Attachment_2_-_List_of_Exhibits_REV_NWDTP.pdf

October 2011

List of Exhibits

EXHIBIT SOW

REF. TITLE PAGE

Initial NWDTP 51

Reserved 3

HSHQE5-14-R-00001

Armed PSO Services for Minnesota & Wisconsin

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PSzyman Typewritten Text NWDTP Refresher Training

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EXHIBIT SOW

REF. TITLE PAGE

Conduct on

Federal Property 1

HSHQE5-14-R-00001

Armed PSO Services for Minnesota & Wisconsin pszyman Typewritten Text X pszyman

BLDG # BLDG Address City/ST Post # Post Description Post Operating Hours (*Excluding Holidays)

# of Guards

Start Time End Time Hours/Day

Armed/ Unarmed

Security Clearance

Post Requires Relief (Y/N)

Post Requires Vehicle (Y/N)

0003WI 626 E. Wisconsin Ave. Milwaukee 331A Screening M-TH* 1 6:00 18:00 12.00 Armed MBI N N 0003WI 626 E. Wisconsin Ave. Milwaukee 331A Screening FRIDAYS ONLY * 1 6:00 17:00 11.00 Armed MBI N N 0003WI 626 E. Wisconsin Ave. Milwaukee 331B Screening Mon-Fri* 1 7:00 17:00 10.00 Armed MBI N N MN0015 515 W. First Street Duluth 55A Screening Mon-Fri* 1 6:00 18:00 12.00 Armed MBI N N MN0015 515 W. First Street Duluth 55B Patrol and Response Mon-Fri* 1 6:00 18:00 12.00 Armed MBI N N MN0015 515 W. First Street Duluth 55C Patrol and Response Sat/Sun/Hol 1 8:00 16:00 8.00 Armed MBI N N MN0036 212 3rd Avenue South Minneapolis 50A Screening Mon-Fri* 1 16:15 20:00 3.75 Armed MBI N N MN0036 212 3rd Avenue South Minneapolis 50A1 Patrol and Response Mon-Fri* 1 16:15 20:00 3.75 Armed MBI N N MN0036 212 3rd Avenue South Minneapolis 50B Screening Mon-Fri* 1 6:00 7:45 1.75 Armed MBI N N MN0036 212 3rd Avenue South Minneapolis 50B1 Patrol and Response Mon-Fri* 1 6:00 7:45 1.75 Armed MBI N N MN0036 212 3rd Avenue South Minneapolis 80A Screening Mon-Fri* 1 7:45 16:15 8.50 Armed MBI N N MN0036 212 3rd Avenue South Minneapolis 80B Patrol and Response Mon-Fri* 1 7:45 16:15 8.50 Armed MBI N N MN0084 1811 Chicago Ave. So. Minneapolis 51A Screening Mon-Fri* 1 8:45 17:45 9.00 Armed MBI N N MN0084 1811 Chicago Ave. So. Minneapolis 51B Patrol and Response M/T/TH/F* 1 8:45 15:30 6.75 Armed MBI N N MN0084 1811 Chicago Ave. So. Minneapolis 51B Patrol and Response Wednesday only* 1 8:45 12:30 3.75 Armed MBI N N MN0084 1811 Chicago Ave. So. Minneapolis 51C Screening M,W,F* 1 8:30 15:30 7.00 Armed MBI N N MN0084 1811 Chicago Ave. So. Minneapolis 51C Screening T&Th* 1 7:45 15:30 7.75 Armed MBI N N MN0084 1811 Chicago Ave. So. Minneapolis 51D Screening M,W,F* 1 8:30 15:30 7.00 Armed MBI N N MN0084 1811 Chicago Ave. So. Minneapolis 51D Screening T&Th* 1 7:45 15:30 7.75 Armed MBI N N MN0084 1811 Chicago Ave. So. Minneapolis 51E Screening Mon-Fri* 1 9:00 17:00 8.00 Armed MBI N N MN0086 One Federal Drive Ft. Snelling 53A Patrol & response/ Screening Sun-Sat 1 0:00 0:00 24.00 Armed MBI Y N MN0086 One Federal Drive Ft. Snelling 53B Patrol and Response Mon-Fri* 1 6:00 18:00 12.00 Armed MBI Y N MN0086 One Federal Drive Ft. Snelling 53C Screening Mon-Fri* 1 6:00 22:00 16.00 Armed MBI Y N MN0086 One Federal Drive Ft. Snelling 53D Screening Mon-Fri* 1 5:00 18:00 13.00 Armed MBI Y N MN0086 One Federal Drive Ft. Snelling 53E Screening Mon-Fri* 1 6:00 16:00 10.00 Armed MBI Y N MN0086 One Federal Drive Ft. Snelling 53Q Access Control Mon-Fri* 1 5:00 18:00 13.00 Armed MBI Y N MN0087 316 N. Robert Street St. Paul 79C Patrol and Response Sat/Sun/Hol 1 0:00 0:00 24.00 Armed MBI N N MN0087 316 N. Robert Street St. Paul 79C1 Patrol and Response Sat/Sun/Hol 1 0:00 0:00 24.00 Armed MBI N N MN0087 316 N. Robert Street St. Paul 79D Patrol and Response Mon-Fri* 1 18:00 6:00 12.00 Armed MBI N N MN0087 316 N. Robert Street St. Paul 79D1 Patrol and Response Mon-Fri* 1 18:00 6:00 12.00 Armed MBI N N MN0088 404 NW 2nd Street Austin 76A Patrol and Response Mon-Fri* 1 9:00 16:00 7.00 Armed MBI N N MN0092 300 S. 4th Street Minneapolis 59B Control Center Sat/Sun/Hol 1 0:00 0:00 24.00 Armed MBI N N MN0092 300 S. 4th Street Minneapolis 59D Control Center Mon-Fri* 1 0:00 6:00 6.00 Armed MBI N N MN0092 300 S. 4th Street Minneapolis 59D Control Center Mon-Fri* 1 18:00 0:00 6.00 Armed MBI N N MN0092 300 S. 4th Street Minneapolis 59E Patrol and Response Mon-Fri* 1 0:00 6:00 6.00 Armed MBI N N MN0092 300 S. 4th Street Minneapolis 59E Patrol and Response Mon-Fri* 1 18:00 0:00 6.00 Armed MBI N N MN0092 300 S. 4th Street Minneapolis 59F Patrol and Response Sat/Sun/Hol 1 0:00 0:00 24.00 Armed MBI N N MN1583 2901 Metro Drive Bloomington, 65A Patrol and Response Mon-Fri* 1 7:00 15:30 8.50 Armed MBI N N MN1583 2901 Metro Drive Bloomington 65B Patrol and Response M/T/TH/F* 1 7:30 15:30 8.00 Armed MBI N N MN1583 2901 Metro Drive Bloomington 65C Screening Mon-Fri* 1 7:00 18:00 11.00 Armed MBI N N MN1583 2901 Metro Drive Bloomington 65F Screening T&Th* 1 9:00 17:00 8.00 Armed MBI N N MN1583 2901 Metro Drive Bloomington 65F1 Patrol and Response M & W * 1 13:00 17:00 4.00 Armed MBI N N MN1583 2901 Metro Drive Bloomington, 65F-2 Screening M & W * 1 9:00 13:00 4.00 Armed MBI N N MN1583 2901 Metro Drive Bloomington 65G Patrol and Response M/T/TH/F* 1 7:30 15:30 8.00 Armed MBI N N MN1583 2901 Metro Drive Bloomington 65H Patrol and Response M/T/TH/F* 1 7:30 15:30 8.00 Armed MBI N N MN1583 2901 Metro Drive Bloomington 65I Patrol and Response M/T/TH/F* 1 7:30 15:30 8.00 Armed MBI N N MN1592 130 W. Superior St., Suite #400 Duluth 68A Patrol and Response Mon-Fri* 1 9:00 16:00 7.00 Armed MBI N N MN1600 30 E. 7th Street St. Paul 87A Patrol and Response Mon-Fri* 1 8:30 17:00 8.50 Armed MBI N N MN1606 1103 Broadway Street Alexandria 66A Patrol and Response Mon-Fri* 1 9:00 16:00 7.00 Armed MBI N N MN1610 190 E. 5TH St., Suite 800 ST. Paul 52A Patrol and Response Mon-Fri* 1 8:45 16:45 8.00 Armed MBI N N MN1611 180 E. 5th Street St. Paul 81A Screening Mon-Fri* 1 6:00 18:00 12.00 Armed MBI N N MN1625 53 E. 3rd Street Winona 73A Patrol and Response Mon-Fri* 1 9:00 16:00 7.00 Armed MBI N N MN1626 7850 Metro Pkwy Bloomington 61A Screening Mon-Fri* 1 8:30 17:00 8.50 Armed MBI N N MN1627 1023 W. Lincoln Avenue Fergus Falls 75A Patrol and Response Mon-Fri* 1 8:45 16:15 7.50 Armed MBI N N MN1634 12 Civic Ctr Plaza, Suite 1550 Mankato 63A Patrol and Response Mon-Fri* 1 8:30 16:30 8.00 Armed MBI N N

