SOW Attachment 05 - PIV Badge Template.pdf
PDF 293 KB Posted
- Solicitation number
- 36C24124Q0517
About this file
The provided document is a PIV Badge Request Template for the Department of Veterans Affairs VA Maine Healthcare System Police Department. It outlines the required information to be submitted for issuance of a PIV (Personal Identity Verification) or non-PIV badge, including the applicant's personal details, contact information, and employment details. The template indicates that all highlighted information must be provided for a badge to be issued.
The related federal contract opportunity is a Request for Quote (RFQ) for the Togus, Maine VA Medical Center, seeking to install security upgrades and PACS (Physical Access Control System) devices. The Solicitation Number is 36C24124Q0517, and it is a Small Business (SB) Set-Aside. Interested parties are advised to reference the Scope of Work (SOW) and associated attachments for further details regarding this opportunity.
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Other files
| File | Type | Posted |
|---|---|---|
| 36C24124Q0517 0001.docx | DOCX document | |
| Wage Determination - ME20240009 5-24-2024.pdf | ||
| 36C24124Q0517.docx | DOCX document | |
| SOW Attachment 02 - VA ICRA.pdf | ||
| SOW Attachment 07 - Local Permits.pdf | ||
| SOW Attachment 04 - Seasonal Influenza with Vaccines.pdf | ||
| SOW Final Revised.docx | DOCX document | |
| SOW Attachment 08 - Specifications.pdf | ||
| Wage Determination - ME20240009.pdf | ||
| SOW Attachment 06 - RM Verbiage for 6500 SOW.docx | DOCX document | |
| SOW Attachment 01 - VA PCRA.pdf | ||
| SOW Attachment 03 - Togus Campus Map.pdf |
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Text version
Project Name: Type of Badge Requested: PIV NON-PIV FLASH
Circle one
Departmentof Veterans Affairs
VA Maine Healthcare System
Police Department
1 VA Center 07B
Augusta, ME 04330
207 623-5796
Last Name First Name Middle
Physical Street Address City State and Zip Code
Social Security Number
Gender (M) (F)
Service Line or Company Name Company or Cell Phone Number
Date of Birth
Place of Birth Occupation Title
Personal email for activation of badge process
For Engineers to fill out:
Contract end date:
Service Line Official Date
All highlighted info must be submitted, or a badge cannot be issued
FOR TOG US POLICE USE ONLY
VISTA RECORDS:
DATE CHECKED BY RECORDS FOUND TYPE
VAPS RECORDS:
DATE CHECKED BY RECORDS FOUND TYPE
LOCAL RECORDS:
DATE CHECKED BY RECORDS FOUND TYPE
STATUS F YES NO ADVANCED TO HR
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File details come from the government source that posted it. Updated .