Attachment 3 Statement of Witness.pdf

803 KB Posted

Attached to
Logistic Support Services FLETC Glynco, GA
Solicitation number
70LGLY23RGLB00002
Issued by

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This solicitation requests proposals for logistic support services at the Federal Law Enforcement Training Center in Glynco, Georgia. The contractor shall provide project management, inter-office mail and parcel delivery, postal operations, furniture and equipment delivery and assembly, assets and logistics management support, on-call moving services, and on-call support. Services are required Monday through Friday from 8:00 AM to 5:00 PM, excluding federal holidays. The solicitation was issued by the Department of Homeland Security Federal Law Enforcement Training Center. Proposals are due by the date specified in the solicitation document. The contract will have a one-year base period and four one-year options that can be exercised at the government's discretion.

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Attachment 3

LOGISTIC SUPPORT SERVICES

STATEMENT OF WITNESS

(Attach additional sheets if necessary)

1. DID YOU SEE THE

ACCIDENT?

2. WHEN DID THE ACCIDENT HAPPEN? FORM APPROVED

O.M.B. NUMBER

3090-0118

a. TIME a.m.

p.m.

b. DATE

3. WHERE DID THE ACCIDENT HAPPEN? (Give street location and city)

4. TELL IN YOUR OWN WAY HOW THE ACCIDENT HAPPENED

5. WHERE WERE YOU WHEN THE ACCIDENT OCCURRED?

6. WAS ANYONE INJURED, AND IF SO, EXTENT OF INJURY IF KNOWN?

7. DESCRIBE THE APPARENT DAMAGE TO PRIVATE PROPERTY

8. DESCRIBE THE APPARENT DAMAGE TO GOVERNMENT PROPERTY 9. IF TRAFFIC CASE, GIVE

APPROXIMATE SPEED OF:

a. GOVERNMENT VEHICLE Miles per Hr.

b. OTHER VEHICLE Miles per Hr.

10. GIVE THE NAMES AND ADDRESSES OF ANY OTHER WITNESSES TO THE ACCIDENT (If known)

a. NAMES b. ADDRESSES (Include ZIP Code)

WITNESS

COM-

PLETING

THIS

FORM

11. HOME ADDRESS (Include ZIP Code) 12. WITNESS (Print Name) a. HOME TELEPHONE NO.

Sign here

b. TODAY'S DATE

13. BUSINESS ADDRESS (Include ZIP Code) TELEPHONE NO.

NSN 7540-00-634-4045

94-105

STANDARD FORM 94 (REV. 2-83)

Prescribed by GSA, FPMR 101-39.8

14. INDICATE ON THE DIAGRAM BELOW WHAT HAPPENED:

File details come from the government source that posted it. Updated .