W911SA-22-Q-3016 Attachment 4 Form 452.pdf
PDF 1 MB Posted
- Solicitation number
- W911SA-22-Q-3016
About this file
This document contains a federal contract solicitation and an installation access pass request form. The solicitation is for tanker purge services at multiple locations in Illinois, Indiana, Michigan and Ohio. The contractor will provide all labor, transportation, equipment, materials and supervision to perform the services in accordance with the performance work statement and task and frequency charts. The period of performance is from 15 February 2022 through 14 February 2023 with four additional one-year options and a six month option to extend services. Written questions are due by 18 January 2022, and the solicitation is set aside as 100% small business under NAICS code 811310 with a size standard of $8 million. The installation access pass request form collects information to determine suitability of individuals requesting access to Fort McCoy, including personal details, visit details, and sponsor information.
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Other files
| File | Type | Posted |
|---|---|---|
| W911SA-22-Q-3016 Attachment 3 Form 451.pdf | ||
| W911SA-22-Q-3016 Attachment 1 Price Schedule.xlsx | XLSX spreadsheet | |
| W911SA-22-Q-3016 Tanker Purge Solicitation SF1449.docx | DOCX document | |
| W911SA-22-Q-3016 Attachment 5 Wage Determinations.pdf | ||
| W911SA-22-Q-3016 Attachment 2 AT OPSEC.pdf |
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Fort McCoy Form 452 May 2021
AEM6.2 V 7.0
Page of Fort McCoy Form 452 February 2021 Obsolete Fort McCoy Installation Access Pass Request PRIVACY ACT STATEMENT AUTHORITY: The Privacy Act of 1974, Title 5 USC 552a. PRINCIPLE PURPOSE(S): To determine suitability of individual(s) requesting access to Fort McCoy. ROUTINE USE(S): Personal information may be disclosed to appropriate military and civilian emergency and investigation agencies to assist in determining suitability for access to Fort McCoy. DISCLOSURE: Voluntary, however failure to provide information will result in a refusal to grant access to Fort McCoy.
Legal Name as Appears on Driver's License or State ID: Example: John Edward Doe 25-Jan-15 24-Jan-16
MON-FRI 0700-1700 HOURS
Bldg 100 Commissary/TCI Example: Plumber/Bagger Last Name First Name Middle Name or NMN if non Begin Date End Date Work Access Hours Work Area/ Visit Location Company Name Employees Position/ Event Remarks Block (At a minimum include: purpose for access; contract number and expiration date) ** Note: If access is for contract purpose, Sponsor will be the COR. In all cases, Sponsor must be affiliated with Fort McCoy. ***NCIC-III Check Date, PS Specialist and PS Specialist Signature for DES USE ONLY**** When complete submit to: usarmy.mccoy.id-readiness.mbx.des-physical-security-iacs-form@mail.mil Legal Name as Appears on Driver's License or State ID: Example: John Edward Doe 25-Jan-15 24-Jan-16
MON-FRI 0700-1700 HOURS
Bldg 100 Commissary/TCI Example: Plumber/Bagger Last Name First Name Middle Name or NMN if non Begin Date End Date Work Access Hours Work Area/ Visit Location Company Name Employees Position/ Event 11.0.0.20130303.1.892433.887364 280-4222
DHR ASD
Trudy L. Ward FMF452_Fort McCoy Installation Access Pass Request 20210212 20210212
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