HSHQE5-14-R-00001

Armed PSO Services for Minnesota & Wisconsin

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MN1650 2900 Hannah Avenue NW Bemidji 77A Patrol and Response Mon-Fri* 1 8:45 16:15 7.50 Armed MBI N N MN1652 456 S. State Street Fairmont 69A Patrol and Response Mon-Fri* 1 9:00 16:00 7.00 Armed MBI N N MN1653 3280 Northway Drive Brooklyn Ctr 56A Patrol and Response Mon-Fri* 1 8:45 16:30 7.75 Armed MBI N N MN1654 3800 8th St. N., Suite 100 St. Cloud 57A Patrol and Response Mon-Fri* 1 8:30 16:30 8.00 Armed MBI N N MN1654 3800 8th Street No St. Cloud 83A Patrol and Response Mon-Fri* 1 8:30 17:00 8.50 Armed MBI N N MN1672 250 Marquette Ave., Suite 300 Minneapolis 60A Screening Mon-Fri* 1 7:30 16:30 9.00 Armed MBI N N MN1672 250 Marquette Ave Minneapolis 84A Patrol and Response Mon-Fri* 1 8:30 17:00 8.50 Armed MBI N N MN1674 1921 Excel Drive Mankato 85A Patrol and Response Mon-Fri* 1 8:30 17:00 8.50 Armed MBI N N MN1675 1550 American Blvd Bloomington 86A Patrol and Response Mon-Fri* 1 8:30 17:00 8.50 Armed MBI N N MN1676 507 Jewett Street Marshall 71A Patrol and Response Mon-Fri* 1 9:00 16:00 7.00 Armed MBI N N MN1679 1122 E. 25th Street Hibbing 70A Patrol and Response Mon-Fri* 1 8:30 16:30 8.00 Armed MBI N N MN1683 8331 Brandon Road Baxter 67A Patrol and Response Mon-Fri* 1 8:45 16:00 7.25 Armed MBI N N MN1685 1501 Freeway Blvd Brooklyn Center 78A Screening Mon-Fri* 1 18:00 6:00 12.00 Armed Top Secret N N MN1685 1501 Freeway Blvd Brooklyn Center 78B Patrol and Response Sat/Sun/Hol 1 0:00 0:00 24.00 Armed Top Secret N N MN1685 1501 Freeway Blvd Brooklyn Center 78C Screening Mon-Fri* 1 6:00 18:00 12.00 Armed Top Secret N N MN1685 1501 Freeway Blvd Brooklyn Center 78D Patrol and Response Mon-Fri* 1 7:00 17:00 10.00 Armed Top Secret N N MN1687 2443 Clare Lane NE, 100 Rochester 72A Patrol and Response Mon-Fri* 1 8:45 16:15 7.50 Armed MBI N N MN1693 6161 American Blvd Bloomngton 33A Patrol and Response Mon-Fri* 1 8:45 16:45 8.00 Armed MBI N N MN1720 310 S BROADWAY Rochester 82A Patrol and Response Mon-Fri* 1 8:15 16:45 8.50 Armed MBI N N WI0096 4020 Durand Avenue Racine 308A Patrol and Response Mon-Fri* 1 8:45 16:15 7.50 Armed MBI N N WI0098 606 N. 9th Street Sheboygan 325A Patrol and Response Mon-Fri* 1 8:45 16:15 7.50 Armed MBI N N WI0103 425 State Street La Crosse 333A Patrol and Response Mon-Fri* 1 8:15 16:45 8.50 Armed MBI N N WI0350 120 N. Henry Street Madison 302A Patrol and Response Mon-Fri* 1 16:00 8:00 16.00 Armed MBI N N WI0350 120 N. Henry Street Madison 302B Patrol and Response Sat/Sun/Hol 1 0:00 0:00 24.00 Armed MBI N N WI1529 5624 6th Avenue Kenosha 315A Patrol and Response Mon-Fri* 1 8:45 16:45 8.00 Armed MBI N N WI1542 310 W. Wisconsin Ave., Suite #260 Milwaukee 303A Patrol and Response Mon-Fri* 1 8:45 16:30 7.75 Armed MBI N N WI1542 310 W. Wisconsin Ave., Suite #300 Milwaukee 303C Patrol and Response Mon-Fri* 1 8:00 16:30 8.50 Armed MBI N N WI1600 660 Washington Madison 306A Patrol and Response Mon-Fri* 1 7:30 17:30 10.00 Armed MBI N N WI1600 660 Washington Madison 306A Patrol and Response Mon-Fri* 1 7:30 17:00 9.50 Armed MBI N N WI1623 1901 E. Capital Drive Appleton 336A Patrol and Response M,W,F* 1 8:15 16:45 8.50 Armed MBI N N WI1635 6300 W. Fond Du Lac Milwaukee 305A Patrol and Response Mon-Fri* 1 6:50 16:20 9.50 Armed MBI N N WI1635 6300 W. Fond Du Lac Milwaukee 305B Patrol and Response Mon-Fri* 1 8:55 17:40 8.75 Armed MBI N N WI1636 1603 Mirro Drive Manitowoc 318A Patrol and Response Mon-Fri* 1 8:30 16:15 7.75 Armed MBI N N WI1641 4120 Oakwood Hill Pkwy Eau Claire 58A Patrol and Response Mon-Fri* 1 8:45 16:30 7.75 Armed MBI N N WI1646 707 N. Grand Ave., 1st Flr. Waukesha 327A Patrol and Response Mon-Fri* 1 8:45 16:15 7.50 Armed MBI N N WI1650 310 E. Knapp Street Milwaukee 310A Patrol and Response Mon-Fri* 1 7:30 17:30 10.00 Armed MBI N N WI1650 310 E. Knapp Street Milwaukee 310B Screening Mon-Fri* 1 7:30 17:30 10.00 Armed MBI N N WI1650 310 E. Knapp Street Milwaukee 310C Screening Mon-Fri* 1 7:00 15:00 8.00 Armed MBI N N WI1650 310 E. Knapp Street Milwaukee 310E Patrol and Response Sat/Sun/Hol 1 0:00 0:00 24.00 Armed MBI N N WI1650 310 E. Knapp Street Milwaukee 310E Patrol and Response Sun-Sat 1 0:00 0:00 24.00 Armed MBI N N WI1660 607 W. Northland Ave. Appleton 311A Patrol and Response Mon-Fri* 1 8:30 16:30 8.00 Armed MBI N N WI1682 6011 Odana Road Madison 307A Patrol and Response Mon-Fri* 1 8:30 16:30 8.00 Armed MBI N N WI1686 1703 W. Knapp Street Rice Lake 324A Patrol and Response Mon-Fri* 1 8:30 16:30 8.00 Armed MBI N N WI1687 352 Grand Avenue Wausau 328A Patrol and Response Mon-Fri* 1 8:30 16:30 8.00 Armed MBI N N WI1689 222 N. Academy Street Janesville 314A Patrol and Response Mon-Fri* 1 8:45 16:45 8.00 Armed MBI N N WI1690 1710 S. 7th Street Milwaukee 304A Patrol and Response Mon-Fri* 1 6:45 15:30 8.75 Armed MBI N N WI1690 1710 S. 7th Street Milwaukee 304B Patrol and Response Mon-Fri* 1 9:00 17:45 8.75 Armed MBI N N WI1694 2875 Village Road Portage 322A Patrol and Response Mon-Fri* 1 8:30 16:30 8.00 Armed MBI N N WI1697 2213 8th Street South Wisconsin Rapids 330A Patrol and Response Mon-Fri* 1 8:30 16:30 8.00 Armed MBI N N WI1698 1561 Dousman Street Green Bay 313A Patrol and Response Mon-Fri* 1 8:45 16:15 7.50 Armed MBI N N WI1711 2403 Folsom Eau Claire 337A Patrol and Response Mon-Fri* 1 8:15 16:45 8.50 Armed MBI N N WI1718 4221 Tower Ave. Superior 326A Patrol and Response Mon-Fri* 1 8:55 16:10 7.25 Armed MBI N N WI1720 211 W. Wisconsin Milwaukee 338A Patrol and Response Mon-Fri* 1 8:15 16:45 8.50 Armed MBI N N WI1721 8455 W. Layton Avenue Greenfield 320A Patrol and Response Mon-Fri* 1 8:30 16:30 8.00 Armed MBI N N WI1724 5020 W. North Avenue Milwaukee 301A Patrol and Response Mon-Fri* 1 6:45 16:00 9.25 Armed MBI N N WI1724 5020 W. North Avenue Milwaukee 301B Patrol and Response Mon-Fri* 1 9:00 17:45 8.75 Armed MBI N N WI1730 210 7th St. So, Suite 100 LaCrosse 316A Patrol and Response Mon-Fri* 1 8:30 16:30 8.00 Armed MBI N N WI1732 180 Knights Way Fond Du Lac 312A Patrol and Response Mon-Fri* 1 8:45 16:15 7.50 Armed MBI N N

