ATTACHMENT 4 SFS Form 3_EAL Request.pdf

181 KB Posted

Attached to
WST Security Upgrades
Solicitation number
W50S8P24B0002
Issued by

About this file

Written by GovTribe AI ·

This document is a Controlled Unclassified Information (CUI) request form for the 121st Air Refueling Wing to allow contractor/visitor access to the Aircrew Training System (ATS) facility at Rickenbacker Air National Guard Base.

The key details are:

  • The 121st Air Refueling Wing is integrating the KC-135R ATS into the Distributed Training Center Network, which requires security upgrades to the ATS facility.
  • The upgrades include controlled access, a separate classified briefing area, HVAC, fire systems, and power for the MAF DMO equipment.
  • The construction/contract duration is anticipated to be 120 calendar days.
  • This project will be competitively solicited as a Small Business Set-aside, with NAICS code 236220 and a size standard of $45M average annual revenue.
  • The solicitation and associated documents will be available only through the SAM.gov website. Any questions should be emailed to the Contract Specialist and Contracting Officer.

View the file

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CUI

121 SFS Form 3 (Nov 2021)

Controlled By:

CUI Category: PRVY Dissemination: FEDCON

POC:

CUI

EAL# 121 SFS CONTRACTOR/VISITOR REQUEST

CONTROLLED UNCLASSIFIED INFORMATION (CUI) This document contains information that must be protected under the Privacy ACT OF 1974 (See AFI 33-332) and protected from disclosure under the Freedom, of Information Act, 5 USC 552. Do not release outside of DoD channels without the consent of the originator’s office.

SSN: Mandatory for all unescorted entries. Escorts must be provided by the sponsoring organization for all personnel with missing information or the inability to validate the credentials.

DISCLOSURE IS VOLUNTARY; however, failure to disclose required information will prohibit unescorted access. Failure to provide complete and accurate information will delay the processing of this request.

EMPLOYEE/VISITOR INFORMATION BACKGROUND

CHECK

LAST FIRST MI SSN DRIVERS

LIC #

STATE COMPANY/ORG JOB

SITE

START

DATE

END

DATE

DATE METHOD

NOTES:

SPONSOR INFORMATION

NAME/RANK ORGANIZATION PHONE EMAIL DATE SIGNATURE

SECURITY FORCES USE ONLY

OFFICER NAME/RANK DATE SIGNATURE DENIED CONTRACTOR/ VISITOR

EAL:
EMPLOYEEVISITOR INFORMATION:
LASTRow1:
FIRSTRow1:
MIRow1:
SSNRow1:
DRIVERS LIC Row1:
STATERow1:
COMPANYORGRow1:
JOB SITERow1:
START DATERow1:
END DATERow1:
DATERow1:
METHODRow1:
LASTRow2:
FIRSTRow2:
MIRow2:
SSNRow2:
DRIVERS LIC Row2:
STATERow2:
COMPANYORGRow2:
JOB SITERow2:
START DATERow2:
END DATERow2:
DATERow2:
METHODRow2:
LASTRow3:
FIRSTRow3:
MIRow3:
SSNRow3:
DRIVERS LIC Row3:
STATERow3:
COMPANYORGRow3:
JOB SITERow3:
START DATERow3:
END DATERow3:
DATERow3:
METHODRow3:
LASTRow4:
FIRSTRow4:
MIRow4:
SSNRow4:
DRIVERS LIC Row4:
STATERow4:
COMPANYORGRow4:
JOB SITERow4:
START DATERow4:
END DATERow4:
DATERow4:
METHODRow4:
LASTRow5:
FIRSTRow5:
MIRow5:
SSNRow5:
DRIVERS LIC Row5:
STATERow5:
COMPANYORGRow5:
JOB SITERow5:
START DATERow5:
END DATERow5:
DATERow5:
METHODRow5:
LASTRow6:
FIRSTRow6:
MIRow6:
SSNRow6:
DRIVERS LIC Row6:
STATERow6:
COMPANYORGRow6:
JOB SITERow6:
START DATERow6:
END DATERow6:
DATERow6:
METHODRow6:
LASTRow7:
FIRSTRow7:
MIRow7:
SSNRow7:
DRIVERS LIC Row7:
STATERow7:
COMPANYORGRow7:
JOB SITERow7:
START DATERow7:
END DATERow7:
DATERow7:
METHODRow7:
LASTRow8:
FIRSTRow8:
MIRow8:
SSNRow8:
DRIVERS LIC Row8:
STATERow8:
COMPANYORGRow8:
JOB SITERow8:
START DATERow8:
END DATERow8:
DATERow8:
METHODRow8:
LASTRow9:
FIRSTRow9:
MIRow9:
SSNRow9:
DRIVERS LIC Row9:
STATERow9:
COMPANYORGRow9:
JOB SITERow9:
START DATERow9:
END DATERow9:
DATERow9:
METHODRow9:
LASTRow10:
FIRSTRow10:
MIRow10:
SSNRow10:
DRIVERS LIC Row10:
STATERow10:
COMPANYORGRow10:
JOB SITERow10:
START DATERow10:
END DATERow10:
DATERow10:
METHODRow10:
NOTES:
NAMERANKRow1:
ORGANIZATIONRow1:
PHONERow1:
EMAILRow1:
DATERow1_2:
SIGNATURERow1:
OFFICER NAMERANKRow1:
DATERow1_3:
SIGNATURERow1_2:
DENIED CONTRACTOR VISITORRow1:
Text1:
Text2:

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