DD369 - Police Record Check.pdf

PDF 41 KB Posted Aug 12, 2020

Attached to: Apron Lighting System Construction 156th AW PR ANG Federal contract opportunity
Solicitation number: W50S9320B5017
Issued by: Department of the Army National Guard

About this file

Written by GovTribe AI · Dec 28, 2023

This federal solicitation is for the construction of a new apron lighting system at the 156th Airlift Wing of the Puerto Rico Air National Guard. Key details include the project magnitude being between $500,000 to $1,000,000, a 365 day period of performance after notice to proceed, a 15% minimum self-performance requirement, and NAICS code 236220 with a small business size standard of $36.5 million. Questions are due by August 26th and the solicitation will issue on or around August 28th. A mandatory site visit is scheduled for August 19th. The bid due date is September 26th. The procurement is set aside 100% for small businesses and will be awarded without discussions to the responsive responsible bidder offering the lowest price.

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Other files for this federal contract opportunity

Other files attached to Apron Lighting System Construction 156th AW PR ANG, newest first.
File	Type	Posted
NRA_Notification_70 feet poles.pdf	PDF	Sep 12, 2020
NRA_Notification_80 feet poles.pdf	PDF	Sep 12, 2020
PRANG Construct Apron Lighting_B-3 Final Design Submission_SPECIFICATIONS_26JUNE2020 (002).pdf	PDF	Aug 11, 2020
PRANG Construct Apron Lighting_B-3 Final Design Submission_DRAWINGS_26JUNE2020 (002).pdf	PDF	Aug 11, 2020
QASP - TUMR112120 CONSTRUCT APRON LIGHTING SYSTEM.pdf	PDF	Aug 11, 2020
3. SOW - TUMR 112120.pdf	PDF	Aug 11, 2020
Form_813_Construct_Apron_Lighting.pdf	PDF	Aug 11, 2020

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DRAFT

PREVIOUS EDITION IS OBSOLETE.

Page of

DD FORM 369, APR 2019

Prescribed By: DoDI 1304.02

POLICE RECORD CHECK

Police Record Check OMB No. 0704-0007 OMB approval expires March 31, 2021 OMB No. 0704-0007 OMB approval expires March 31, 2021 The public reporting burden for this collection of information is estimated to average 27 minutes per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing the burden, to the Department of Defense, Washington Headquarters Services, at whs.mc-alex.esd.mbx.dd-dod-informationcollections@mail.mil. Respondents should be aware that notwithstanding any other provision of law, no person shall be subject to any penalty for failing to comply with a collection of information if it does not display a currently valid OMB control number.

PLEASE DO NOT RETURN YOUR FORM TO THE ABOVE ORGANIZATION. RETURN COMPLETED FORM TO ADDRESS SHOWN AT BOTTOM OF FORM.

AGENCY DISCLOSURE NOTICE

SECTION I - (To be completed by Recruiting Service) SECTION I - (To be completed by Recruiting Service)

3. SEX

4. PLACE OF BIRTH

6. A. ETHNICITY

6. B. RACE (Select one or more)

8. ADDRESS IN ADDRESSEE'S JURISDICTION (See "MAIL TO" block)

9. DATES RESIDED AT THIS ADDRESS

10. PERSON MAKING THIS REQUEST

SECTION II - (To be completed by Applicant) SECTION II - (To be completed by Applicant)

PRIVACY ACT STATEMENT

AUTHORITY: 10 U.S.C. Sections 136, 504, 505, 12102; 14 U.S.C. Sections 351 and 632; DoDI 1304.2; DoDI 1304.26; and E.O. 9397 (SSN), as amended.

PRINCIPAL PURPOSE(S): The information collected on this form is used to screen and identify applicants to the Armed Forces who may have discreditable involvement with the police or other law enforcement agencies. Completed forms are used to conduct background records checks used to determine eligibility of applicants for accession into the Armed Forces. Completed forms are covered by recruiting and official military personnel SORNs maintained by each of the Services.

