Attachment 5 - Contractor Base Access Request Form.pdf

PDF 354 KB Posted Aug 13, 2020

Attached to: Repair NC3, 2F, WG CP/CAT Federal contract opportunity
Solicitation number: FA460020B0002
Issued by: Department of the Air Force Air Combat Command

About this file

Written by GovTribe AI · Dec 28, 2023

This document contains a contractor base access request form and details of a related federal contract opportunity for repair work. The form collects personally identifying information from contractors such as name, date of birth, drivers license information, and security clearance details. It is used to request and document base access approval for contractors working on the identified Air Force opportunity.

The federal contract opportunity is for renovating approximately 8,120 square feet into a command post and crisis action team area within an existing Air Force facility. The scope of work includes installing raised flooring, cable trays, dedicated HVAC, and constructing equipment and conference rooms to support classified operations. Exterior work involves adding antenna mounting platforms with associated electrical, grounding and cabling.

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Other files for this federal contract opportunity

Other files attached to Repair NC3, 2F, WG CP/CAT, newest first.
File	Type	Posted
Attachment 11 - B500_S13_A-401.pdf	PDF	Sep 11, 2020
Amend 3 - Solicitation FA460020B00020003.pdf	PDF	Sep 11, 2020
Attachment 9 - Q and A (2).pdf	PDF	Sep 11, 2020
Attachment 10 - Spec Section 23 07 00.pdf	PDF	Sep 11, 2020
Attachment 12 - B500_S11_A-103.pdf	PDF	Sep 11, 2020
Attachment 7 - Q and A.pdf	PDF	Sep 4, 2020
Attachment 8 - Sign In Sheet.pdf	PDF	Sep 4, 2020
Attachment 6 - Revision Summary-Drawings.pdf	PDF	Sep 4, 2020
Amend 2 - Solicitation FA460020B00020002.pdf	PDF	Sep 4, 2020
Amend 1- Site Visit FA460020B00020001 SF 30.pdf	PDF	Aug 14, 2020
Solicitation - FA460020B0002.pdf	PDF	Aug 13, 2020
Attachment 3 - Specifications.pdf	PDF	Aug 13, 2020
Attachment 1 - Bid Submission and Opening Information.pdf	PDF	Aug 13, 2020
Attachment 2 - Wage Determination.pdf	PDF	Aug 13, 2020
Attachment 4 - Drawings.pdf	PDF	Aug 13, 2020

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Full Name U.S. Citizen Last, First, MI Year Month Day Drivers License/ID # State SSAN Days Hrs Dates (MMDDYYY) Yes / No

Personally Identifying Information (PII) being collected by this form is authorized for collection under provisions of 10 U.S.C. 8013, Secretary of the Air Force, DoD 5200.2R, DoD Personnel Security Program; AFI 33-202, Computer Security, Information will be maintained by local

Security Forces Authority while access requirements exist. Information access is restricted to personnel responsible for contract administration, or otherwise needed in the performance of official DoD duties. Information will be properly disposed of when its required use has been concluded. Providing this information is voluntary; however, failure to provide all of the required data shown on the spreadsheet will result in denial of entry to the installation. This information is exempt from OMB licensing under provisions of AFI 33-324, Information Collections and

Reports Management Program; Controlling Internal, Public, and Interagency Air Force Collections, paragraphs 3.16.11 and 3.16.16.3.

55 SFS CONTRACTOR/VENDOR NCIC SCREENING & PASS REQUEST SPREADSHEET

Date of Birth

Offutt AFB Sponsoring Agency / Unit:

Base Sponsor's Name:

Base Sponsor's Phone #:

Request Date:

Work Schedule

Company Name:

Company Address:

Company Representative Name:

Company Representative Phone Number:

Contract#:

Contract Start/End Dates:

Sponsoring Unit Security Manager or Commander Signature Block/Signature

Offutt AFB Sponsoring Agency Unit: (Filled in by base sponsor)

Company Name: Company

Base Sponsors Name: (Filled in by sponsoring agency)

Company Address: Address

Base Sponsors Phone: (Filled in by base sponsor)

Company Representative Name: Name

Request Date: (Filled in by base sponsor)

Last First MIRow1: Name

YearRow1: 19XX

MonthRow1: MAY

DayRow1: XX

Drivers LicenseID Row1: G59XXXXX

StateRow1: NE

SSANRow1: xxx-xx-xxxx

DaysRow1: Mon-Sat

HrsRow1: 0600-1800

Dates MMDDYYYRow1: 11152016-05252017

Yes NoRow1: Yes

Last First MIRow2:

YearRow2:

MonthRow2:

DayRow2:

Drivers LicenseID Row2:

StateRow2:

SSANRow2:

DaysRow2:

HrsRow2:

Dates MMDDYYYRow2:

Yes NoRow2:

Last First MIRow3:

YearRow3:

MonthRow3:

DayRow3:

Drivers LicenseID Row3:

StateRow3:

SSANRow3:

DaysRow3:

HrsRow3:

Dates MMDDYYYRow3:

Yes NoRow3:

Last First MIRow4:

YearRow4:

MonthRow4:

DayRow4:

Drivers LicenseID Row4:

StateRow4:

SSANRow4:

DaysRow4:

HrsRow4:

Dates MMDDYYYRow4:

Yes NoRow4:

Last First MIRow5:

YearRow5:

MonthRow5:

DayRow5:

Drivers LicenseID Row5:

StateRow5:

SSANRow5:

DaysRow5:

HrsRow5:

Dates MMDDYYYRow5:

Yes NoRow5:

Last First MIRow6:

YearRow6:

MonthRow6:

DayRow6:

Drivers LicenseID Row6:

StateRow6:

SSANRow6:

DaysRow6:

HrsRow6:

Dates MMDDYYYRow6:

Yes NoRow6:

Last First MIRow7:

YearRow7:

MonthRow7:

DayRow7:

Drivers LicenseID Row7:

StateRow7:

SSANRow7:

DaysRow7:

HrsRow7:

Dates MMDDYYYRow7:

Yes NoRow7:

Last First MIRow8:

YearRow8:

MonthRow8:

DayRow8:

Drivers LicenseID Row8:

StateRow8:

SSANRow8:

DaysRow8:

HrsRow8:

Dates MMDDYYYRow8:

Yes NoRow8:

Last First MIRow9:

YearRow9:

MonthRow9:

DayRow9:

Drivers LicenseID Row9:

StateRow9:

SSANRow9:

DaysRow9:

HrsRow9:

Dates MMDDYYYRow9:

Yes NoRow9:

Last First MIRow10:

YearRow10:

MonthRow10:

DayRow10:

Drivers LicenseID Row10:

StateRow10:

SSANRow10:

DaysRow10:

HrsRow10:

Dates MMDDYYYRow10:

Yes NoRow10:

Last First MIRow11:

YearRow11:

MonthRow11:

DayRow11:

Drivers LicenseID Row11:

StateRow11:

SSANRow11:

DaysRow11:

HrsRow11:

Dates MMDDYYYRow11:

Yes NoRow11:

Last First MIRow12:

YearRow12:

MonthRow12:

DayRow12:

Drivers LicenseID Row12:

StateRow12:

SSANRow12:

DaysRow12:

HrsRow12:

Dates MMDDYYYRow12:

Yes NoRow12:

Last First MIRow13:

YearRow13:

MonthRow13:

DayRow13:

Drivers LicenseID Row13:

StateRow13:

SSANRow13:

DaysRow13:

HrsRow13:

Dates MMDDYYYRow13:

Yes NoRow13:

Last First MIRow14:

YearRow14:

MonthRow14:

DayRow14:

Drivers LicenseID Row14:

StateRow14:

SSANRow14:

DaysRow14:

HrsRow14:

Dates MMDDYYYRow14:

Yes NoRow14:

Last First MIRow15:

YearRow15:

MonthRow15:

DayRow15:

Drivers LicenseID Row15:

StateRow15:

SSANRow15:

DaysRow15:

HrsRow15:

Dates MMDDYYYRow15:

Yes NoRow15:

Last First MIRow16:

YearRow16:

MonthRow16:

DayRow16:

Drivers LicenseID Row16:

StateRow16:

SSANRow16:

DaysRow16:

HrsRow16:

Dates MMDDYYYRow16:

Yes NoRow16:

Last First MIRow17:

YearRow17:

MonthRow17:

DayRow17:

Drivers LicenseID Row17:

StateRow17:

SSANRow17:

DaysRow17:

HrsRow17:

Dates MMDDYYYRow17:

Yes NoRow17:

Last First MIRow18:

YearRow18:

MonthRow18:

DayRow18:

Drivers LicenseID Row18:

StateRow18:

SSANRow18:

DaysRow18:

HrsRow18:

Dates MMDDYYYRow18:

Yes NoRow18:

Last First MIRow19:

YearRow19:

MonthRow19:

DayRow19:

Drivers LicenseID Row19:

StateRow19:

SSANRow19:

DaysRow19:

HrsRow19:

Dates MMDDYYYRow19:

Yes NoRow19:

Last First MIRow20:

YearRow20:

MonthRow20:

DayRow20:

Drivers LicenseID Row20:

StateRow20:

SSANRow20:

DaysRow20:

HrsRow20:

Dates MMDDYYYRow20:

Yes NoRow20:

Contract #: Need this

Contract End Date: Need this

Company Phone #: 402-293-xxxx

File details come from the government source that posted it. Updated Aug 14, 2020.