HSHQE5-14-R-00001

Armed PSO Services for Minnesota & Wisconsin

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WI1733 175 West Alona Lane Lancaster 317A Patrol and Response Mon-Fri* 1 8:00 16:00 8.00 Armed MBI N N WI1734 2023 Navajo Street Rhinelander 323A Patrol and Response Mon-Fri* 1 8:45 16:15 7.50 Armed MBI N N WI1735 400 City Center Suite B Oshkosh 321A Patrol and Response Mon-Fri* 1 8:30 16:30 8.00 Armed MBI N N WI1738 440 Security Blvd Green Bay 339A Patrol and Response T&Th* 1 8:00 16:30 8.50 Armed MBI N N WI1748 1145 VERN STREET West Bend 329A Patrol and Response Mon-Fri* 1 8:45 16:15 7.50 Armed MBI N N WI1756 2023 Lake Park Drive Marinette 319A Patrol and Response Mon-Fri* 1 8:45 16:15 7.50 Armed MBI N N WI1770 2501 W. Beltline Hwy Madison 306C Patrol and Response Mon-Fri* 1 8:00 16:30 8.50 Armed MBI N N WI1784 1241 Fourier Drive Madison 334A Patrol and Response Mon-Fri* 1 8:15 16:45 8.50 Armed MBI N N

HSHQE5-14-R-00001

Armed PSO Services for Minnesota & Wisconsin

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EXHIBIT #1

Exhibit 2 List of Required Forms

Form

SOW

Reference Form Title Location

HSHQE5-14-R-00001

Armed PSO Services for Minnesota & Wisconsin

Exhibit 2A Contractor Information Worksheet

Type Contractor PSO Non-PSO

Prefer Online (e-QIP)

(MBI / LBI / BI only) Routine Expedite (Extra Cost)

1. Contract Employee Information NAME: Last/Family First/Given Middle Suffix

Social Security

Date of Birth

MMDDYYYY

Place of Birth: City State Country

E-mail Address Phone # (Day) Phone # (Cell)

Position (Job) Title IT/System Admin Position?

Prior Investigation?

Yes No

Investigation Date Sex Male Female

U.S. Citizen Yes No

Aliens: Port of Entry City and State Date of Entry Alien Registration # Citizenship

2. Contract Information Company Name Company is

Prime Sub Contractor

If Sub, Name of Prime

Contract /Work Order / RWA # Contract Start Date End Date

Has Option Years OR End Date TBD

Company Point of Contact (POC) Name

Phone # (Day) E-mail Address

3. Project/Work Location Information (Government site where contractor is working) Building Name GSA Building # Building Address

4. Type of Investigation Requested for: HSPD-12 PIV Card Credential Public Trust Positions (Suitability) Moderate Risk - (LBI / MBI) HIGH Risk - (BI)

National Industrial Security Clearance

CONFIDENTIAL (NACLC) SECRET (NACLC) TOP SECRET

(SSBI)

5. Requesting Official (Sponsor) Information Sponsor's Name Title Is COR

Yes

FPS Regional Office Number

E-mail Address Phone # (Day) Forms Reviewed Yes

Review Date

HSHQE5-14-R-00001

6. DHS Federal Protective Service Contract Suitability Adjudication (Staff use ONLY) Personnel Security Investigation:

OPM PIPS Inv

Inv #

Status

Date of INV e-QIP Invitation #

Date E-Mail Sent

Release Form

CER

Med Release

GSA 3665

FD 258

CS Case

FD 258 RAP

Just

Date Forms Received

SF85PReviewed

Scanned/TIF

Date Sent to OPM

Suitability Decision Preliminary Date

Favorable Unfavorable

Final Date

Favorable Unfavorable

Notify Preliminary Decision eMail: COR/ Requesting Official eMail: Subject eMail: Subject’s Company POC

Final Decision eMail: COR/ Requesting Official eMail: Subject eMail: Subject’s Company POC

Comments/Notes:

Contractor Information Worksheet Instructions

Privacy Act Notice In compliance with the Privacy Act of 1974, the following information is provided: Solicitation of the information is authorized by the Federal Property and Administrative Services Act of 1949, as amended, and Part III of Title 5, U.S.C; O. 9397 Disclosure of the information is voluntary. This form will be used as a means to prepare and issue a credential or pass.

