Contractor Background Investigation Request Form.pdf
PDF 89 KB Posted
- Attached to
- RENOVATE BLDG. 126 OP BASEMENT FOR ADMIN OFFICES Federal contract opportunity
- Solicitation number
- 36C25820B0019
About this file
This document contains a contractor background investigation request form and details of a related federal contract opportunity for renovations. The background investigation request form collects individual and company information needed to conduct screening on a contractor, including name, date of birth, address, citizenship status, and position title. It also requests billing information for the sponsoring government organization. The related federal contract opportunity is solicitation number 36C25820B0019 from the Department of Veterans Affairs to renovate the basement of Building 126 at the Tibor Rubin VA Medical Center in Long Beach, California for use as administrative offices and to address facility condition assessment deficiencies. The renovation work is required to support operations at the facility.
View the file
Other files for this federal contract opportunity
| File | Type | Posted |
|---|---|---|
| Revised RFIs Log as of 8-14-2020 .pdf | ||
| 600-16-114 _ attendance bidders sheet 7 30 2020.pdf | ||
| RFIs Questions and Answers Log 8-12-2020 .pdf | ||
| 36C25820B0019 0004.pdf | ||
| 600-16-114 FINALSPEC-VOL2.pdf | ||
| 36C25820B0019 0003.pdf | ||
| 36C25820B0019 0001.pdf | ||
| BIDSET_VOL-1.pdf | ||
| PIV Office Fingerprint Request Form.pdf | ||
| 7.31.2019 Matrix for CFMs Contractors PIV Process.sc.pdf | ||
| 600-14-114 SPECS Folder.zip | ZIP file | |
| 600-16-114 APPENDIX-CD.pdf | ||
| VA Form 0710.pdf | ||
| 600-15-136 SPECS Folder.zip | ZIP file | |
| Self Certification.pdf | ||
| 36C25820B0019.pdf | ||
| OPM Form 306.pdf | ||
| RFI Form.doc | DOC document | |
| 600-14-114 SPECS and DWGs 2.zip | ZIP file |
Show all 19
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Text version
Contractor Background Investigation Request
VA Organization Billing Information
| Organization: [ ] |
| Station: |
| Station Label: Station # |
| Date Label: Current Date: |
| Date: |
| Organization Label: VA Organization |
| City Of Birth Label: City of Birth |
| Date of Birth Label: Date of Birth |
| Company POC Label: Company POC |
| Company POC Email Label: POC Email Address |
| Company City Label: City |
| Company Zip Label: Zip |
| Last Name: |
| Middle Name: |
| Country of Birth: [ ] |
| City of Birth: |
| Date of Birth: |
| Company State: [ ] |
| First Name: |
| Company State Label: State |
| Last Name Label: Last Name |
| Middle Name Label: Middle Name |
| First Name Label: First Name |
| SSN Label: SSN |
| SSN: |
| Gender: |
| Gender Label: Gender |
| Email Address: |
| Country of Citizenship: [ ] |
| Country Of Birth Label: Country of Birth |
| State of Birth Label: State of Birth |
| Email Address Label: Email Address |
| Country of Citizenship Label: Country of Citizenship |
| Position Title Label: Position Title |
| Company POC: |
| Position Title: |
| Priority Label: Priority |
| Child Care Label: Child Care |
| Priority: Off |
| Child Care: Off |
| Individual Information Label: Individual Information |
| Company Information Label: Company Information |
| COR Information: CO / COR |
| COR Email Label: CO / COR Email |
| COR Address 1 Label: CO / COR Address 1 |
| COR Address 2 Label: CO / COR Address 2 |
| COR Name Label: Name of CO / COR |
| COR Phone Label: CO / COR Phone Number |
| COR Station Label: CO / COR Station # |
| COR State: [ ] |
| State of Birth: [ ] |
| COR State Label: State |
| COR City Label: City |
| COR Zip Label: Zip |
| Company Zip: |
| Company City: |
| COR City: |
| COR Address 1: |
| COR Zip: |
| COR Address 2: |
| Company POC Email: Use semicolons for multiple addresses. |
| COR Email: Use semicolons for multiple addresses. |
| COR Name: |
| COR Station: |
| State Instructions: Leave blank if foreign born. |
| Options Label: Additional options may be presented after an investigation is selected. |
| Investigation Label: Investigation |
| Investigation: [Select One...] |
| COR Phone: |
| Contractor Company Label: Contractor Company |
| Contractor Company: |
| Task Order Number Label: Task Order Number |
| Task Order Number: |
| POC Address Label: POC Address |
| POC Address: |
| Phone Number Label: Phone Number |
| Phone Number: |
| Reinvestigation Label: Reinvestigation |
| Reinvestigation: Off |
| Include SAC Label: Include SAC |
| Include SAC: Off |
File details come from the government source that posted it. Updated .