Attachment 5 - Fillable Site Visit Visitor Application.pdf
PDF 260 KB Posted
- Attached to
- Wastewater Outfall Auto Samplers Installation Federal contract opportunity
- Solicitation number
- 12805B24Q0374
About this file
This document is an Attachment 5 - Fillable Site Visit Visitor Application for a federal contract opportunity with Solicitation Number 12805B24Q0374 for the "Wastewater Outfall Auto Samplers Installation" project.
The key details are:
- The site visit is mandatory for offerors or quoters, who must register to attend by providing names of attendees and company information to the Point of Contact.
- The fillable application collects personal information such as name, citizenship status, company details, and requests the visitor to password protect and encrypt the completed form for privacy and security.
- The application states the information is collected under various federal authorities and will be used for internal visitor processing purposes only.
- The completed form should be emailed to the NBAF Sponsor, and the password provided separately.
- The DELIVERY & INSTALLATION ADDRESS is USDA ARS PA NBAF, 1980 Denison Ave, Manhattan, KS 66502.
View the file
Other files for this federal contract opportunity
| File | Type | Posted |
|---|---|---|
| RFI_No1 NBAF Wastewater Outfall Samplers_12805B24Q0374.pdf | ||
| Sol_12805B24Q0374.pdf | ||
| Attachment 4 Davis-Bacon Act WD KS20240056 Building Date 05 April 2024 Mod 2 Riley County KS.pdf | ||
| Attachment 3 USDA Provided Equipment Information 12805B24Q0374 .pdf | ||
| Attachment 6 - Site Visit Information.docx | DOCX document | |
| Attachment 1 Statement of Work 12805B24Q0374 .pdf | ||
| Attachment 2 Wastwater Autosamplers Locations 12805B24Q0374 .pdf |
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Text version
Attachment 5 Site Visit Attendee Visitor Application Information
RFQ 12805B24Q0374
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: brian.jorgensen@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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File details come from the government source that posted it. Updated .