Information will be transferred to appropriate Federal, State, local or foreign agencies, when relevant to civil, criminal or regulatory investigations or prosecutions, or pursuant to a request by DHS or such other agency in connection with the firing or retention of an employee, the issuance of a security clearance, the investigation of an employee, the letting of a contract, or the issuance of a license, grant, or other benefit. If the individual does not provide some or any part of the requested information, the employee will not be issued a credential and will not be allowed to enter a GSA-controlled building after normal working hours or when the building is under security.

Submission Information

Ensure all information is complete and accurate

Return this form to your Supervisor/Contracting Officer for delivery to FPS Regional Field Contract Suitability Adjudication Office for “e- QIP” invite.

If a contractor opts to fill out a "Hard Copy" version of the SF-85P due to emergency operations, complete the background investigation package and send it along with Contractor Information Worksheet. SF-85P is available on GSA InSite

MAILING INSTRUCTIONS FOR FPS Staff:

If the contractor is a Non-Protective Security Officer (PSO) and performing contract administrative duties on the PSO contract at the federal government facilities, the background investigation package must be mailed to the respective FPS Regional Contract Suitability Adjudication Field Offices listed below:

HSHQE5-14-R-00001

Region Regional CSA PoC Phone # FAX Street Suite, Room City ST Zip + 4

HQ Evelyn Flores (202) 245-

(202) 245- 2610 1900 Half St SW Rm 5354 Washington DC 20528

HQ Sean Mihaly (202) 245-

(202) 245- 2610 1900 Half St SW Rm 5351 Washington DC 20528

ARRA Terry Hudson (202) 245-

(202) 245- 2610 1900 Half St SW Rm 5350-

S Washington DC 20528

1 Valerie DiMare (617) 565-

(617) 565-

10 Causeway St 935 Boston MA 02222-

2 George L. Ware (212) 264-

(212)264- 9803 26 Federal Plaza 17-130 New York NY 10278-

3 Lisa M. Leo (215) 521-

(215) 521- 2169 701 Market St 4200 Philadelphia PA 19106-

4 Todd Ware (404) 893-

(404) 893-

180 Spring St, NW 525 Atlanta GA 30303-

5 Doris Meaux (312) 353-

(312) 353- 0257 230 S. Dearborn St. 3540 Chicago IL 60604-

6 Sara Reisenbichler

(816) 426-

(816) 426-

601 E 12TH ST 1712 Kansas City MO 64106-

8 "Mike" Prado (303) 236-7813 x326

(303) 236-

W 6TH Ave & Kipling St Lakewood CO 80225-

9 May S. Joe (213) 894-

(213) 894- 3767 300 N Los Angeles St. 2207 Los

Angeles CA 90012-

10 Janis Davis (253) 815-

(253) 815- 4754 32125 - 32nd Ave S. 2nd Fl Auburn WA 98001-

Type of Investigation Requirements- Contractor Position

Type Position Sensitivity

Levels Clearance Levels DHS Investigation Requirement

Single Scope Backgrnd Inv

National Agency Checks w/Law & Credit

Background Investigation Minimum Background Investigation

National Agency Check w/Written Inquiries

HSHQE5-14-R-00001

ICE Inventory Serial Number Accessory Location Bldg #

CS617684 320CKV2440 Case CIS/ICE WI1650 CS617686 320CKV2442 Case CIS/ICE WI1650 CS617687 320CKV2443 Clip / mic Milw SSA South WI1590 CS617688 320CKV2445 Clip / mic Milw SSA South WI1590 CS617689 320CKV2444 Clip / mic Milw SSA West WI1558 CS617690 320CKV2446 Clip / mic Milw SSA West WI1558 CS618881 320CKX1416 Clip / mic Milw SSA North WI1573 CS618882 320CKX1417 Clip / mic Milw SSA North WI1573 CS618883 320CKX1418 Case Greenfield SSA WI1509 CS618884 320CKX1419 Case IRS Milwaukee WI1720 CS618885 320CKX1420 Mic / case Milwaukee SSA Rm 260 WI1542 CS618887 320CKX1422 Mic / case Milwaukee SSA-ODAR Rm 300 WI1542 CS380281 320CDQ1297 Clip US Forestry Bldg AX0500AX CS380204 320CDU6582 Clip US Forestry Bldg AX0500AX

CS617540 320CKV2008 Whipple FOB - Twin Cities MN0086 CS618862 320CKX1397 Whipple FOB - Twin Cities MN0086 CS617534 320CKV2002 Whipple FOB - Twin Cities MN0086 CS617673 320CKV2429 Whipple FOB - Twin Cities MN0086 CS617674 320CKV2430 Whipple FOB - Twin Cities MN0086 CS617531 320CKV1999 Whipple FOB - Twin Cities MN0086 CS395301 320CDN2930 Whipple FOB - Twin Cities MN0086 CS380205 320CDU6580 Whipple FOB - Twin Cities MN0086 CS395091 320CDN2428 Whipple FOB - Twin Cities MN0086

CS618866 320CKX1401 CIS - ICE MN1583

CS617672 320CKV2428 CIS - ICE MN1583

CS617533 320CKV2001 CIS - ICE MN1583

CS617682 320CKV2438 CIS - ICE MN1583

CS617537 320CKV2005 CIS - ICE MN1583

CS617681 320CKV2437 CIS - ICE MN1583

CS617532 320CKV2000 CIS - ICE MN1583

CS617539 320CKV2007 CIS - ICE MN1583

CS617538 320CKV2006 SSA and SSA-ODAR MN0084 CS415311 320CDN2484 SSA and SSA-ODAR MN0084 CS380380 320CDQ1127 SSA and SSA-ODAR MN0084 CS415315 320CDN2471 SSA and SSA-ODAR MN0084 CS617679 320CKV2435 SSA and SSA-ODAR MN0084 CS617675 320CKV2431 SSA and SSA-ODAR MN0084

CS617535 320CKV2003 Minneapolis FOB & US Cthse MN0092 CS617677 320CKV2433 Minneapolis FOB & US Cthse MN0092

CS617683 320CKV2439 Federal Building MN0036 CS617678 320CKV2434 Federal Building MN0036

CS617671 320CKV2427 Burger FOB & US Cthse MN0087 CS617676 320CKV2432 Burger FOB & US Cthse MN0087

