Attachment 12 - Base Access Form_Blank.pdf

103 KB Posted

Attached to
REPAIR AIRCRAFT FIRE TRAINING FACILITY HOMESTEAD AIR RESERVE BASE (HARB) FL
Solicitation number
FA664825R0004
Issued by

About this file

Written by GovTribe AI ·

This document is a Base Access Request Form for a federal contract opportunity at Homestead Air Reserve Base (HARB). The form is designed to collect personal information for individuals requiring base access, including last name, first name, date of birth, Social Security Number, driver's license details, citizenship status, and alien registration number if applicable. The form is part of a solicitation (FA664825R0004) for repairing the Aircraft Fire Training Facility, which is a 100% Small Business Set-Aside competitive solicitation with an estimated value between $1,000,000 and $5,000,000. The base access form is specifically required for potential contractors planning to attend a mandatory site visit on 16 May 2025, with registration deadlines and submission instructions provided in the associated solicitation details.

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Solicitation Amendment FA664825R00040002 SF 30.pdf PDF
Attachment 17 - Consolidated Requests for Information Q-As (6-4-25).xlsx XLSX spreadsheet
Solicitation Amendment FA664825R00040001 SF 30.pdf PDF
Attachment 1 - SOW KYJM 18-9007 rev.6 (5-21-25).pdf PDF
Attachment 17 - Consolidated Requests for Information Q-As.xlsx XLSX spreadsheet
Attachment 18 - Site Visit Photos.pdf PDF
Attachment 19 - Site Visit Sign in Sheet REDACTED.pdf PDF
Attachment 1 - SOW KYJM 18-9007 rev.5 (4-24-25).pdf PDF
Attachment 7 - KYJM18-9007 DRAWINGS.pdf PDF
Attachment 8 - KYJM 18-9007_AF 66_Construction.xlsx XLSX spreadsheet
Attachment 16 - Section M FA664825R0004.pdf PDF
Attachment 5 - UFC 3 250 03.pdf PDF
Attachment 9 - CONSTRUCTION COST ESTIMATE (BLANK).xlsx XLSX spreadsheet
Attachment 13 - Past Performance Fact Sheet - Fire Trainer (Offeror).docx DOCX document
Solicitation - FA664825R0004.pdf PDF
Attachment 3 - UFC 3 230 02.pdf PDF
Attachment 4 - UFC 3 250 01.pdf PDF
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Attachment 10 - Template - AF 3064 - Progress Schedule.xlsx XLSX spreadsheet
Attachment 15 - Section L FA664825R0004.pdf PDF
Attachment 2 - T.O. 35E1-2-13-1.pdf PDF
Attachment 11 - DBA Wage Determination FL20250215 dated 4-11-25.pdf PDF
Attachment 14 - Past Performance Questionnaire.docx DOCX document
Show all 23

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LAST NAME FIRST NAME M DOB SSN DRIVER'S LICENSE # STATE OF

ISSUE

US CITIZEN?

YES OR NO

IF NO, ALIEN

REGISTRATION #

VCC / BDOC USE

ONLY

LAST NAME FIRST NAME M DOB SSN DRIVER'S LICENSE # STATE OF

ISSUE

US CITIZEN?

YES OR NO

IF NO, ALIEN

REGISTRATION #

VCC / BDOC USE

ONLY

LAST NAME FIRST NAME M DOB SSN DRIVER'S LICENSE # STATE OF

ISSUE

US CITIZEN?

YES OR NO

IF NO, ALIEN

REGISTRATION #

VCC / BDOC USE

ONLY

LAST NAME FIRST NAME M DOB SSN DRIVER'S LICENSE # STATE OF

ISSUE

US CITIZEN?

YES OR NO

IF NO, ALIEN

REGISTRATION #

VCC / BDOC USE

ONLY

LAST NAME FIRST NAME M DOB SSN DRIVER'S LICENSE # STATE OF

ISSUE

US CITIZEN?