ROUTINE USE(S): The routine uses are found in the associated system of records notices listed below:

DoDM 1145.02, Military Entrance Processing Station (MEPS); https://www.esd.whs.mil/Portals/54/Documents/DD/issuances/dodm/114502m.pdf?ver=2018-07-23-121425-917 A0601-210c TRADOC, Army Recruiting Prospect System; http://dpcld.defense.gov/Privacy/SORNsIndex/DOD-wide-SORN-Article-View/Article/570073/a0601-210c-tradoc/ F036 AETC R, Air Force Recruiting Information Support System (AFRISS) Records; http://dpcld.defense.gov/Privacy/SORNsIndex/DOD-wide-SORN-Article-View/Article/569780/f036-aetc-r/ M01133-3, Marine Corps Recruiting Information Support System (MCRISS); http://dpcld.defense.gov/Privacy/SORNsIndex/DOD-wide-SORN-Article-View/Article/570628/m01133-3/ N01133-2, Recruiting Enlisted Selection System; http://dpcld.defense.gov/Privacy/SORNsIndex/DOD-wide-SORN-Article-View/Article/570318/n01133-2/ DHS/USCG-027, Recruiting Files System of Records; http://www.gpo.gov/fdsys/pkg/FR-2011-08-10/html/2011-20225.htm

DISCLOSURE: Voluntary. However, failure of the applicant to complete Section II may result in refusal of enlistment in the Armed Forces of the United States. An applicant's SSN is used to conduct the police records check and keep all records together during the enlistment process.

PRIVACY ACT STATEMENT

11. I HEREBY CONSENT TO RELEASE YOUR FILES FROM THE INFORMATION REQUESTED BELOW.

SECTION III - (To be completed by Police or Juvenile Agency) SECTION III - (To be completed by Police or Juvenile Agency) The person described above, who claims to have resided at the address shown above, has applied for enlistment in the Armed Forces of the United States. Please furnish from your files the information relative to Section III below. A return envelope is provided for your convenience.

The person described above, who claims to have resided at the address shown above, has applied for enlistment in the Armed Forces of the United States. Please furnish from your files the information relative to Section III below. A return envelope is provided for your convenience.

12. DOES THE APPLICANT HAVE A POLICE OR JUVENILE RECORD, TO INCLUDE MINOR TRAFFIC VIOLATIONS?

13. IS APPLICANT NOW UNDERGOING COURT ACTION OF ANY KIND?

THIS IS TO CERTIFY THAT THE ABOVE DATA, AS CORRECTED, ARE TRUE AND CORRECT ACCORDING TO THE RECORD ON FILE IN THIS OFFICE. THIS INFORMATION IS CONFIDENTIAL AND CANNOT BE USED IN ANY OTHER MANNER EXCEPT FOR OFFICIAL PURPOSES.

9.0.0.2.20120627.2.874785

DD 369 - POLICE RECORD CHECK

CurrentPage:
PageCount:
1. DATE OF REQUEST (YYYYMMDD):
2. NAME OF APPLICANT (Last, First, Middle Name(s), Alias):
Male: 0
Female: 0
4. A. CITY:
4. B. COUNTY:
4. C. State:
5. DATE OF BIRTH	(YYYYMMDD):
6. (1) HISPANIC OR LATINO: 0
6. (2) NOT HISPANIC OR LATINO: 0
(1) AMERICAN INDIAN/ALASKA NATIVE: 0
(2) ASIAN: 0
(3) BLACK OR AFRICAN AMERICAN: 0
(4) NATIVE HAWAIIAN OR OTHER PACIFIC ISLANDER: 0
(5) WHITE: 0
7. SOCIAL SECURITY NUMBER:
8. A. NUMBER AND STREET (include apartment no.):
8. B. CITY:
8. C. STATE:
8. D. ZIPCODE:
9. A. FROM (YYYYMMDD):
9. B. TO (YYYYMMDD):
10. A. NAME (Last, First, Middle Name(s)):
10. B. RANK:
10. C. SIGNATURE:
10. D. TITLE:
12 SIGNATURE:
14. YES: 0
14. YES: 0
15. NO: 0
15. NO: 0
12. (if YES, what was the offense or charge, date, disposition and sentence?):
13. (if YES, give details.):
14. DATE (YYYYMMDD):
15. TITLE:
16. VERIFIED BY (Signature):
LAW ENFORCEMENT AGENCY

MAIL TO::

RECRUITING AGENCY

MAIL FROM::

File details come from the government source that posted it. Updated Aug 13, 2020.