SOW Attachment 3 - PIV Badge Template.pdf
PDF 293 KB Posted
- Solicitation number
- 36C24124Q0323
About this file
This document appears to be a template for a PIV (Personal Identity Verification) Badge Request form for the Department of Veterans Affairs (VA) Maine Healthcare System. The template includes fields for the requestor's personal information, employment details, and required approvals. It indicates that all highlighted information must be submitted in order for a badge to be issued. This form is likely used to request and obtain access badges for personnel working on VA contracts or projects.
The related federal contract opportunity is for the provision of construction services to repair the concrete flooring of the 4th floor mechanical room in Building 207 at the VA Maine, Togus Campus. The solicitation number is 36C24124Q0323, and quotations are due no later than May 10, 2024 at 1:00 PM EST. The work is to be performed for the Department of Veterans Affairs, Veterans Health Administration, Veterans Integrated Service Network 1.
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Other files
| File | Type | Posted |
|---|---|---|
| 402-24-006 ICRA.pdf | ||
| SOW Attachment 2 - Togus Campus Map.pdf | ||
| SOW - B207 4th Floor Mechanical Floor Work .docx | DOCX document | |
| ME Wage Determinations 2-9-2024.pdf | ||
| Spec Package - 4th Floor Mechanical Floor Work.pdf | ||
| 36C24124Q0323.docx | DOCX document | |
| SOW Attachment 1 - Seasonal Influenza with Vaccines.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 .