Attachment 08 - PIV Badge Template.pdf
PDF 293 KB Posted
- Solicitation number
- 36C24124R0063
About this file
This document appears to be a PIV Badge Template for the Department of Veterans Affairs VA Maine Healthcare System Police Department. The template outlines the required information to be submitted in order to obtain a PIV (Personal Identity Verification) or non-PIV badge, including the applicant's name, address, social security number, date of birth, and occupation title. The template also indicates that all highlighted information must be provided, otherwise a badge cannot be issued. This template is likely used in support of a federal contract opportunity, as referenced in the related information provided.
The related federal contract opportunity is a Request for Proposal (RFP) for Structural Repairs and Improvements to Support Buildings at the Togus, Maine VA Medical Center. The Solicitation Number is 36C24124R0063, and it is a Small Business (SB) Set-Aside. The Department of Veterans Affairs Veterans Health Administration Veterans Integrated Service Network 1 is the agency involved. Further details regarding the Scope of Work (SOW) and other attachments are provided in the solicitation information.
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Text version
Project Name: Type of Badge Requested: PIV NON-PIV FLASH
Circle one
Departmentof Veterans Affairs
VA Maine Healthcare System
Police Department
1 VA Center 07B
Augusta, ME 04330
207 623-5796
Last Name First Name Middle
Physical Street Address City State and Zip Code
Social Security Number
Gender (M) (F)
Service Line or Company Name Company or Cell Phone Number
Date of Birth
Place of Birth Occupation Title
Personal email for activation of badge process
For Engineers to fill out:
Contract end date:
Service Line Official Date
All highlighted info must be submitted, or a badge cannot be issued
FOR TOG US POLICE USE ONLY
VISTA RECORDS:
DATE CHECKED BY RECORDS FOUND TYPE
VAPS RECORDS:
DATE CHECKED BY RECORDS FOUND TYPE
LOCAL RECORDS:
DATE CHECKED BY RECORDS FOUND TYPE
STATUS F YES NO ADVANCED TO HR
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