Self Certification of Continuous Service.pdf
PDF 159 KB Posted
- Attached to
- Replace Linear Accelerator at Greater Los Angeles VAHCS Federal contract opportunity
- Solicitation number
- 36C25821B0004
About this file
This document contains a federal contract opportunity solicitation for replacing a linear accelerator at the Greater Los Angeles Veterans Health Administration Healthcare System. The solicitation seeks a contractor to completely prepare the site for building operations including demolition, coordinate with the government's equipment provider, and furnish labor and materials to perform work including renovating rooms for the linear accelerator, control room, mechanical room, and data server room. Additional requirements include replacing ceiling and flooring, rewiring, providing new lead shielding as required, installing a new air compressor and dryer system along with piping, two 2-ton HVAC units and a dedicated fan coil unit for gantry cooling with new ductwork. The contractor must also install new drywall, finishes, casework and paint, revise the fire protection system as required, and furnish and install a ceiling-mounted patient lift with a minimum 770-pound carrying capacity. The expected construction period duration includes all pre-construction activity and post-construction testing, third-party inspections and commissioning.
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Other files for this federal contract opportunity
| File | Type | Posted |
|---|---|---|
| Sign in Sheet for 11 Jan Site Walk Linear Accelerator.pdf | ||
| 36C25821B0004 0002.pdf | ||
| 36C25821B0004 0001 RFI Amendment.pdf | ||
| Fingerprint Record Prep Sheet BLANK.PDF | ||
| 36C25821B0004.pdf | ||
| Wage Rate Determination CA20200022.docx | DOCX document | |
| Atch 1 Self Performance Calculations.pdf | ||
| 6 4Radixact Full Set.pdf | ||
| Contractor Background Investigation Request Form (May 2019).pdf | ||
| 6 8Infection Control Permit_revised.pdf | ||
| of0306.pdf | ||
| VA0710.pdf | ||
| 6 2 Drawings 2 of 2.pdf | ||
| 6 3Specification CSI 121.pdf | ||
| 6 1 Drawings1 of 2.pdf |
Show all 15
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Text version
DEPARTMENT OF VETERANS AFFAIRS
PERSONNEL SECURITY ADJUDICATION CENTER
Self Certification of Continuous Service
I hereby certify my break in service from my last federal employment is indicated by the block checked below.
I have NOT had a break in service.
My break in service was less than 60 days.
My break in service was greater than 60 days, but less than two (2) years. (You are required to submit the OF 306, Declaration for Federal
Employment, with this form.)
My break in service is greater than two (2) years; or I have never had federal employment as defined above.
Print Name: Social Security Number:
Signature: Date:
VA Personnel Security/HR Use Only:
Current Investigation in PIPS: Date:
Risk level of current position: Verified by:
(Check One)
Federal employment is defined as any branch of the United States military (Active, Guard or Reserve), federal government civilian employee (any federal government agency), or a contractor working for the federal government.
Self Certification of Continuous Service Form Revised February 28, 2020
Previous Versions are Obsolete
| I have NOT had a break in service: Off |
| My break in service was less than 60 days: Off |
| My break in service was greater than 60 days but less than 2: Off |
| My break in service is greater than 2 years or I have never worked: Off |
| Print Name: |
| Social Security Number: |
| Date: |
| Current Investigation in PIPS: |
| Date_2: |
| Risk level of current position: |
| Verified by: |
File details come from the government source that posted it. Updated .