YES OR NO

IF NO, ALIEN

REGISTRATION #

VCC / BDOC USE

ONLY

LAST NAME FIRST NAME M DOB SSN DRIVER'S LICENSE # STATE OF

ISSUE

US CITIZEN?

YES OR NO

IF NO, ALIEN

REGISTRATION #

VCC / BDOC USE

ONLY

LAST NAME FIRST NAME M DOB SSN DRIVER'S LICENSE # STATE OF

ISSUE

US CITIZEN?

YES OR NO

IF NO, ALIEN

REGISTRATION #

VCC / BDOC USE

ONLY

COMPANY NAME: _______________ REQUESTER NAME:_______________

JOBSITES: _______________ REQUEST DATE: _______________

JOB END DATE: _______________ REQUESTER PHONE #: ____________

*MAX 1 YEAR*

BACKGROUND INVESTIGATION REQUEST

FOR OFFICIAL USE ONLY

HOMESTEAD ARB

LAST NAME FIRST NAME M DOB SSN DRIVER'S LICENSE # STATE OF

ISSUE

US CITIZEN?

YES OR NO

IF NO, ALIEN

REGISTRATION #

VCC / BDOC USE

ONLY

LAST NAME FIRST NAME M DOB SSN DRIVER'S LICENSE # STATE OF

ISSUE

US CITIZEN?

YES OR NO

IF NO, ALIEN

REGISTRATION #

VCC / BDOC USE

ONLY

LAST NAME FIRST NAME M DOB SSN DRIVER'S LICENSE # STATE OF

ISSUE

US CITIZEN?

YES OR NO

IF ALIEN / RESIDENT

A NUMER

VCC / BDOC USE

ONLY

LAST NAME FIRST NAME M DOB SSN DRIVER'S LICENSE # STATE OF

ISSUE

US CITIZEN?

YES OR NO

IF NO, ALIEN

REGISTRATION #

VCC / BDOC USE

ONLY

LAST NAME FIRST NAME M DOB SSN DRIVER'S LICENSE # STATE OF

ISSUE

US CITIZEN?

YES OR NO

IF NO, ALIEN

REGISTRATION #

VCC / BDOC USE

ONLY

LAST NAME FIRST NAME M DOB SSN DRIVER'S LICENSE # STATE OF

ISSUE

US CITIZEN?

YES OR NO

IF NO, ALIEN

REGISTRATION #

VCC / BDOC USE

ONLY

LAST NAME FIRST NAME M DOB SSN DRIVER'S LICENSE # STATE OF

ISSUE

US CITIZEN?

