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