TE 06B - Sample Network Access Request Form.pdf

99 KB Posted

Attached to
HVAC Automated Logic Controls (ALS) Services Amend 1
Solicitation number
W91QF4-23-Q-0043
Issued by

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This document contains a sample network access request form and information about a related federal contract opportunity. The form is a template requesting computer network extension access for a contract employee providing on-site technical support services at Fort Leavenworth, Kansas. It collects identifying information such as the employee's name, SSN, DOB, clearance status and date, installation point of contact, contract details including dates and CAGE code, and email address.

The related federal contract opportunity is solicitation number W91QF4-23-Q-0043 for HVAC Automated Logic Controls (ALS) services amendments. It is being issued by the Department of the Army Materiel Command Mission and Installation Contracting Command at Fort Eustis for unspecified HVAC ALS services. No further details are provided regarding required products or services, response dates, or other salient information.

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Business names

Date

Ed Rolling Garrison Security Manager 290 Grant Ave Fort Leavenworth, KS 66027-1360

Re: Request Computer Network Extension Access for Contract Employee – Employee Name

Dear Mr. Rolling:

I respectfully request computer network access for an employee of XXXXX, Inc. providing on-site technical support services for the Directorate of Public Works at Fort Leavenworth, Kansas. The following information identifies this individual:

Name:

SSN:

DOB:

Clearance Status:

Clearance Date:

Type of Investigation:

Installation Point of Contact:

Contract:

Contract Dates:

Cage Code :

Email address:

NAME

123-45-6789 01-02-1234 None N/A None

Dates

XXXXX

Please feel free to contact me at (XXX) XXX-XXXX if you have questions or require any additional information regarding this request.

Sincerely, Signature Block

File details come from the government source that posted it. Updated .