NCIC Screening and Pass Request.pdf

PDF 209 KB Posted

Attached to
Offutt AFB Boiler Repair Federal contract opportunity
Solicitation number
FA460025Q0003
Issued by
Department of the Air Force Air Combat Command

About this file

Written by GovTribe AI ·

This document is a NCIC Screening and Pass Request Spreadsheet for contractors and vendors requesting access to Offutt Air Force Base. The spreadsheet collects personally identifiable information such as name, date of birth, driver's license, and social security number for the purpose of conducting a National Crime Information Center (NCIC) background check. The information is authorized for collection under U.S. Code and Department of Defense regulations. Providing this information is voluntary, but failure to do so will result in denial of entry to the installation. The spreadsheet must be submitted to the 55th Security Forces Squadron by the sponsoring agency or unit no later than a specified date prior to the requested access dates. A site visit and question/answer period are also scheduled for the related federal contract opportunity to repair boilers at Offutt AFB, with offers due on November 8, 2024.

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PWS B457 Boiler 1 repair rev 2.docx DOCX document
COMBO - CES Boiler Repair - Amendment 0001.pdf PDF
B457 Boiler 1 Repair - Questions and Answers.docx DOCX document
Seminole 6-5-500.pdf PDF
COMBO - CES Boiler Repair.pdf PDF
PWS B457 Boiler 1 repair.pdf PDF
SCA - Wage Determination.pdf PDF
original boiler record.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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