CS395232 320CDN2427 SSA MN1592

CS395306 320CDN2916 Heaney FOB & US Cthse MN0015

STATEMENT OF WORK

EXHIBIT 2B

Radio Inventory

HSHQE5-14-R-00001

CS380280 320CDQ1287 Heaney FOB & US Cthse MN0015

CS618864 320CKX1399 IRS MN1600

CS618869 320CKX1404 IRS MN1672

CS618870 320CKX1405 IRS MN1675

CS618863 320CKX1398 SSA MN1653

CS618865 320CKX1400 SSA MN1610

CS618868 320CKX1403 SSA MN1693

CS617536 320CKV2004 SSA-ODAR MN1672

CS618867 320CKX1402 SSA-ODAR MN1672

CS415313 320CDN2474 FBI MN1685

CS380206 320CDU6588 FBI MN1685

CS395512 320CDUA314 Corps of Engineers MN1611

CS618861 320CKX1396 DECO Supervisor CS395508 320CDUA310 DECO Supervisor CS380399 320CDQ1292 DECO Supervisor CS380251 320CDQ1295 DECO Supervisor

HSHQE5-14-R-00001

Exhibit 2C Key Personnel Resume

Employee’s Name: SSN: - -

PROPOSED POSITION TITLE: ______________________________________

SUPERVISOR'S NAME: ____________________________________________

CURRENT POSITION WITH THE CONTRACT FIRM: ____________________

TIME IN CURRENT POSITION: (Yrs. Mos.) ____________________________

RESPONSIBLE FOR THE WORK OF: ___________ PERSONS

DESCRIPTION OF SCOPE OF CURRENT JOB: (Use attached sheet if necessary)

WORK EXPERIENCE: (Beginning with the most recent for the past 10 years.)

Dates (From – To) Position or Title Company Name and Address Reference and Phone Number

HSHQE5-14-R-00001

Employee’s Name: SSN: - -

EDUCATION SUMMARY:

Name and Address of Institution

Dates Attended

Diploma or Certificate

High School College Technical Trade Schools

PROVIDE A BRIEF STATEMENT OF WHY CONTRACTOR BELIEVES THAT THIS

INDIVIDUAL HAS THE QUALIFICATIONS FOR THIS CONTRACT.

HSHQE5-14-R-00001

Exhibit 2D Lautenberg Statement

Public Law 104-208 & Title 18 USC Sections 921, 922 and 925

HSHQE5-14-R-00001

Exhibit 2E Receipt for Government Property

Federal Protective Service Government Property Hand Receipt

TRANSFERRED FROM (AGENCY): TYPE OF TRANSFER Page_______of _______

Date

Permanent Temporary

TRANSFERRED TO (COMPANY):

Property Custodian

Transfer Loan Telephone Number

Estimated return date if temporary:

Instructions or Remarks:

Item No.

(1)

Description (2)

Bar Code Number (3)

Serial Number (4)

Unit of Issue (5)

Original Cost (6)

Acceptance of Responsibility: I certify that I received the above listed Government Accountable Property, it is in my physical custody, and that the list includes all currently issued items. I am responsible for the proper use, care, and safeguarding of all Government Property in my possession or under my accountability and stewardship control. I will report any changes to this Hand Receipt within five (5) business days to the Property Custodian.

Issued by (print name): Received by (print name):

Date Signature and Title Date Signature and Title

HSHQE5-14-R-00001

Exhibit 2F Record of Time

Arrival and Departure from Facility

RECORD OF TIME OF ARRIVAL

AND DEPARTURE FROM

BUILDINGS (DURING SECURITY

HOURS)

BUILDING YEAR MONTH

TIME OF

DATE PRINT NAME

(Last - First - Initial) SIGNATURE AGENCY

OR FIRM

ROOM

NUMBE

R

PURPOSE

OF VISIT

*SEE

FOOTNOTE ARRIVA

L

DEPARTUR

E

*Federal Protective Service and Contract Administration personnel, when conducting an investigation, must place an "X" in this column.

HSHQE5-14-R-00001

Exhibit 2G Non-Disclosure Agreement

NON-DISCLOSURE AGREEMENT

Protected Critical Infrastructure Information (PCII)

Sensitive Security Information (SSI)

Other Sensitive but Unclassified (SBU)

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HSHQE5-14-R-00001

NON-DISCLOSURE AGREEMENT

WITNESS:

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Exhibit 2H Offense/Incident Report

HSHQE5-14-R-00001

INSTRUCTIONS

TYPE

CODE NO

SORT

TYPE OF OFFENSE OR INCIDENT

CASE CONTROL NO

BUILDING NO

ADDRESS

AGENCY/BUREAU NAME

AGENCY/BUREAU CODE

SPECIFIC LOCATION

LOCATION CODE

. DATE/TIME OF OFFENSE/INCIDENT

DAY

DATE/TIME REPORTED

DAY

JURISDICTION

NO. OF DEMONSTRATORS

NO. EVACUATED

HSHQE5-14-R-00001

TIME START

TIME END

PERSONS INVOLVED

ID (IDENTIFICATION) CODE

NAME AND ADDRESS

AGE

SEX

RACE

COUNTRY OF BIRTH

NATIONALITY

INJURY CODE

TELEPHONE

VEHICLE

STATUS

YEAR

MAKE

MODEL

COLOR

IDENTIFYING CHARACTERISTICS

REGISTRATION

VIN (VEHICLE IDENTIFICATION NUMBER)

HSHQE5-14-R-00001

VALUE.

ITEMS TAKEN

NAME OF ITEM

QUANTITY

OWNERSHIP

BRAND NAME.

SERIAL NUMBER

COLOR

MODEL

VALUE

UNUSUAL OR UNIQUE FEATURES.

PROPERTY WAS.

STATUS OF PROPERTY

NARRATIVE

NOTIFICATION

EVIDENCE.

TYPE WHERE STORED

ATTACHMENTS

SUSPECT'S STATUS

DISPOSITION OF SUSPECT

TIME (OF OFFENSE/INCIDENT). RECEIVED

ARRIVED RETURNED TO SERVICE.

REVIEWED BY.

NAME AND SIGNATURE

HSHQE5-14-R-00001

DATE.

BADGE.

CALLSIGN

K9 CONTRACT GUARD

COMPANY

NAME AND SIGNATURE

DATE SUBMITTED

CASE REFERRED TO.

CASE STATUS.

APPROVING OFFICIAL (SIGNATURE AND NAME)

DATE

DETECTIVE STATUS

CASE NUMBER

HOW CLOSED

SUSPECT

ENTERED NCIC (NATIONAL CRIME INFORMATION CENTER)

PROPERTY RECOVERED.

VALUE OF PROPERTY

CLEARED NCIC

REFERRED TO

DATE REFERRAL ACCEPTED.

