Attachment_3_-_Site_Visit_Submission_Form.doc
DOC document 53 KB Posted
- Attached to
- 7 CES Mezzaine
- Solicitation number
- FA4661-18-Q-0049
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Site Visit Submission Form
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| File | Type | Posted |
|---|---|---|
| Questions_and_Answers_Responses__1.docx | DOCX document | |
| Attachment_1_-_SOW.pdf | ||
| 18-Q-0049_7_CES_Mezzanine.docx | DOCX document | |
| Attachment_2_-_Question_Form.doc | DOC document | |
| Diagram.pdf |
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CONTRACTOR SITE VISIT REGISTRATION FORM
INSTRUCTIONS: Please complete and return this form to Mr. Michael C. Bradberry by no later than 1030 Central Standard Time on 7 May 2018, if you wish to attend the site visit. Completed forms must be sent via e-mail to michael.bradberry.1@us.af.mil Address:
7th Contracting Squadron
Attn: Mr. Michael. C. Bradberry
381 Third Street
Dyess AFB TX 79607
Name & Address of Firm:
Point of Contact: ___________________________________
E-Mail Address: ____________________________________ Phone No.: _______________ Fax No.:_____________
Number of individuals to attend the contractor site visit: ____
CONTRACTOR/VENDOR LIST
Name of Prime Contractor:
Name of Sub Contractor:
| Company Address: |
| Company Address: |
| Phone number: |
| Phone Number: |
Contract For/or Type of Service:
Contract Number:
Start Date:
Completion Date:
| Base Sponsor/Unit: |
| 7 CONS/LGCA |
| POC: |
Duty Phone:
Vouch
Y or N
| Name: (Last, First Middle) |
| Local Address: |
| SSN:xxx-xx-xxxx |
| DOB: |
YY/MM/DD
| Driver LIC /State: |
| Resident Alien Card (If,AP)(MAN) |
N
N
N
N
N
N
N
N
N
The above information is correct to the best of my knowledge. The contractor or designated employee must sign, date and print name in signature block below.
Printed Name:
Signature:
Date:
SPONSOR INFORMATION ONLY:
| The above personnel have been checked against the base debarment listing. |
| YES |
NO
| Personnel will be working on the following days/times: |
| DAYS |
HOURS
By signing below I certify that I have a DD Form 557 (Signature Card) on file at Pass & Registration. (Ext 696-3088)
Printed Name:
Signature:
Date:
Privacy Act Statement
Information contained herein is personal and will not be disclosed to the public without permission of the individual, IAW AFI 37-312. DYESS FORM 173
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