NCIC Screening Pass Request.pdf

PDF 205 KB Posted

Attached to
Vertical Transportation and Equipment (VTE) Inspections and Maintenance
Solicitation number
FA460024Q0007_Revision01
Issued by

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This document is a NCIC Screening Pass Request form for Offutt Air Force Base. It collects personally identifiable information from contractor/vendor personnel, including name, date of birth, driver's license details, and social security number, in order to conduct a National Crime Information Center (NCIC) background check and issue a base access pass. The form states that providing this information is voluntary, but failure to do so will result in denied entry to the installation. The information collected is authorized under various DoD and Air Force regulations and will be maintained by the local Security Forces Authority. This form is exempt from OMB licensing requirements.

The related federal contract opportunity is a solicitation for Vertical Transportation Equipment (VTE) inspections and maintenance services on Offutt Air Force Base. The contract will cover the persistent maintenance, inspection, and servicing of various elevators and lift systems. An Elevator Maintenance Log from 2019-2024 is provided for offerors. A site visit is scheduled for July 17, 2024, and questions are due by July 22, 2024. Offers are due by July 29, 2024 at 11:00 AM CDT. The contracting office contact information is provided for submitting offers, questions, and access pass requests.

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Other files

File Type Posted
Combination Solicitation Document FA460024Q0007 Amendment 0001.pdf PDF
Elevator Maintenance Log.xlsx XLSX spreadsheet
Performance Work Statement - PWS - FA460024Q0007.docx DOCX document
SCA WD 79-0917.pdf PDF
Combination Solicitation Document - FA460024Q0007.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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