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Exhibit 2I Identification Access Control Card Request

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Exhibit 2J Federal Emergency Response Official

Designation Request

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Exhibit 3A Contractor’s Certification of Basic Training

Employee’s Name: _____________________________________________________

SSN: - -

CERTIFIED BY:

(Printed Name of Contractor’s Authorized Representative) (Signature) (Date)

HSHQE5-14-R-00001

Exhibit 3B Contractor’s Certification of Initial Weapons Training

Employee’s Name: _____________________________________________________

SSN: - -

CERTIFIED BY:

(Printed Name of Contractor’s Authorized Representative) (Signature) (Date)

HSHQE5-14-R-00001

Exhibit 3C Contractor’s Certification of

Government-Provided Training

Employee’s Name: _____________________________________________________

SSN: - -

CERTIFIED BY:

(Printed Name of Contractor’s Authorized Representative) (Signature) (Date)

HSHQE5-14-R-00001

Exhibit 3D Contractor’s Certification of Refresher Training

Employee’s Name: _____________________________________________________

SSN: - -

CERTIFIED BY:

(Printed Name of Contractor’s Authorized Representative) (Signature) (Date)

HSHQE5-14-R-00001

September 2011

Exhibit 3E Contractor’s Certification of Weapons Refresher Training

Employee’s Name: _____________________________________________________

SSN: - -

I hereby certify that the above named employee successfully completed all required Weapons Training subjects including practical exercises and examinations in accordance with SOW, as required by Contract number ____________________________________.

Semi-annual Firearms Training provided from ___________ to __________

(DATE) (DATE)

Refresher Baton Training provided from ___________ to __________

(DATE) (DATE)

Refresher OC Training provided from ___________ to __________

(DATE) (DATE)

Other Training____________ provided from ___________ to __________

(TYPE) (DATE) (DATE)

Weapons Training Subjects presented by:

_________________________________ of __________________________________ (Name of Instructor) (Name of Company)

Employee’s Score: _______________________

Employee’s Signature: ______________________________

CERTIFIED BY:

(Printed Name of Contractor’s Authorized Representative) (Signature) (Date)

Information provided in this certification is subject investigation and verification under Title 18, Section 1001, United States Code. Any false or misleading information may be punishable by fine or imprisonment.

HSHQE5-14-R-00001

Exhibit 4 Required Training

Training Frequency Provider Section Reference Exhibit

Initial NWDTP One Time Only G 4

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Armed PSO Services for Minnesota & Wisconsin

PSzyman Typewritten Text

PSzyman Typewritten Text

PSzyman Typewritten Text

PSzyman Typewritten Text

PSzyman Typewritten Text

PSzyman Typewritten Text

PSzyman Typewritten Text Government-Provided

PSzyman Typewritten Text NWDTP Refresher

PSzyman Typewritten Text Annual

PSzyman Typewritten Text Government

PSzyman Typewritten Text 6.7.4

PSzyman

4H

Exhibit 4A Contractor’s Training Schedule and Plan

Date:

Times:

Instructor(s):

Training Facility Address:

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Exhibit 4B Contractor-Provided Basic Training

IMPORTANT NOTE

, but under no circumstances shall the Instructor provide less than 64 hours of training

64 Hours

Subject Hours Scope

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Subject Hours Scope

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Exhibit 4C Contractor-Provided Initial and Transitional-

Platform Firearms and Less-Than-Lethal Weapons Training and Qualification

Subject Hours Scope

HSHQE5-14-R-00001

, but under no circumstances shall an Instructor provide less than 40 hours training during initial weapons training

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Handgun Qualification Course

Firearms:

Ammunition:

Target:

Course of Fire (Handgun)

STAGE DISTANCE ROUNDS POSITION DESCRIPTION

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STAGE DISTANCE ROUNDS POSITION DESCRIPTION

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Shotgun Qualification Course

Firearm: (Note: A specific post requirement must exist for PSOs to be armed with a shotgun.)

Ammunition:

Target:

Course of Fire:

NOTE:

Course of Fire (Shotgun)

STAGE DISTANCE ROUNDS POSITION DESCRIPTION

Note: Total of five rifled slugs will be fired with a minimum of four rifled slugs required to be in the four ring or higher at twenty-five yards.

HSHQE5-14-R-00001

NOTE: Prior to firing Stage 3, Instructors must ensure impact area is clear of obstructions (i.e., rocks, lead buildup, etc.) that might cause pellets to ricochet..

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Exhibit 4D Contractor-Provided

Annual Weapons Refresher Training and Qualification

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Exhibit 4E Contractor-Provided Refresher Training

IMPORTANT NOTE

, but under no circumstances shall the Instructor provide less than 40 hours of training

40 Hours

Subject Hours Scope

(Note: FPS will provide the instructor with information on this program to assist in training).

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Bomb Component Detection

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Exhibit 4F Government-Provided Orientation Training

8 Hours

Subject Hours Scope

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EXHIBIT 4G

GOVERNMENT-PROVIDED TRAINING

WEAPONS DETECTION TRAINING PROGRAM (WDTP) – INITIAL

Contractor will provide COR with training roster identifying Protective Security Officers (PSO) that will attend each training session. For informational purposes, the government estimates training sessions will be limited to six students perinstructor. COR will provide Contractor with training locations and dates. “Hours” column identifies approximate training time to cover course material. Actual time may fluctuate per subject, but total training time will not exceed sixteen (16) hours.

16 Hours Total Subject Hours Scope

Point PSO 3 Lecture and practical application required to perform Point PSO Duties

Metal Detector Operator Walk Through Metal Detector

Instruction will include lecture and practical application to prepare PSO how to screen persons using a walk-through metal detector

Metal Detector Operator Hand Held Metal Detector 4

Instruction will include lecture and practical application to prepare PSO how to screen persons using a hand-held metal detector.

X-ray Machine Operator 6 Instruction will include lecture and practical application related to duties of a PSO an X-ray Machine at a screening station.

Written Examination and Practical Demonstration Requirements PSOs identified in 6.7.3.1 must pass written examination with a minimum 70%.

Examination will consist of multiple-choice questions that come directly from 16-hour training.

PSOs identified in 6.7.3.1 must demonstrate ability during a graded practical exercise to perform duties of the Point PSO with 70% accuracy; detection and identification of dangerous weapons and/or prohibited items with 100% accuracy.

PSOs identified in 6.7.3.1 must Demonstrate ability to perform duties of Metal Detector Operator (Walk Through and Hand-held Metal Detector) during a graded practical exercise with 70% accuracy; detection and identification of dangerous weapons and/or prohibited items with 100% accuracy.

PSOs identified in 6.7.3.1 must demonstrate ability to perform duties of X-ray Machine Operator during a graded practical exercise with 70% accuracy; detection and identification of dangerous weapons and/or prohibited items with 100% accuracy

HSHQE5-14-R-00001

EXHIBIT 4H

GOVERNMENT-PROVIDED TRAINING

WEAPONS DETECTION TRAINING PROGRAM (WDTP) – ANNUAL REFRESHER

Contractor will provide COR with training roster identifying Protective Security Officers (PSO) that will attend each training session. For informational purposes, the government estimates training sessions will be limited to six students per instructor COR will provide Contractor with training locations and dates. “Hours” column identifies approximate training time to cover course material. Actual time may fluctuate per subject, but total training time will not exceed eight (8) hours.

8 Hours Subject Hours Scope

Point PSO 1 Practical application required to perform Point PSO Duties

Metal Detector Operator Walk Through Metal Detector

Practical application to prepare PSO how to screen persons using a walk-through metal detector

Metal Detector Operator Hand Held Metal Detector 2

Instruction will include practical application to prepare PSO how to screen persons using a hand-held metal detector.

