Attachment 6F_ Security_PIVSponsorshipForm.pdf
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- Attached to
- Y1DA--VISN 5 - MULTIPLE AWARD TASK ORDER CONTRACT CONSTRUCTION 2022 Federal contract opportunity
- Solicitation number
- 36C24522R0056
About this file
This solicitation is for a Multiple Award Task Order Contract for construction services within VISN 5. The contractor shall provide all labor, materials, equipment and supervision for general construction categories including maintenance, repair, alteration, mechanical, electrical, HVAC, demolition, painting, paving, earthwork, carpentry, concrete, roofing, site work, excavation, interior renovation and other specialty construction work. Task orders will be issued for varying sizes and dollar amounts, and may involve some or all elements of the listed work categories. Work will be performed at VA medical centers and involve occupied, operational hospital facilities. The Department of Veterans Affairs Veterans Health Administration VISN 5 is the contracting agency. Contractors will be provided a fair opportunity to be considered for task orders valued above the simplified acquisition threshold, with exceptions if statutory requirements are met.
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Text version
Revised Form January 2022
Department of Veterans Affairs
WMC HROO ELR Shared Services Unit Personnel Security
VSC.Security@va.gov
VHA SERVICE CENTER PIV SPONSORSHIP FORM #3
(Please see Instruction Form #3a for assistance in completing this form)
CONTRACTOR / EMPLOYEE INFORMATION
* All fields are mandatory except va.gov email *
(US Citizen, Naturalized, Non-Citizen)
A Full Legal Name (First Middle Last):
B Date of Birth (MM/DD/YYYY):
C Social Security Number:
D Citizenship:
E Assigned Duty Station:
F Address of Assigned Duty Station:
G VA.GOV Email Address:
H Gender:
I Race:
J Height:
K Weight:
L Eye Color:
M Hair Color:
N Place of Birth (City, State, Country):
O Position Title:
P Contractor Company Name:
Q Company Address:
Street Address, City, State, Zip Code
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File details come from the government source that posted it. Updated .