Attachment 3 Site Visit Application.pdf
PDF 170 KB Posted
- Attached to
- Fuel Line and Sump System Testing Services - Manhattan, KS Federal contract opportunity
- Solicitation number
- 12805B25Q0136
About this file
The document is a Visitor Application Information form for site access to the National Bio & Agro-Defense Facility (NBAF). The form requires detailed personal and contact information, including full legal name, citizenship status, company details, and requires password protection and encryption when submitted. The form emphasizes personal security, noting that personally identifiable information should not be shared widely and the document will be destroyed after processing. The Privacy Act statement indicates that providing information about foreign visits is mandatory under Executive Order 12958, and failure to provide information may impact planned visits.
The form is associated with a specific federal contract opportunity (Solicitation Number 12805B25Q0136) for Fuel Line and Sump System Testing Services in Manhattan, KS, issued by the Department of Agriculture Agricultural Research Service. The solicitation is set aside for 100% Small Business under NAICS code 213112, with a size standard of $47M. Offers are due by 12:00 PM CST on 18 April 2025, to be submitted electronically to the Contract Specialist David Hildebrand. The evaluation will use Lowest Priced Technically Acceptable (LPTA) methodology, with key technical factors including KDHE UST contractor certification and demonstration of relevant project capabilities.
View the file
Other files for this federal contract opportunity
| File | Type | Posted |
|---|---|---|
| 12805B25Q0136 Combined Synopsis Solicitation.pdf | ||
| Attachment 1 Statement of Work.pdf | ||
| Exhibit A - Bid Schedule - 12805B25Q0136.xlsx | XLSX spreadsheet | |
| Attachment 2 WD 2015-5337 Rev 25 Dated 23 Dec 2024.pdf |
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Text version
Visitor Application Information
Full Legal Name (Last, First, Middle)
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
Lawful Permanent Resident Company Name Company Phone Number Company Address
Once completed please e-mail this document to the NBAF Sponsor:
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.
Contract / Project:
| Contract Project: Fuel Line System Testing Service Contract |
| Name Last First MI: |
| If Not US Citizen Country of Birth: |
| Company Name: |
| Company Phone Number: |
| Company Address: |
| Text3: Jonathan.Lagerquist@usda.gov |
| Dropdown4: [ ] |
| Dropdown5: [ ] |
| Lawful permanent resident: [ ] |
File details come from the government source that posted it. Updated .