ATTACHMENT 5- - 1818 Pre-enrollment sample (2).pdf

PDF 175 KB Posted

Attached to
Replace Lights in Building 732, Bay 1 Federal contract opportunity
Solicitation number
SP3300-24-Q-0094
Issued by
Defense Logistics Agency Distribution

About this file

This document is a DLA Form 1818, which is a Privacy Act Statement and Visit Notification for access to the Defense Logistics Agency (DLA) installation in Ft. Belvoir, VA. The form provides the authority, purpose, routine uses, and voluntary disclosure requirements for visitor access to the DLA facility.

The related federal contract opportunity is for the replacement of lights in Building 732, Bay 1 at the DLA Distribution Susquehanna, PA (DDSP) location in New Cumberland, PA. The project is set aside 100% for Women-Owned Small Businesses, under NAICS code 236220 with a size standard of $45 million. The magnitude of the construction effort is between $100,000 and $250,000. The tentative solicitation issuance date is on or around March 29, 2024, and a pre-proposal/site visit will be conducted. The work must be completed within 120 calendar days of the Notice to Proceed. Award will be made to the lowest priced responsible offeror.

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Text version

PRIVACY ACT STATEMENT

VISIT NOTIFICATION

1. ACTIVITY TO BE VISITED

AUTHORITY:

PRINCIPAL PURPOSE:

ROUTINE USES:

DISCLOSURE:DEFENSE LOGISTICS AGENCY

8725 JOHN J. KINGMAN ROAD

FT BELVOIR, VA 22060-6220

Section 21, 50 U.S.C. 781 et seq.; Executive Order 10450.

To control access to and movement on DoD installations, buildings, or facilities.

Used by General Services Administration Protective Service Personnel for access control and for any of the Blanket Routine Uses published by DLA.

Voluntary. However, failure to provide all the requested information may result in refusal to grant access to the installation, building, or facility.

DLA PRIVACY ACT SYSTEM NOTICE S500.50 DLA-I APPLIES

SECTION I

2. NAME OF REQUESTOR/PREPARER 4. TELEPHONE3. OFFICE CODE

5. DATE(S) OF VISIT 6. POINT OF CONTACT (at facility to be visited) 7. POC TELEPHONE

8. PURPOSE OF VISIT

SECTION II

9.

NAME(S) OF VISITOR(S)

(Last, First, MI)

10.

GRADE/RANK

11.

SSN

12.

DATE OF BIRTH

13.

STATE /COUNTRY OF

BIRTH

14.

CLEARANCE/DATE

GRANTED

15.

TYPE OF INVESTIGATION/

DATE

16. TYPED NAME OF SECURITY REPRESENTATIVE

SECTION III

18. ACTIVITY 19. TELEPHONE NUMBER 20. DATE17. SIGNATURE OF SECURITY REPRESENTATIVE

DLA FORM 1818, JUL 96 (EG)

FROM: TO:

PDF (DLA)

RequesterName: Mogen Gilson
OfficeCode: J7/AB
FacPOC: Chad Shry
Phone: 717-770-4757
POCPhone: 717-770-4703
VisitedActivity: DLA DISTRIBUTION

Meet at PASS/ID

10:00 AM-11:00 AM

VisitPurpose: Site Visit: BLDG 732 Light Replacement

Visitor has registered utilizing the pre-enrollment website: https://dbids-global.dmdc.mil

DateTo: 4-23-2024
Visitor:
0: Doe, John M.
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