Attachment FM1A_Contract Security Service Request.pdf

PDF 129 KB Posted

Attached to
Z1DA--MACC Group 1 | Upgrade Entrance Doors at Bldgs. 6 & 7 | Project 593-24-102
Solicitation number
36C26124R0058
Issued by

About this file

This document is a Contract Security Services Request Form for the Department of Veterans Affairs (VA). It provides details for a federal contract opportunity related to security services.

The key details include the contract information such as the VA Contracting Officer, Contract End Date, RPO Region, VISN & Station Number, and Purchase/Task Order or Contract Number. The form also includes contractor position details such as the Investigation Level required and the Contract Company Name. The bulk of the form contains a table for listing the Contractor Employee Information, including the employee's full legal name, social security number, email address, date of birth, and place of birth. A Contracting Officer signature is required to verify the existence of an official contract prior to processing the applicants for badging.

The related federal contract opportunity is for a task order to upgrade the administration and education entrance doors in Buildings 6 and 7, install protective canvas canopies, and construct a new concrete gutter at the Building 6 entrance for the VA Southern Nevada Health Care System. The solicitation is for contractors who were previously awarded a VISN 21 Multiple-Award Construction Contract. The project specifications and associated documents will be provided in the Task Order Bid Request.

View the file

Other files

File Type Posted
ISON IAHP1 LED.pdf PDF
IMG 0206.jpeg JPEG file
100264 EP 301B.pdf PDF
RFI finalized.docx DOCX document
36C26124R0058 0003.docx DOCX document
087113.pdf PDF
100264 EP 301A.pdf PDF
Hanbook 0023.pdf PDF
SOW Revised.pdf PDF
VA Signage Info.pdf PDF
36C26124R0058 0002.docx DOCX document
36C26124R0058 0001.docx DOCX document
Attachment 593-24-102_Combined Drawings.pdf PDF
Attachment WMC Form Ktr Employee Sponsor Request.pdf PDF
Attachment ENG_FORM_4288-R.pdf PDF
Attachment 240117_SOP for PIV Badging Process.docx DOCX document
Attachment Badging Checklist-sample.xlsx XLSX spreadsheet
Attachment 593-24-102 SOW.pdf PDF
Attachment 593-24-102 Combined Specifications.pdf PDF
Attachment 5 List of Bid Items.pdf PDF
Attachment Card reader install notes Eshop.pdf PDF
Attachment Price Proposal_Breakdown.docx DOCX document
36C26124R0058_1 Solicitation.docx DOCX document
Attachment VSC FM OF 306 Declaration of Fed Empl.pdf PDF
Show all 24

On GovTribe

Work with this file

  • Download the original file
  • Contacts named in this file
  • Similar government files
  • Ask GovTribe AI about this file

Text version

CONTRACT INFORMATION

Department of Veterans Affairs VHA 106A WMC HROO PerSecContractor Team

CONTRACT SECURITY SERVICES REQUEST

FORM # 1A

(Email to: VHAWMCPerSecContractor@va.gov)(Make sure it is encrypted or password protected)

VA Contracting Officer Name & Phone:

COR Name & Phone:

Contract End Date (Including Options):

RPO Region (East/West/Central):

VISN & Station#:

Purchase/Task Order or Contract Number:

Contractor Position Description:

Investigation Level (SAC/Tier 1/Tier 2/Tier 4):

Contract Company Name (Subcontractor):

Contract Company Address:

Contractor POC Name & Phone:

Contractor POC Email:

Contracting Officer Signature:

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

Contractor Employee Information

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

(City, State/Country)

*Please use Continuation Form # 1B for additional individuals*

Current as of January 2023

Employee Name Full Legal NameRow1:
SSNRow1:
Email AddressRow1:
DOBRow1:
Place of Birth City StateCountryRow1:
Employee Name Full Legal NameRow2:
SSNRow2:
Email AddressRow2:
DOBRow2:
Place of Birth City StateCountryRow2:
Employee Name Full Legal NameRow3:
SSNRow3:
Email AddressRow3:
DOBRow3:
Place of Birth City StateCountryRow3:
Employee Name Full Legal NameRow4:
SSNRow4:
Email AddressRow4:
DOBRow4:
Place of Birth City StateCountryRow4:
Employee Name Full Legal NameRow5:
SSNRow5:
Email AddressRow5:
DOBRow5:
Place of Birth City StateCountryRow5:
Employee Name Full Legal NameRow6:
SSNRow6:
Email AddressRow6:
DOBRow6:
Place of Birth City StateCountryRow6:
Employee Name Full Legal NameRow7:
SSNRow7:
Email AddressRow7:
DOBRow7:
Place of Birth City StateCountryRow7:
Employee Name Full Legal NameRow8:
SSNRow8:
Email AddressRow8:
DOBRow8:
Place of Birth City StateCountryRow8:
Employee Name Full Legal NameRow9:
SSNRow9:
Email AddressRow9:
DOBRow9:
Place of Birth City StateCountryRow9:
Employee Name Full Legal NameRow10:
SSNRow10:
Email AddressRow10:
DOBRow10:
Place of Birth City StateCountryRow10:
Employee Name Full Legal NameRow11:
SSNRow11:
Email AddressRow11:
DOBRow11:
Place of Birth City StateCountryRow11:
Text2:
Text3: Mark S. Smith 702-791-9000 ext 14054
Text4:
Text5: Central
Text6: 21 / 593
Text7:
Text8:
Text9: T1
Text10:
Text11:
Text12:
Text13:

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