 USC Section 423, 5CFS Section 2635.602, AR 340-21 Title 10 and 37 USC.

ROUTINE USE(S): To authorize access to DoD facilities. Information may be reported to federal, state, and local law enforcement agencies with jurisdictional interests.

DISCLOSURE: Voluntary. Failure to provide requested information will result in denial of access to DoD facilities.

√ LEGAL LAST NAME

FULL FIRST

NAME

FULL MIDDLE

NAME

DATE OF

BIRTH

ISSUING

STATE OF ID

MILITARY

ID √ RANK/NOTES:

128th Air Refueling Wing - VISITOR ACCESS REQUEST

PRIVACY ACT STATEMENT

PRINCIPLE PURPOSE: To enable military security and/or law enforcement personnel to conduct citizenship and criminal background investigations for civilians requesting access to DoD facilities.

Date:

ARW Form 11, 27 Jan 2015

SUBJECT TO THE PRIVACY ACT OF 1974

Properly dispose of this document after use AUTHENTICATED BY (SFS E6 or Higher):_____________

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AUTHENTICATED BY SFS E6 or Higher:

AUTHORITY Privacy Act of 1974 5 USC Section 522A7 41 USC Section 423 5CFS Section 2635602 AR 34021 Title 10 and 37 USC_2:

DISCLOSURE Voluntary Failure to provide requested information will result in denial of access to DoD facilities_2:

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AUTHENTICATED BY SFS E6 or Higher_2:

Text1:

File details come from the government source that posted it. Updated Apr 19, 2021.