Attachment IV - Site visit Authorization Form.docx
DOCX document 124 KB Posted
- Attached to
- U. S. Chancery London - Window cleaning services
- Solicitation number
- 19GE5025R0006
About this file
This is an authorization form for site visits related to a window cleaning services contract at the U.S. Embassy in London. The document is a Department of State release form that allows Special Agents, Investigators, or representatives of the U.S. Office of Personnel Management to obtain information about individuals within one year of signing.
The form requires individuals to provide their full name, other names used, current address, signature, and date. It authorizes the release of various types of information including academic records, residential history, employment details, criminal records, credit information, and tax records. The document is marked as "SENSITIVE BUT UNCLASSIFIED" and releases record custodians from liability related to compliance with the information request.
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Other files
| File | Type | Posted |
|---|---|---|
| 19GE5025R0006_A0002 (FE).pdf | ||
| 19GE5025R0006 Questions and answers.pdf | ||
| 19GE5025R0006 0001.pdf | ||
| Attachment V - Site visit Vetting Request Spreadsheet.xlsx | XLSX spreadsheet | |
| Attachment III - Instructions for W14 Form.pdf | ||
| Attachment I - Pricing.xlsx | XLSX spreadsheet | |
| 19GE5025R0006.pdf | ||
| Attachment II - W14 Form.pdf | ||
| Attachment VI - Site visit Visitor Access Request.docx | DOCX document | |
| 19GE5025R0006 Cover Letter.pdf |
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Text version
THIS IS A LEGAL DOCUMENT
DEPARTMENT OF STATE
Washington, D.C. 20520
AUTHORITY FOR THE RELEASE OF INFORMATION
TO WHOM IT MAY CONCERN:
I hereby authorize any Special Agent or Investigator of the United States Department of State, or any Investigator or duly accredited representative of the United States Office of Personnel Management bearing this release or a copy thereof, within one year of its date, to obtain any information from schools, residential management agents, employers, criminal justice agencies, credit agencies or individuals, relating to my activities. This information may include, but is not limited to, academic, residential, achievement, performance, attendance, personal history, disciplinary, arrest and conviction records, credit information and Income Tax records. I hereby direct you to release such information upon any such request by the bearer of this document.
I hereby release any individual, including record custodians, from ANY and ALL liability for damages of whatever kind or nature, which may at any time result to me on account of compliance, or any attempts to comply, with this authorization. Should there be any question as to the validity of this release, you may contact me as indicated below.
Full Name: ___________________________________________________
Other Names used: ___________________________________________________
Current Address: ___________________________________________________
Signature: ___________________________________________________
Date of signing: ___________________________________________________
SENSITIVE BUT UNCLASSIFIED
SENSITIVE BUT UNCLASSIFIED
SENSITIVE BUT UNCLASSIFIED
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File details come from the government source that posted it. Updated .