Attachment 9 -DL1818 Visit Notification Form.pdf

PDF 130 KB Posted

Attached to
ESS Repair & Maintenance Services Federal contract opportunity
Solicitation number
SP330022Q5049
Issued by
Defense Logistics Agency Distribution

About this file

This document contains a visit notification form and details of a related federal contract opportunity. The visit notification form collects information on visitors to Defense Logistics Agency facilities, including requester name and contact details, visitor names and personal information, security representative signature, and visit details.

The related federal contract opportunity is solicitation number SP330022Q5049 for ESS Repair and Maintenance Services at Defense Logistics Agency Distribution facilities. The requirement is for on-site repair and maintenance services for environmental control systems and related equipment. The solicitation is open to all offerors, with responses due on an unspecified date and award anticipated at an unspecified future date. Pricing terms, socioeconomic set-asides, incumbent contractor information, and other salient details are not provided in this document.

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Text version

PRIVACY ACT STATEMENT

VISIT NOTIFICATION

1. ACTIVITY TO BE VISITED

AUTHORITY:

PRINCIPAL PURPOSE:

ROUTINE USES:

DISCLOSURE:DEFENSE LOGISTICS AGENCY

8725 JOHN J. KINGMAN ROAD

FT BELVOIR, VA 22060-6220

Section 21, 50 U.S.C. 781 et seq.; Executive Order 10450.

To control access to and movement on DoD installations, buildings, or facilities.

Used by General Services Administration Protective Service Personnel for access control and for any of the Blanket Routine Uses published by DLA.

Voluntary. However, failure to provide all the requested information may result in refusal to grant access to the installation, building, or facility.

DLA PRIVACY ACT SYSTEM NOTICE S500.50 DLA-I APPLIES

SECTION I

2. NAME OF REQUESTOR/PREPARER 4. TELEPHONE3. OFFICE CODE

5. DATE(S) OF VISIT 6. POINT OF CONTACT (at facility to be visited) 7. POC TELEPHONE

8. PURPOSE OF VISIT

SECTION II

9.

NAME(S) OF VISITOR(S)

(Last, First, MI)

10.

GRADE/RANK

11.

SSN

12.

DATE OF BIRTH

13.

STATE /COUNTRY OF

BIRTH

14.

CLEARANCE/DATE

GRANTED

15.

TYPE OF INVESTIGATION/

DATE

16. TYPED NAME OF SECURITY REPRESENTATIVE

SECTION III

18. ACTIVITY 19. TELEPHONE NUMBER 20. DATE17. SIGNATURE OF SECURITY REPRESENTATIVE

DLA FORM 1818, JUL 96 (EG)

FROM: TO:

PDF (DLA)

RequesterName:
OfficeCode:
FacPOC:
Phone:
POCPhone:
VisitedActivity:
VisitPurpose:
DateTo:
Visitor:
0:
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GradeRank:
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SSN:
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DOB:
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StateCountry:
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ClearDate:
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InvestDate:
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DateFrom:
SecRepName:
Activity:
ActPhone:
SecRepDate:
tVisitor:
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tcsControl:
addcsBtn:
ResetMe:
resetBtn:

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