Attachment 6 - Base Pass.docx
DOCX document 25 KB Posted
- Attached to
- Integrated Solid Waste Management (ISWM) Federal contract opportunity
- Solicitation number
- FA485524R0007
About this file
This document is an Attachment 6 - Base Pass request form for a federal contract opportunity. It outlines the information required to request a base pass for an individual to access Cannon Air Force Base in New Mexico for the performance of contract work. The key details include the contract employee's personal information, the requested pass dates, authorized days and hours, and the destination on the base. The document also provides instructions and privacy act notices related to the base pass process.
The related federal contract opportunity is a Request for Proposal (RFP) for Integrated Solid Waste Management (ISWM) services at Cannon AFB. The requirement is projected to be awarded as a 100% Women-Owned Small Business set-aside firm-fixed price contract under NAICS code 562111 - Solid Waste Collection. The projected period of performance is July 2024 to April 2029, with a 10-month base period and four 12-month option periods. An optional site visit is scheduled for May 14, 2024. Responses to the solicitation are due by May 22, 2024, and questions are due by May 17, 2024.
View the file
Other files for this federal contract opportunity
| File | Type | Posted |
|---|---|---|
| Solicitation - FA485524R0007.pdf | ||
| SAPR Cover Letter - CO Unsigned.pdf | ||
| Attachment 7 Instruction to Offerors (SAPR).pdf | ||
| Attachment 1 - PWS - 1.pdf | ||
| Attachment 2 - WD 2015-5457 REV 23.pdf | ||
| Attachment 3 - Price Breakdown - 1.xlsx | XLSX spreadsheet | |
| Attachment 4 - Past Performance Reference Sheet.pdf | ||
| Attachment 5 - Past Performance Questionnaire.pdf |
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Text version
REQUEST FOR BACKGROUND CHECK AND/OR BASE PASS
| TO: |
| FROM: (CONTRACTOR PROVIDE PHONE NUMBER) |
| DATE: |
27 SOSFS/S5P
27 SOCONS/PKA
Date completed
1. Request the individual and vehicle (if applicable) listed below be granted access to Cannon AFB for the performance of contract work. The following actions are requested (please check the applicable blocks below).
| US Citizen: |
| x |
| Worker Pass |
Sponsor Pass
Renewal
2. CONTRACT EMPLOYEE AND VEHICLE INFORMATION
CONTRACT EMPLOYEE’S NAME
SSAN
DOB (MMDDYYYY)
EMPLOYER (CONTRACTOR COMPANY)
COMPLETE ADDRESS
HOME PHONE or CELL (TO INCLUDE AREA CODE)
WORK PHONE (TO INCLUDE AREA CODE)
DRIVER’S LICENSE OR ID NUMBER (State DL or ID)
STATE OF ISSUE
PLACE OF BIRTH
Enhanced? Y or N
3. PASS INFORMATION
PASS DATES (NOT TO EXCEED 1 YEAR)
(00 XXX 2017)
| AUTHORIZED DAYS (i.e., Mon-Fri) |
| AUTHORIZED HOURS (i.e., 0700-1600) |
| DESTINATION (i.e., Bldg xxx, R/W xxx) |
3/26/2024
Tuesday
0800-1500
Bldg. 444
The above named individual was instructed that this pass is to be used for entry onto Cannon AFB for the sole purpose of completing contract work assignments only. He/she was further instructed that this pass does not authorize any base privileges (i.e., Base Exchange, Shoppette, Golf etc.).
At the time of requesting above pass, the individual must have in their possession their social security card and a valid state, or federal form of picture identification. If requesting to drive on CAFB the individual must have a valid driver's license, insurance documents, and vehicle registration.
All sponsoring agencies are responsible for passes issued under their contract. When a contract is terminated or an employee is terminated or quits, the pass is to be recovered by the sponsoring agency and returned to Pass & Registration. In the event the sponsor is unable to retrieve the pass from a terminated employee, the sponsor must notify Pass & Registration in writing the next duty day.
| FULL NAME OF PERSON AUTHORIZED TO SIGN REQUESTS |
| DUTY PHONE |
| SIGNATURE |
| DATE (00 xxx 2016) |
4. ENDORSER (TO BE COMPLETED BY PASS & REGISTRATION PERSONNEL)
| CLERK WHO FILLED PASS |
| PASS NUMBER |
| DATE ISSUED |
Please fill out below if the pass is a second issue (to be completed by Pass & Registration clerk).
| SECOND ISSUE: CLERK WHO FILLED PASS |
| PASS NUMBER |
| DATE ISSUED |
PRIVACY ACT NOTICE
Privacy Act 1974 as Amended may apply--this communication contains personal information which must be protected IAW DOD 5400.11R, and is FOR OFFICIAL USE ONLY (FOUO)
11 Jul 14
File details come from the government source that posted it. Updated .