Attachment 3 - NCIC Screening and Pass Request.pdf
PDF 250 KB Posted
- Solicitation number
- FA4600-25-R-0009
About this file
This document is a Contractor/Vendor NCIC Screening & Pass Request Spreadsheet for accessing Offutt Air Force Base, required as part of the B457 Design and Repair Admin Roof solicitation (FA4600-25-R-0009). The form is marked as Controlled Unclassified Information (CUI) and requires contractors to provide detailed personal information for each individual seeking base access, including full name, date of birth, driver's license/ID number, work schedule, and citizenship.
Key requirements include completing the spreadsheet for base access by Monday, 21 July 2025 at 9:00 AM CDT, submitting it to Angela LeRoy and Amanda Smith via email, and ensuring all listed personnel have a REAL ID ACT compliant driver's license or approved alternate photo identification when arriving at the Offutt AFB Visitor Control Center. The spreadsheet is specifically tied to the design-build construction project for roof replacement of the Aircraft Maintenance Administration section in Building 457, with a site visit scheduled for Wednesday, 23 July 2025 at 9:00 AM CDT.
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Text version
Contract#:
Contract Start/End Dates: Unit Commander or Security Manager Sig Block
NOTE:
Security Manager will ensure all listed personnel are briefed that they must present a REAL ID ACT compliant driver’s license, or state ID, or an approved alternate form of photo identification upon arrival at Offutt AFB Visitor Control Center.
CUI
55 SFS CONTRACTOR/VENDOR NCIC SCREENING & PASS REQUEST SPREADSHEET
CUI
Contractor/ Vendor NCIC Screening & Pass Request Spreadsheet contain “CONTROLLED UNCLASSIFED INFORMATION” (CUI) which must be protected under the Freedom of Information Act (5 U.S.C. 552) and/or the Privacy Act of 1974 (5 U.S.C. 552a). Unauthorized disclosure or misuse of this PERSONAL INFORMATION may result in disciplinary action, criminal and/or civil penalties. Further distribution is prohibited without the approval of the author of this message unless the recipient has a need to know in the performance of official duties. CONTROLLED BY: 55SFS/MAP/CUI CATEGORY: PRVCY/DISTRIBUTION/DISSEMINATION CONTROL: FEDCON POC: MR.
DERKATCH, GREGORY (402) 232-7339.
Offutt AFB Sponsoring Agency / Unit: Company Name:
Base Sponsor's Name: Company Address:
Base Sponsor's Phone #: Company Representative Name:
Request Date: Company Representative Phone Number:
Full Name Date of Birth Work Schedule Country of Last, First, MI Year Month Day Drivers License/ID # State SSAN Days Hrs Start Date - End Date (MMDDYYYY) Citizenship
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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
File details come from the government source that posted it. Updated .