Attachment 13 Fillable Site Visit Application.pdf
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- Solicitation number
- 12805B24R0036
About this file
This document is a Site Visit Attendee Visitor Application form related to a Request for Quote (RFQ) for site security improvements at the National Bio & Agro-Defense Facility in Manhattan, KS. The RFQ number is 12805B24R0036. The application collects information such as the attendee's name, whether they have a previously issued PIV access card, citizenship status, company details, and contact information. Attendees are instructed to password protect and encrypt the completed form before emailing it to the NBAF Sponsor. The Privacy Act statement indicates the information is mandatory under Executive Order 12958 and will be used for internal visitor processing purposes. The related federal contract opportunity has a mandatory site visit scheduled for July 29th. All RFI questions must be submitted by August 1, 2024, and will only be answered if the submitter attended the site visit.
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Attachment 13 Site Visit Attendee Visitor Application Information
RFQ12805B24R0036
Name (Last, First, MI)
Previously issued PIV Access Card
(Yes or No) PIV card is not required for site visit attendance.
US Citizen (Yes/No)
If Not US Citizen Country of Birth
Company Name
Company Phone Number
Company Address
Once completed please e-mail this document to the NBAF Sponsor: jonathan.lagerquist@usda.gov
For your personal security, please DO NOT send personally identifiable information (the information contained within this document) to any other e-mail address.
You should password protect and encrypt this form when returning it to NBAF and send the password in a separate email.
To password protect this document, follow the instructions below:
FOR PC: Select File tab, then select Protect Using Password; select Viewing; create a Password; reenter the Password to verify, then click on Apply.
FOR MAC: Select File tab, then select Export, and click on Encrypt; create a Password; reenter the
Password to verify, then click Save.
For your personal security this form will be destroyed immediately upon completion of access request process.
PRIVACY ACT STATEMENT The Privacy Act, 552a, requires that federal agencies inform individuals, at the time information is solicited from them, whether the disclosure is mandatory or voluntary, by what authority such information is solicited, and what uses will be made of the information. The collection of this information is authorized by EO 9397, 6 USC 341, 44 USC 3101, and EO 12958. Provision of the information concerning foreign visits is mandatory under the provisions of EO 12958. Failure to provide it may impact planned visits. Use of this information is for internal purposes to facilitate visitor processing.
Controlled// SP-SPIIWhen filled out, this document contains sensitive information exempt from mandatory disclosure under the Freedom of Information act, 5 U.S.C. 552 (b)(2). Do not release without prior approval by USDA.
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