X-ray Machine Operator 4 Instruction will include lecture and practical application related to duties of a PSO an X-ray Machine at a screening station.

Written Examination and Practical Demonstration Requirements PSOs identified in 6.7.3.1 must demonstrate ability during a graded practical exercise to perform duties of the Point PSO with 70% accuracy; detection and identification of dangerous weapons and/or prohibited items with 100% accuracy.

PSOs identified in 6.7.3.1 must Demonstrate ability to perform duties of Metal Detector Operator (Walk Through and Hand-held Metal Detector) during a graded practical exercise with 70% accuracy; detection and identification of dangerous weapons and/or prohibited items with 100% accuracy.

PSOs identified in 6.7.3.1 must demonstrate ability to perform duties of X-ray Machine Operator during a graded practical exercise with 70% accuracy; detection and identification of dangerous weapons and/or prohibited items with 100% accuracy

Exhibit 5 Reserved

THIS PAGE LEFT BLANK INTENTIONALLY

HSHQE5-14-R-00001

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Exhibit 6 PTS Instructions

[PLACEHOLDER]

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Exhibit 7 Medical Questionnaire and Physical Abilities Test Manual

Protective Security Officers (PSO) Medical Examination and Certification Standards

General Background

Medical Exam Questionnaire and Certification of Standards

A licensed physician must review and complete this Questionnaire. A licensed physician’s determination of a limiting condition will result in a failure to meet required medical standards.

oSection 1:

oSection 2 oSection 3 oAttachment 1 oAttachment 2

HSHQE5-14-R-00001

Section 1: Critical Tasks

Common Critical Tasks

Occasional Critical Tasks

Common Critical Tasks

Stand post at the entry/exit gates to verify all persons' identification and conduct inquiries and surveillance of items, packages, and people. Check packages, briefcases, containers, or any other items in the possession of people entering or leaving a Federally controlled facility.

2 Operate metal detectors to search visitors for prohibited items. Operate x-ray machine to search deliveries, visitors' packages, equipment, and hand carried articles for prohibited items.

3 Monitor security and fire alarms and closed-circuit television to detect security risks or threats.

4 Conduct vehicle inspection, which may include inspecting under seats, in the trunk, and under the vehicle.

Conduct patrols in accordance with routes and schedules contained in post orders. Inspect facilities and perimeters for hazards, mechanical problems, and unsafe conditions and report problems to appropriate authorities. Close and secure open windows, doors, gates, or other access points.

6 Investigate the source of suspicious odors and sounds.

7 Patrol locations in areas which are a potentially hazardous to the public (e.g., construction sites).

8 Observe unique characteristics of an individual for identification purposes. Observe a person's body language to assess attitude and intention.

9 Close off areas to traffic, establish perimeters, and set up barricades to secure incident scenes or facilities.

Occasional Critical Tasks

Locate and review documents and information (e.g., logs, lists). Read memos and other written material to obtain and maintain knowledge. Review maps, floor plans, diagrams, or other information to become familiar with facility and property boundaries.

2 Use defensive tactics to prevent or control movements of individuals.

3 Subdue violent persons with or without assistance. Break up fights. Disarm individuals.

4 Apply handcuffs to individuals who are displaying erratic or violent behavior.

5 Use baton or chemical spray to temporarily incapacitate a violent individual. Participate in training in the use of chemical agents, restraining devices, and batons to be used in emergency situations.

6 Discharge firearm during daylight or in dark or low light environment while using flashlight.

7 Evacuate individuals from dangerous and/or life threatening situations.

8 Administer cardio-pulmonary resuscitation (CPR).

9 Pursue fleeing individual on foot.

HSHQE5-14-R-00001

Section 2: Medical Exam Questionnaire

Patient’s Name:__________________________________

VISION

QUESTIONS TO DETERMINE ELIGIBILITY CIRCLE

1. Does candidate wear corrective lenses? If yes, in the below chart indicate with a check mark the type of lenses used and which lenses are used most frequently, and identify the prescription strength:

Visual Aid Yes Used Most Frequently

Prescription Strength

Glasses Soft Contact

Lenses

Hard Contact

Gas Permeable

Yes No

2. Does candidate have 20/30 vision while using both eyes? Yes No

3. Visual Acuity: Identify candidate’s visual acuity with and without corrective lenses. If the candidate does not wear corrective lenses insert “NA”.

Normal Acuity: ___________Corrective Acuity:_________

4. Is candidate capable, in at least one eye, of reading a minimum of Jaegar Number 2 or equivalent type and size letter at a distance of no less than 12 inches on a standard Jaegar chart?

Yes No

5. Does candidate exhibit normal color vision? Yes No

6. Does candidate exhibit any visual conditions that may impact their ability to perform critical tasks of a PSO? For example, peripheral vision deficits or night blindness. Yes No

7. Use this section to explain any limiting factors or why candidate does not meet above requirements for vision.

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HEARING

QUESTIONS TO DETERMINE ELIGIBILITY CIRCLE

1. Does candidate require use of a hearing aid? Yes No

2. Does candidate have hearing less than or equal to 25db? Yes No

3. Identify candidate’s average hearing (corrected, if applicable) across the following 500, 1000, 2000, and 3000 Hz levels: ___________ db

4. Does candidate have hearing less than or equal to 45db? Yes No

5. Identify candidate’s hearing (corrected, if applicable) at the 4000 and 5000 Hz levels:

___________ db

6. Does candidate have a hearing variance between left and right ears?

If yes, identify the ear with more hearing loss? Left______ Right______

What is difference between 500 to 3000 Hz range? ________db

Required: Test candidate further for sound localization deficiency if difference exceeds 15 db.

What is the difference between 4000 to 5000 Hz range? _______ db

Required: Test candidate further for sound localization deficiency if difference exceeds 30 db.

Yes No

7. Does candidate present evidence of inner/middle/outer ear disorders affecting equilibrium?

Yes No

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CARDIOVASCULAR SYSTEM

The physician should administer the Physical Ability Test (Attachment 2) or review the results of the hiring agency’s administered physical abilities test prior to completing this section.

QUESTIONS TO DETERMINE ELIGIBILITY

1. Identify candidate’s aerobic capacity in METs ___________or in VO2 Max__________

Required standard: Minimum nine (9) METs or 31.5 ml/kg/min VO2 Max

2. Identify candidate’s resting blood pressure:

mmHg Systolic__________mmHg Diastolic__________

Required standard: Maximum 180 mmHg systolic, 90 mmHg diastolic.

3. Use this section to explain any limiting factors or why candidate does not meet the above requirements for the cardiovascular system.

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MUSCULOSKELETAL SYSTEM

QUESTIONS TO DETERMINE ELIGIBILITY CIRCLE

1. Does candidate exhibit full range of motion? Yes No

2. Is candidate able to easily get up and down from a kneeling position? Yes No

3. Is candidate able to lift 40 pounds minimum from floor to waist? Yes No

4. Is candidate able to bench press at least 40% of their body weight? Yes No

5. Is candidate able to perform sit-ups and pushups continuously for at least 30 seconds?

Note: The candidate is to perform this task without stopping, irrespective of number of repetitions. This task tests candidate’s strength, range of motion, and flexibility while performing a certain continuous motion for 30 seconds. It is not designed to test candidate’s ability to do sit-ups and/or pushups.

