W911SA-20-Q-3019_Attachment_7_Form_451.xlsx

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Attached to
Custodial Services
Solicitation number
W911SA-20-Q-3019
Issued by

About this file

This document contains a federal contract solicitation and related files. The solicitation is for custodial services to be provided at a military installation in Nebraska. The contractor will provide all labor, transportation, equipment, materials and supervision to perform custodial services in accordance with the performance work statement. The period of performance is from February 2020 through January 2021 with five one-year option periods to extend services. The procurement is set aside for small businesses with a NAICS code of 561720 and size standard of $19.5 million. The site visit will be held on October 30th and questions are due by November 5th. The solicitation can be found on FBO and interested parties should monitor the site for amendments.

The related files include a template for requesting installation access and conducting background checks for contract personnel. It collects personal information for security screening and granting access to military bases. Information provided is voluntary but required for entry.

W911SA-20-Q-3019 Attachment 7 Form 451

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Text version

Sheet1

88th RD Installation Access NCIC-III Check Request V 1.6 (18 JAN 2019)
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 Military Installations. This information will be used to generate state and federal criminal history records checks. 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 Military Installations. DISCLOSURE: Voluntary; however failure to provide information will result in a refusal to grant access to Military Installations.
Legal Name as Appears on Driver's License or State ID. Example: John Edward DoeM29-Apr-64F123-4567-8912-54WI25-Jan-1924-Jan-20MON-FRI 0700-1700 HOURSBldg 100Commissary / TCIExample: Plumber / Bagger
Last NameFirst NameMiddle name or "NMN" if noneSEX
(M/F)DOB:DRIVERS LICENSE NUMBERDRIVERS LICENSE STATEBEGIN DATEEND DATEWORK ACCESS HRSWORK AREA/ VISIT LOCATIONCOMPANY NAMEEMPLOYEES POSITION/ EVENT

BELOW INFORMATION IS TO BE COMPLETED BY 88TH RD CONTRACTING OFFICER REPRESENTATIVE Remarks Block (At a minimum include Purpose for Access, Contract number and expiration date if Applicable)

Contract info: (Number, Exp Date)

Sponsor Name (first, MI, Last)Sponsor Phonemailto:usarmy.mccoy.imcom-central.list.des-physical-security@mail.mil
Sponsor Name OrganizationSponsor Email
*** Note If Access is for Contract purpose Sponsor will be the COR*** In all Cases Sponsor must be affiliated with 88th RD***
88th RD FORM 451 (ALL PREVIOUS VERSIONS ARE OBSOLETE)

&"-,Bold"FOUO

Page &P 88th RD FM Form 451 V 1.6 (18 JAN 2019) FOUO

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