Tinker_AFB_Form_534_-_Coolant-Coolant_Recycling_Svcs.pdf

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CONTRACTOR SPACE REQUIREMENT

ORGANIZATION SPONSORING CONTRACT:

PROGRAM SUPPORTED:

POC NAME:

POC OFFICE SYMBOL:

POC PHONE:

DESCRIPTION OF CONTRACT ACTION

FOLLOW-ON TO PREVIOUSLY AUTHORIZED CONTRACT ACTION (NO NEW

SPACE REQUESTED)

PREVIOUS CONTRACT NUMBER FOR THIS REQUIREMENT:

A C P C NEW REQUIREMENT, BUT THE SPONSORING ORGANIZATION CAN SUPPORT WITHIN CURRENTLY ASSIGNED SPACES (NO NEW SPACE REQUIRED) H P A E R T C O E ADJUSTMENT TO PREVIOUSLY AUTHORIZED CONTRACTOR SPACE REQUIREMENT (EXPLAIN ADJUSTMENTS IN REMARKS) K P G R O Note: This form is not a request for additional space. To request additional space, please submit a Space Request form (available on the 72 ABW/CEAR website). No contractor space requirements will be authorized unless the area in question is already duly assigned to the sponsoring organization.

NEW REQUIREMENT; ADDITIONAL SPACE REQUIRED

IN ORDER TO ACCOMMODATE CONTRACTORS.

T I R H A Y E T E

OTHER (PROVIDE EXPLANATION IN REMARKS)

CONTRACT/PR/ORDER NUMBER (72 ABW/CEAR cannot complete this review without a unique contract

TYPE OF FUNDING:

identification number)

TYPE OF AWARD

COMPETITIVE

SOLE SOURCE

OTHER (EXPLAIN IN REMARKS)

Once the contract is awarded, the sponsoring organization will contact 72 ABW/CEAR and provide the contractor name and address Identify contractor below Identify contractor below

CONTRACTOR NAME:

CONTRACTOR ADDRESS:

PERIOD OF OCCUPANCY

Identify the dates the contractor personnel will be occupying the area in question. This will typically be the same as the period of performance for the contract. If the actual date of contract award results in a period of occupancy that is different than the one specified when the requirement was authorized, it is the responsibility of the sponsoring organization to notify 72 ABW/CEAR of the change.

START DATE:

END DATE:

DESCRIPTION OF SPACE TO BE OCCUPIED

TYPE OF AWARD

OTHER (PROVIDE EXPLANATION IN REMARKS)

WAREHOUSE

ADMINISTRATIVE

INDUSTRIAL

Please complete the following information for all spaces occupied by contractor personnel under this contract. Drawings showing all areas occupied by contractors must be attached to this form. Use the remarks section of the form if additional space is required.

NUMBER OF CONTRACTORS WHO WILL OCCUPY SPACE:

BUILDING/FACILITY:

POST/ROOM NUMBER;

AREA (FT2) ALLOTTED TO CONTRACTOR:

NUMBER OF CONTRACTORS WHO WILL OCCUPY SPACE:

BUILDING/FACILITY:

POST/ROOM NUMBER;

AREA (FT2) ALLOTTED TO CONTRACTOR:

NUMBER OF CONTRACTORS WHO WILL OCCUPY SPACE:

BUILDING/FACILITY:

POST/ROOM NUMBER;

AREA (FT2) ALLOTTED TO CONTRACTOR:

NUMBER OF CONTRACTORS WHO WILL OCCUPY SPACE:

BUILDING/FACILITY:

POST/ROOM NUMBER;

AREA (FT2) ALLOTTED TO CONTRACTOR:

TOTAL NUMBER OF CONTRACTOR PERSONNEL:

TOTAL AREA (FT2) ALLOCATED TO CONTRACTORS:

REMARKS/ADDITIONAL INFO: (Use reverse side as necessary)

COORDINATION

OFFICE SYMBOL:

NAME (Typed or Printed and Signature):

DATE:

TELEPHONE NO:

Space Manager for Sponsoring Organization (must be completed prior to submittal 72 ABW/CEAR) 72 ABW/CEAR (or designated agent of the Facility Board Space Working Group)

72 ABW/CEAR

TINKER AFB FORM 534, 20080820

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