Yes No

6. Use this section to explain any limiting factors or why candidate does not meet the above requirement for the musculoskeletal system.

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GENERAL HEALTH

QUESTIONS TO DETERMINE ELIGIBILITY

Conditions listed below could potentially influence a PSOs performance; these conditions would not solely exclude a candidate from a PSO position, but serve as indicators for further review. Physician’s evaluation will determine if a condition limits a candidate’s ability to perform tasks (Attachment 1).

CIRCLE

1. Does candidate exhibit a loss of sense of smell, aphonia, or other abnormalities of nose, throat, or ears that may prevent successful task performance?

Yes No

2. Does candidate exhibit evidence of chronic bronchitis, emphysema (moderate or severe), infectious pulmonary tuberculosis, or other respiratory abnormalities that may prevent successful task performance?

Yes No

3. Does candidate exhibit evidence of eczema, psoriasis, dermatitis, or other dermatological condition that may prevent successful task performance?

Yes No

4. Does candidate exhibit evidence of a gastrointestinal issue that may prevent successful task performance? (Candidate may be required to stand or walk continuously for eight (8) hours without regular access to a restroom.)

Yes No

5. Use this section to explain any limiting factors or why candidate does not meet the above requirements for general health.

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Section 3: Conclusions

Signature: ______________________________________ Date: __________________

Examining Physician’s Name_____________________________________________ (Print or stamp):

Address: _______________________________________________________________

Telephone: _____________________________________________________________

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Attachment 1: PSO Functions and Task

PSO Specific Tasks (6 Core Areas/84 total tasks)

These tasks entail the minimum set of specific tasks all PSOs are expected to perform Access Control

1 Stand post at the entry/exit points to verify all persons' identification and conduct inquiries and surveillance of suspicious items, packages, and people.

2 Ensure individuals do not depart with government material unless they are authorized to do so.

3 Verbally challenge individuals who are approaching restricted areas.

4 Direct individuals who cause a disturbance to leave the property.

5 Operate traffic control points.

6 Close off areas to traffic, establish perimeters, and set up barricades to secure incident scenes or facilities.

7 Control access to incident scenes.

8 Help ensure integrity of a crime scene, maintaining it in its original condition until law enforcement personnel take over.

9 Coordinate the receipt, issuance, and tracking of all keys, key cards, lock combinations, vehicle passes/decals, etc.

10 Identify suspicious persons or vehicles.

Screening 1 Inspect packages, briefcases, containers, or any other items in the possession of people entering or leaving a federally controlled facility.

2 Operate metal detectors to search visitors for prohibited items.

3 Operate x-ray machine to search deliveries and visitors' packages, equipment, and hand carried articles for prohibited items.

4 Conduct vehicle inspection, which may include inspecting under seats, in the trunk, and under the vehicle.

5 Conduct frisks or pat downs for weapons or other unauthorized items.

Visitor Processing 1 Verify proper identification of visitors required for issuance of visitor badges.

2 Process visitors.

Patrol and Response 1 Inspect appropriate countermeasures, including facility critical protection points and classified containers.

2 Inspect facilities for hazards, mechanical problems, and unsafe conditions and report problems to appropriate authorities.

3 Close and secure open windows, doors, gates, or other access points.

4 Manually open and close heavy gates and doors.

5 Conduct patrols in accordance with routes and schedules contained in post orders.

6 Inform dispatcher of present status and changes in conditions.

7 Patrol locations in areas which are potentially hazardous to the public (e.g. construction sites).

8 Inspect the perimeter, property, and buildings for hazards, intruders, and suspicious activities.

9 Observe the environment for suspicious vehicles or persons on or around Federal property.

10 Review maps, floor plans, diagrams, or other information to become familiar with facility and property boundaries.

11 Evacuate individuals from dangerous and/or life threatening situations.

12 Guide and assist First Responders (e.g., with scene management or security).

13 Assess the condition of injured individuals.

14 Perform basic first aid in response to emergencies.

15 Administer cardio-pulmonary resuscitation (CPR).

16 Administer/deploy automatic external defibrillator (AED).

17 Use fire extinguisher to put out a minor fire.

18 Request emergency assistance in response to traffic accidents.

19 Assist in conducting accident and incident scene searches and investigations (e.g., check visitor logs, video) in search of relevant evidence and information to determine the facts of the situation.

20 Follow directions to and respond to emergency and routine calls for service until the situation is resolved or until relieved by a higher authority.

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Attachment 1: PSO Functions and Task

21 Investigate the source of suspicious odors and sounds.

22 Pursue fleeing individual.

23 Escort money, valuables, or people to provide security.

24 Escort facility tenants and visitors to and/or from their vehicles after hours.

Control Center Operations 1 Check radio equipment for proper operation.

2 Monitor security and fire alarms and closed-circuit television to detect security risks, threats, or prohibited items carried by visitors.

3 Dispatch PSOs in response to calls for service, alarms, or emergencies.

Common Tasks 1 Report potentially threatening situations and violations of law and security procedures.

2 Observe unique characteristics of an individual for identification purposes.

3 Collect information about stolen or missing property or suspicious activities to aid investigations.

4 Take detailed field notes so reports can be completed.

5 Write and/or speak situation reports regarding security related information (e.g., accidents, bomb threats, unlawful acts, characteristics of individuals).

6 Communicate with individuals to establish rapport.

7 Adjust communication to ensure understanding.

8 Provide direction or information to tenants or visitors.

9 Advise persons relative to problems, situations, etc.

10 Encourage people to approach by using effective non-verbal communication (e.g., making eye contact, smiling, greeting a person cordially, and nodding).

11 Communicate with rude or abusive people.

12 Use body language to project control and influence.

13 Use voice commands to project control and direct actions.

14 Explain rules, regulations, and procedures to individuals.

15 Interact with a subject who does not speak English.

16 Interact with a subject who has communication impairment (e.g., is deaf, has a speech impediment).

17 Interact with a subject who has mobility impairment (e.g., is blind, is wheelchair bound).

18 Interact with public, including children.

19 Interview witnesses to obtain description of possible suspects or description of what happened.

20 Advise appropriate personnel of potentially hazardous conditions (e.g., slippery floors).

21 Communicate with first responders.

22 Testify in court regarding criminal activity or other incidents.

23 Report misconduct of other Security Officers.

24 Ensure that all security equipment is activated and operating properly; if not, report to proper authority.

25 Inventory physical objects (e.g., keys, keycards, vehicles, visitor badges) and log accordingly.

26 Locate and review documents and information (e.g., logs, lists).

27 Read memos and other written material to acquire and maintain knowledge.

28 Participate in search for missing child.

29 Activate alarm systems.

30 Provide backup assistance to Law Enforcement Officers and other PSOs.

31 Maintain situational awareness regarding individuals’ body language, projected attitudes, and intentions.

32 Care for and maintain firearms.

33 Participate in firearms training.

34 Participate in training in the use of intermediate force weapons to be used in…