NCIC Screening Pass Request Amendment 0001.pdf

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Attached to
Bldg 457 Roll Up Door Replacement
Solicitation number
FA460024Q0020
Issued by

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This document is a screening and pass request spreadsheet for contractors and vendors requiring access to Offutt Air Force Base. The spreadsheet collects personally identifiable information such as name, date of birth, driver's license/ID number, and social security number, as well as work schedule details and sponsoring agency/unit information. Providing this information is voluntary, but failure to do so will result in denied entry to the installation. The information is collected under the authority of 10 U.S.C. 8013 and DoD 5200.2R, and will be maintained by local Security Forces while access is required, with proper disposal when no longer needed.

The related federal contract opportunity is a solicitation for the removal and replacement of the existing Cornell AlarmGuard fire door, track, frame, and motor at Building 457, Room 438 on Offutt AFB. Technical questions are due by June 14, 2024, with answers available on June 18, 2024. Quotations are due by June 21, 2024, to be submitted via email. A site visit is not currently scheduled but may be requested. The solicitation is being issued by the Department of the Air Force, Air Combat Command.

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Questions and Answers.pdf PDF
Combo FA460024Q0020 Amendment 0001.pdf PDF
Site Visit MFR Amendment 0001.pdf PDF
Statement of Work.pdf PDF
SCA Wage Determination.pdf PDF
Combo FA460024Q0020.pdf PDF

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Contract#:

Contract Start/End Dates: Unit Commander or Security Manager Sig Block

Full Name Country of Last, First, MI Year Month Day Drivers License/ID # State SSAN Days Hrs Start Date - End Date (MMDDYYYY) Citizenship

Personally Identifying Information (PII) being collected by this form is authorized for collection under provisions of 10 U.S.C. 8013, Secretary of the Air Force, DoD 5200.2R, DoD Personnel Security Program; AFI 33-202, Computer Security, Information will be maintained by local Security Forces Authority while access requirements exist. Information access is restricted to personnel responsible for contract administration, or otherwise needed in the performance of official DoD duties. Information will be properly disposed of when its required use has been concluded.

Providing this information is voluntary; however, failure to provide all of the required data shown on the spreadsheet will result in denial of entry to the installation. This information is exempt from OMB licensing under provisions of AFI 33-324, Information Collections and Reports Management Program; Controlling Internal, Public, and Interagency Air Force Collections, paragraphs 3.16.11 and 3.16.16.3.

55 SFS CONTRACTOR/VENDOR NCIC SCREENING & PASS REQUEST SPREADSHEET

Date of Birth

Offutt AFB Sponsoring Agency / Unit:

Base Sponsor's Name:

Base Sponsor's Phone #:

Request Date:

Work Schedule

Company Name:

Company Address:

Company Representative Name:

Company Representative Phone Number:

NOTE:

Security Manager will ensure all listed personnel are briefed that they must present a REAL ID ACT compliant drivers license, or state ID, or an approved alternate form of photo identification upon arrival at Offutt AFB Visitor Control Center.

Contract Start/End Dates: Unit Commander or Security Manager Sig Block 55 WG/IP Sig Block - Needed For Non U.S. Visitors

Contract Start/End Dates: Unit Commander or Security Manager Sig Block 55 WG/IP Sig Block - Needed For Non U.S. Visitors

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