PWS Attachment_5.1.3 Customer Support Request - Third Party Request.pdf
PDF 191 KB Posted
- Attached to
- AEWS AN/FPS-124 Radome Replacement Program Federal contract opportunity
- Solicitation number
- FA821725RB003
About this file
The document is a Customer and Third Party Support Request Form from Nasittuq, designed for requesting various support services. The form allows requestors to specify purpose of visit (such as inspections, demonstrations, maintenance, or site access), support requirements (including rations, quarters, ground transportation, equipment, personnel, airlift, and fuel), and access requirements for specific zones like Operations Zone, Security Zone, and COMSEC Area. The form includes sections for detailing personnel requirements, material lists, and additional information, with a note that travel itineraries and visitor screening will be requested prior to arrival. The form is subject to NWSO (Northwest Survival Operations) approval and is intended for both government-directed and commercial activities support requests.
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Text version
Document: 2.16.2 CSR&TPS Request Form Effective: pending review Page: 1 - 3
Copyright © Her Majesty the Queen in Right of Canada (2022)
UNCONTROLLED WHEN PRINTED
CUSTOMER AND THIRD PARTY SUPPORT REQUEST FORM
Original Identification Date
Office Use Only Amendment Date TPS/CSR #:
Description of Request
Purpose of Visit (Choose most applicable)
Inspection/ Audits/ Environmental or Research Assessments Demonstrations/ Briefing or Site Access Additional Work Requirement (AWR)/ Real Property or C&E Site Maintenance System Upgrades and/or Installation
Non-Operational Third Party Equipment Maintenance Service Level Agreements (SLA)/ Memorandum of Understanding (MOU) per Contractor SOW. Including CHL/ AFTAC/USAF/Parks Canada
Non Operational Commercial Accommodations: Rations and Quarter (R&Q) at Cambridge Bay (Zone 2) or Sanirajak (Zone 3), Logistic Support Site (LSS)
Other: Land use, storage, hangar use, material handling, general inquiries, etc.
(specify in description).
Customer Support Request (Government directed)
Third Party Request (Commercial activities)
Date: Date:
Requesting Agency:
Requesting Agency:
NWSO OPI:
Contact Point:
Phone: Phone:
Email Address:
Email Address:
Support Requirement Type of Support Required Support Details
Rations # of visitors:
Quarters Days:
Ground Transportation Pax handling details:
Equipment (Gravel Crusher, MSE etc) *Type:
Personnel (Site Escort/Wildlife Monitor) Skillset(s):
Airlift *Rotary Wing/Fixed Wing:
Fuel Qty: Location:
Other Nasittuq Support List in ‘additional information’ if required.
Effective: pending review Page: 2 - 3
Copyright © Her Majesty the Queen in Right of Canada (2022)
UNCONTROLLED WHEN PRINTED
*Subject to NWSO approval for TPS requests.
*Include site schedule in separate attachment if additional visits required.
Travel Itineraries and visitor screening will be requested prior to arrival.
Description of the Activities
Material List
List of Material Weights (KG) Dimensions Scheduled arrival date/location
Additional Information
Access Requirements Sites to be Visited* Date In Date Out Operations Zone NWSSC and SRD 22 Aug 23 25 Aug 23 Security Zone COMSEC Area
Personnel Requirement
Surname First Name
Rank Gender Company/Position Security Clearance #
Controlled Goods
Effective: pending review Page: 3 - 3
Copyright © Her Majesty the Queen in Right of Canada (2022)
UNCONTROLLED WHEN PRINTED
Please send completed Customer and Third Party Support Form to document to Nasittuq TPS/CSR Coordinator for processing.
| Customer and Third Party Support Request Form |
| Office Use Only |
| Original Identification Date |
| Purpose of Visit |
| (Choose most applicable) |
| Inspection/ Audits/ Environmental or Research Assessments |
| Demonstrations/ Briefing or Site Access |
| Additional Work Requirement (AWR)/ Real Property or C&E Site Maintenance |
| System Upgrades and/or Installation |
| Non-Operational Third Party Equipment Maintenance |
| Service Level Agreements (SLA)/ Memorandum of Understanding (MOU) per Contractor SOW. Including CHL/ AFTAC/USAF/Parks Canada |
| Non Operational Commercial Accommodations: Rations and Quarter (R&Q) at Cambridge Bay (Zone 2) or Sanirajak (Zone 3), Logistic Support Site (LSS) |
| Other: Land use, storage, hangar use, material handling, general inquiries, etc. (specify in description). |
| Third Party Request |
| Customer Support Request |
| (Commercial activities) |
| (Government directed) |
| Date: |
| Date: |
| Requesting Agency: |
| Requesting Agency: |
| Contact Point: |
| NWSO OPI: |
| Phone: |
| Phone: |
| Email Address: |
| Email Address: |
| Support Requirement |
| Support Details |
| Required |
| Type of Support |
| # of visitors: |
| Rations |
| Days: |
| Quarters |
| Pax handling details: |
| Ground Transportation |
| *Type: |
| Equipment (Gravel Crusher, MSE etc) |
| Personnel (Site Escort/Wildlife Monitor) |
| Skillset(s): |
| *Rotary Wing/Fixed Wing: |
| Airlift |
| Qty: Location: |
| Fuel |
| Other Nasittuq Support |
| List in ‘additional information’ if required. |
| Date Out |
| Date In |
| Sites to be Visited* |
| Access Requirements |
| 25 Aug 23 |
| 22 Aug 23 |
| NWSSC and SRD |
| Operations Zone |
| Security Zone |
| COMSEC Area |
| Personnel Requirement |
| Controlled Goods |
| Security Clearance # |
| Gender |
| Rank |
| First Name |
| Company/Position |
| Surname |
| Description of the Activities |
| Material List |
| Weights (KG) |
| Dimensions |
| List of Material |
| Scheduled arrival date/location |
| Additional Information |
File details come from the government source that posted it. Updated .