YES OR NO

IF NO, ALIEN

REGISTRATION #

VCC / BDOC USE

ONLY

Sheet1

LAST NAMERow1:
FIRST NAMERow1:
MRow1:
DOBRow1:
SSNRow1:
DRIVER S LICENSE Row1:
STATE OF ISSUERow1:
US CITIZEN YES OR NORow1:
IF NO ALIEN REGISTRATION Row1:
FIRST NAMEVCC BDOC USE ONLY:
LAST NAMERow1_2:
FIRST NAMERow1_2:
MRow1_2:
DOBRow1_2:
SSNRow1_2:
DRIVER S LICENSE Row1_2:
STATE OF ISSUERow1_2:
US CITIZEN YES OR NORow1_2:
IF NO ALIEN REGISTRATION Row1_2:
FIRST NAMEVCC BDOC USE ONLY_2:
LAST NAMERow1_3:
FIRST NAMERow1_3:
MRow1_3:
DOBRow1_3:
SSNRow1_3:
DRIVER S LICENSE Row1_3:
STATE OF ISSUERow1_3:
US CITIZEN YES OR NORow1_3:
IF NO ALIEN REGISTRATION Row1_3:
FIRST NAMEVCC BDOC USE ONLY_3:
LAST NAMERow1_4:
FIRST NAMERow1_4:
MRow1_4:
DOBRow1_4:
SSNRow1_4:
DRIVER S LICENSE Row1_4:
STATE OF ISSUERow1_4:
US CITIZEN YES OR NORow1_4:
IF NO ALIEN REGISTRATION Row1_4:
FIRST NAMEVCC BDOC USE ONLY_4:
LAST NAMERow1_5:
FIRST NAMERow1_5:
MRow1_5:
DOBRow1_5:
SSNRow1_5:
DRIVER S LICENSE Row1_5:
STATE OF ISSUERow1_5:
US CITIZEN YES OR NORow1_5:
IF NO ALIEN REGISTRATION Row1_5:
FIRST NAMEVCC BDOC USE ONLY_5:
LAST NAMERow1_6:
FIRST NAMERow1_6:
MRow1_6:
DOBRow1_6:
SSNRow1_6:
DRIVER S LICENSE Row1_6:
STATE OF ISSUERow1_6:
US CITIZEN YES OR NORow1_6:
IF NO ALIEN REGISTRATION Row1_6:
FIRST NAMEVCC BDOC USE ONLY_6:
LAST NAMERow1_7:
FIRST NAMERow1_7:
MRow1_7:
DOBRow1_7:
SSNRow1_7:
DRIVER S LICENSE Row1_7:
STATE OF ISSUERow1_7:
US CITIZEN YES OR NORow1_7:
IF NO ALIEN REGISTRATION Row1_7:
FIRST NAMEVCC BDOC USE ONLY_7:
LAST NAMERow1_8:
FIRST NAMERow1_8:
MRow1_8:
DOBRow1_8:
SSNRow1_8:
DRIVER S LICENSE Row1_8:
STATE OF ISSUERow1_8:
US CITIZEN YES OR NORow1_8:
IF NO ALIEN REGISTRATION Row1_8:
FIRST NAMEVCC BDOC USE ONLY_8:
LAST NAMERow1_9:
FIRST NAMERow1_9:
MRow1_9:
DOBRow1_9:
SSNRow1_9:
DRIVER S LICENSE Row1_9:
STATE OF ISSUERow1_9:
US CITIZEN YES OR NORow1_9:
IF NO ALIEN REGISTRATION Row1_9:
FIRST NAMEVCC BDOC USE ONLY_9:
LAST NAMERow1_10:
FIRST NAMERow1_10:
MRow1_10:
DOBRow1_10:
SSNRow1_10:
DRIVER S LICENSE Row1_10:
STATE OF ISSUERow1_10:
US CITIZEN YES OR NORow1_10:
IF ALIEN RESIDENT A NUMERRow1:
FIRST NAMEVCC BDOC USE ONLY_10:
LAST NAMERow1_11:
FIRST NAMERow1_11:
MRow1_11:
DOBRow1_11:
SSNRow1_11:
DRIVER S LICENSE Row1_11:
STATE OF ISSUERow1_11:
US CITIZEN YES OR NORow1_11:
IF NO ALIEN REGISTRATION Row1_10:
FIRST NAMEVCC BDOC USE ONLY_11:
LAST NAMERow1_12:
FIRST NAMERow1_12:
MRow1_12:
DOBRow1_12:
SSNRow1_12:
DRIVER S LICENSE Row1_12:
STATE OF ISSUERow1_12:
US CITIZEN YES OR NORow1_12:
IF NO ALIEN REGISTRATION Row1_11:
FIRST NAMEVCC BDOC USE ONLY_12:
LAST NAMERow1_13:
FIRST NAMERow1_13:
MRow1_13:
DOBRow1_13:
SSNRow1_13:
DRIVER S LICENSE Row1_13:
STATE OF ISSUERow1_13:
US CITIZEN YES OR NORow1_13:
IF NO ALIEN REGISTRATION Row1_12:
FIRST NAMEVCC BDOC USE ONLY_13:
LAST NAMERow1_14:
FIRST NAMERow1_14:
MRow1_14:
DOBRow1_14:
SSNRow1_14:
DRIVER S LICENSE Row1_14:
STATE OF ISSUERow1_14:
US CITIZEN YES OR NORow1_14:
IF NO ALIEN REGISTRATION Row1_13:
FIRST NAMEVCC BDOC USE ONLY_14:
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