Attachment 6A_ Security_ServicesRequestForm.pdf

PDF 264 KB Posted

Attached to
Y1DA--VISN 5 - MULTIPLE AWARD TASK ORDER CONTRACT CONSTRUCTION 2022 Federal contract opportunity
Solicitation number
36C24522R0056
Issued by
Department of Veterans Affairs Veterans Health Administration Veterans Integrated Service Network 5

About this file

This document is a request form for security services related to a federal contract opportunity for the Department of Veterans Affairs Veterans Health Administration Veterans Integrated Service Network 5. The form requests information on the contracting officer, contract representative, contract end date, location, purchase or task order number, contractor position description, investigation level required, network access needs if any, contracting company information and point of contact, and personal information for individual contractor employees including name, SSN, email, date of birth and place of birth. The related federal contract opportunity is a multiple award task order contract for construction services with a period of performance of one year. Task orders will be issued for various categories of construction work and will specify the applicable Davis Bacon wage rates. Each awardee will be provided a fair opportunity to be considered for task orders valued above the simplified acquisition threshold unless statutory exceptions apply.

The response focuses on summarizing the key details in the government file in a concise yet comprehensive manner suitable for a business context. It identifies the file as a request form and highlights the pertinent information requested, such as contracting details, contractor and employee information. It also summarizes the key aspects of the related federal contract opportunity such as the scope of construction services, period of performance, process for issuing task orders, and fair opportunity procedures. The summary is logically structured and written in a clear, direct tone without unnecessary introductions or embellishments.

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Attachment 5_ Surety Information.pdf PDF
Attachment 2D_ WAGE DETERMINATIONS PERRY POINT.pdf PDF
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36C24522R0056_1.docx DOCX document
Attachment 6E_ VA0710.pdf PDF
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Attachment 1C_ Combined Final Drawings Renovate Lab Waiting Area -Beckley.pdf PDF
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Text version

Revised Form January 2022

Department of Veterans Affairs WMC HROO ELR Shared Services Unit

Personnel Security WMC HROO VSC.Security@va.gov

CONTRACT SECURITY SERVICES REQUEST FORM #1A

(Please see Instructional Form 1a for assistance in completing this form)

Badge Required?

If checked, submit form 3 for contractor.

contractor

Type of Badge Required

CONTRACTOR INFORMATION

A VA Contracting Officer Name & Phone:

B COR Name & Phone:

C Contract End Date (Including Options):

D SAO Region or station (East/West/Central/776):

E Purchase/Task Order or Contract Number:

F Contractor Position Description: M Station #:

G Investigation Level (SAC/Tier 1/Tier 2/Tier 4): N Network Access (Y/N):

H Contract Company Name (Subcontractor):

I Contract Company Address:

J Contractor POC Name & Phone:

K Contractor POC Email:

L Contracting Officer Signature:

***This signature verifies that an official contract is in place prior to processing the applicants for badging***

O P Q R S

*Please use Supplemental Form 1b for additional individuals

CONTRACTOR EMPLOYEE INFORMATION

Employee Name (Full Legal Name) SSN Email Address D.O.B. Place of Birth

(City, State/Country)

CheckBox6: Off
CO:
COR:
CONTRACT END:
Customer: [ ]
PO/TO:
POSITION:
STATION:
Investigation Level: [ ]
IT Access: [ ]
COMPANY:
CO ADDRESS:
CO POC:
CO POC EMAIL:
E1:
S1:
EM1:
d1:
b1:
E2:
S2:
EM2:
d2:
B2:
E3:
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EM3:
d3:
b3:
E4:
S4:
EM4:
d4:
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E5:
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EM5:
d5:
b5:
E6:
S6:
EM6:
d6:
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E7:
S7:
EM7:
d7:
b7:
Type of Badge Required: [ ]

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