ATTACHMENT 1- - 1818 Pre-enrollment sample - 1 Page.pdf
PDF 183 KB Posted
- Attached to
- Construction Requirements Contract
- Solicitation number
- SP330024R0002
- Issued by
-
Defense Logistics Agency Distribution
About this file
This document appears to be a Privacy Act Statement for a pre-enrollment visit notification to the Defense Logistics Agency (DLA) Distribution facility in Susquehanna, Pennsylvania.
The federal contract opportunity described is for a multiple award, indefinite delivery/indefinite quantity (ID/IQ) construction contract with DLA Distribution. The work includes various construction, building, alteration, maintenance, and repair activities at the DLA Distribution Susquehanna sites. The contract has a 5-year period of performance from August 1, 2024 to July 31, 2029, with a total estimated value of $45 million. The procurement will be a 100% small business set-aside, with one reservation each for Women Owned Small Business (WOSB), Service-Disabled Veteran Owned Business (SDVOSB), and Historically Underutilized Business Zone (HUBZone) concerns. Award will be made on a best value, lowest price technically acceptable basis. Contractors will compete for individual task orders under the ID/IQ contract.
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Text version
PRIVACY ACT STATEMENT
VISIT NOTIFICATION
1. ACTIVITY TO BE VISITED
AUTHORITY:
PRINCIPAL PURPOSE:
ROUTINE USES:
DISCLOSURE:DEFENSE LOGISTICS AGENCY
8725 JOHN J. KINGMAN ROAD
FT BELVOIR, VA 22060-6220
Section 21, 50 U.S.C. 781 et seq.; Executive Order 10450.
To control access to and movement on DoD installations, buildings, or facilities.
Used by General Services Administration Protective Service Personnel for access control and for any of the Blanket Routine Uses published by DLA.
Voluntary. However, failure to provide all the requested information may result in refusal to grant access to the installation, building, or facility.
DLA PRIVACY ACT SYSTEM NOTICE S500.50 DLA-I APPLIES
SECTION I
2. NAME OF REQUESTOR/PREPARER 4. TELEPHONE3. OFFICE CODE
5. DATE(S) OF VISIT 6. POINT OF CONTACT (at facility to be visited) 7. POC TELEPHONE
8. PURPOSE OF VISIT
SECTION II
9.
NAME(S) OF VISITOR(S)
(Last, First, MI)
10.
GRADE/RANK
11.
SSN
12.
DATE OF BIRTH
13.
STATE /COUNTRY OF
BIRTH
14.
CLEARANCE/DATE
GRANTED
15.
TYPE OF INVESTIGATION/
DATE
16. TYPED NAME OF SECURITY REPRESENTATIVE
SECTION III
18. ACTIVITY 19. TELEPHONE NUMBER 20. DATE17. SIGNATURE OF SECURITY REPRESENTATIVE
DLA FORM 1818, JUL 96 (EG)
FROM: TO:
PDF (DLA)
| RequesterName: Mogen Gilson |
| OfficeCode: J7/AB |
| FacPOC: Johnathan Tassone |
| Phone: 717-770-4757 |
| POCPhone: 717-770-5839 |
| VisitedActivity: DLA DISTRIBUTION |
Meet at Building 67 Parking Lot
10:00 AM-11:00 AM
VisitPurpose: Site Visit: BLDG 67
Visitor has registered utilizing the pre-enrollment website: https://dbids-global.dmdc.mil
| DateTo: 6-21-2024 |
| Visitor: |
| 0: Doe, John M. |
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