NVARNG Personal Security Questionnaire.pdf
PDF 141 KB Posted
- Attached to
- National Guard - Landscaping Services
- Solicitation number
- 43ADG-S4059
- Issued by
- Nevada
About this file
This is a Personal Security Questionnaire form from the Nevada Army National Guard (NVARNG) related to a landscaping services contract opportunity for the Nevada Office of the Military under the Nevada Department of Adjutant General and National Guard. The questionnaire appears to be a pre-qualification or background screening document required for vendors seeking to provide landscaping services at Nevada National Guard facilities. The form is designed to collect security-related information from prospective bidders or their personnel who may require access to military installations or sensitive areas. While specific contract timelines, quantities, and award dates are not detailed within the questionnaire itself, this document serves as a screening mechanism to ensure that qualified vendors and their employees meet security clearance requirements before contract award.
The questionnaire functions as a security vetting tool that prospective landscaping service vendors must complete as part of the proposal submission or pre-award process. This security requirement reflects the sensitive nature of working at military installations and indicates that successful bidders will need to meet Department of Defense or Nevada National Guard security protocols. No pricing information, set-asides, incumbent contractor details, or specific funding amounts are contained within the questionnaire document itself, as it serves primarily as a qualification and compliance screening form rather than a procurement document detailing commercial terms.
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Other files
| File | Type | Posted |
|---|---|---|
| 43ADG-S4059 - Request for Qualifications (2).docx | DOCX document | |
| 43ADG-S4059 -Vendor-Information-Response (1).pdf | ||
| 43ADG-S4059_Cost_Schedule.xlsx | XLSX spreadsheet | |
| 43ADG-S4059 RFQ Service Locations.xlsx | XLSX spreadsheet | |
| 43ADG-S4059 Scope of Work.docx | DOCX document | |
| 43ADG-S4059 - NOM Standard Form Contract.docx | DOCX document | |
| Quote Instructions.pdf | ||
| 43ADG-S4059-Insurance Requirements.docx | DOCX document | |
| 43ADG-S4059 RFQ_Vendor_Qualifications_Response_Form.xlsx | XLSX spreadsheet | |
| Terms-and-conditions-for-services~6.pdf | ||
| NVARNG Environmental Policy Statement.pdf | ||
| Certification-regarding-lobbying~7.pdf |
Show all 12
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Text version
THIS IS A SAMPLE FOR YOUR REVIEW ONLY
NVARNG PERSONAL SECURITY QUESTIONNAIRE
1. Name: ________________, ________________, _________________ Last First Middle (full name)
2. Date of Birth: __________________________ (Month Day, Year)
3. Social Security Number: _________ - ______ - _________
4. Sex: MALE____FEMALE___
5. Driver’s License Number______________________________________
6. Driver’s License State of Issue_________________________________
7. Home Address_____________________________________________
8. City______________________________________________________
9. State_____________________________________________________
10. Place of Birth:__________________________ (City, State, Zip, Country)
11. Employer/Command:________________________________________
12. Phone Numbers: Employer (____) ____-____ Home (____) ____-____
YES NO NA
Are you a U.S. Citizen?
Are you a legal resident alien?
Have you ever been barred from any federal government facility or base?
Have you ever been convicted of a felony?
Do you have any outstanding warrants or are you a fugitive from justice?
Are you currently pending trial?
Are you on an approved Dept. of Prisons program? (probation, parole, work release etc.)
Have you ever been convicted on a weapons charge or Theft
13. Individual Requesting Access. I certify that the above information is correct and I agree to allow NVARNG Provost Marshal and/or local commands to perform a local/national security check on me as required.
Signature: ________________________Date:_________________
14. Employer Supervisor/Manager. I certify that the above information has been verified with the individual’s documents; to include a United States issued birth certificate and a United States issued picture identification (e.g., driver’s license, U.S. military ID, Resident Alien Registration Card, Foreign Passport, Foreign Military ID etc.)
Signature: __________________________Date:_________________
15. FMO/NVNG Representative – Print Name_______________________
Signature: __________________________Date:_________________
Project:________________________Location:_________________________
Contract start date:_______________Contract end date:__________________
File details come from the government source that posted it. Updated .