WG FORM 113 (CAO OCT 2023).pdf

PDF 356 KB Posted

Attached to
Roof Replacement BLDG 2040/3010 Federal contract opportunity
Solicitation number
W50S8224B0001
Issued by
Department of the Army Maryland Army National Guard

About this file

Written by GovTribe AI ·

This document outlines requirements for a roof replacement project at the Maryland Air National Guard in Baltimore, Maryland. The solicitation seeks bids to repair and replace the roofs of Buildings 3010 and 2040, with a project value between $500,000 and $1,000,000. The NAICS code is 238160 for roofing contractors and the size standard is $19 million. A pre-proposal meeting will be held on February 29, 2024 at 10:00 AM EST, followed by a site visit, which will be the only site visit conducted. Questions about the solicitation are due by March 12, 2024. Bids must be submitted by March 20, 2024 at 1:00 PM EST. The opportunity is set aside for 100% HUBZone small businesses and is issued by the Department of the Army Maryland Army National Guard.

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175 WG Form 113, 20220323 Page 1 of 3

INSTALLATION ACCESS APPLICATION

AUTHORITY: Title 10, United States Code 8012. PRINCIPAL PURPOSE: To assist security personnel in establishing a fitness determination through the identity proofing and vetting process. ROUTINE USES: To be utilized by personnel requesting to obtain installation access pass for Warfield Air National Guard Base or for special one-time events. DISCLOSURE: Disclosure of the requested information is voluntary; however, failure to provide information may result in denial of request or the refusal by the Security Forces Squadron, Installation Access Control Section to permit access to the installation.

"FOUO, This document contains information exempt from mandatory disclosure under the FOIA. Title 5 U.S.C. 552 (b) (6) applies.

This document also contains personal information that is protected by the Privacy Act of 1974 and must be safeguarded from unauthorized disclosure."

SPECIAL SECURITY REQUIREMENTS: : IAW DoDM-5200.08 Volume 3, AFMAN 31-101 Volume 3, paragraph 1.1.g.(1)(b), It is the sponsoring organization's responsibility to ensure the visit is properly recorded and documented in the FVS, and the local AFOSI unit is coordinated with in advance of the official foreign visitors' arrival and prior to their departure from the installation. On the day of visit and when the FOREIGN VISITORS have departed the installation, email AFOSI, at AFOSI.FIS7.EC@us.af.mil indicating time of arrival and departure from the installation.

The following information has been provided to aid in the completion of the Access Request. Section I:

Sponsor Information.

Block 1. Title The sponsors title (ie; Mr., Ms., Mrs., or associated rank of Military/GS employee).

Block 2. Last Name, First Name MI (Full name of sponsor, use format assigned).

Block 3. Duty Phone (Office number you can be reached at during business hours).

Block 4. Cell/Home Phone (Phone number you may be reached at during requested access times for your guests).

Block 5. DoD ID Number (Assigned number on your DoD ID Card-This is required to fully identify you in DBIDS).

Block 6. Organization/Home Address (If you are sponsoring for a government purpose use your organization. If it is for personal reasons use your home address).

Block 7. Email Address (email submissions will be sent encrypted utilizing a .mil email address).

Section II: Access Details.

Block 8. Category for Access (Check the category of your guest).

Block 9 Location (Check which location(s) in the Warfield Air National Guard base area you are requesting your guests to have access to – Must be a valid need for entry to these locations. Contractor/Vendors must provide contract number stating access locations are required).

Block 10. Time Frame

From Date (Start date of visit/contract, etc…) To Date (End date of visit/contract, etc…)

From Time (Start time of visit or if continual access, start time each day) To Time (End time of visit or if continual access, end time each day)

Days of Week (Days of week entry is required - If visiting select day(s) visit will take place, if continual access is required – actual days of work required to be present)

Block 11. Reason for Access. Provide specific reason for access (ie; Meeting, Tow Truck, Pop-A-Lock, Taxi, Wedding, Family visit, etc…).

Block 12. Identify the Visiting Organization, Name of Event or if Contractor: Company Name (Prime and Sub Contractor), Contract Number and

Contract Period.

Block 13a, b, c: Sponsor completes each block. Must be legible when completed manually.

Section III: Visitor Center Use Only.

Section IV: Foreign Disclosure Office Use Only.

Section V: Guest Information.

FOREIGN VISITORS must be processed through the Foreign Disclosure Office. Email completed form to 175.WG.PA@us.af.mil

For more than 20 visitors [Special Event] use continuation sheets).

Block 16. Fill in the blocks [alphabetical order] for all visitors 18 years of age or older.

Last Name, First Name MI (Full name of visitor, use format assigned).

DOB: Date of Birth (Use format assigned).

Country (Country of birth for foreign visitors).

ID Type: Must be a valid form of photo ID. Below are acceptable forms. Use the corresponding number when making your selection.

1 = Driver's License 2 = State Identification Card 3 = Veteran's Identification Card 4 = Passport/Visa 5 = Permanent Residence Card 6 = US Citizenship & Immigration Services 7 - Foreign Visitor

ID Number (The associated number assigned to the ID Type) Country of Issue (Country where identification was issued) State of Issue (State where identification was issued) If a tracking number is assigned, the sponsor will relay the number to their guest(s) for announcement at a visitor center. This will allow the Visitor Center Personnel to track completed paperwork for issuance of an access credential.

mailto:AFOSI.Det333@us.af.mil mailto:%20XXX@us.af.mil

175 WG Form 113, 20220323 Page 2 of 3

I. SPONSOR INFORMATION

1. TITLE 2. LAST NAME, FIRST NAME, MI 3. DUTY PHONE 4. ALTERNATE CONTACT NUMBER 5. DOD ID NUMBER

6. ORGANIZATION/HOME ADDRESS 7. EMAIL ADDRESS

II. ACCESS DETAILS

8. CATEGORY OF ACCESS

Contractor/Vendor

Personal Services

Visitor/Volunteer

Special Event

Foreign National

9. PASS TYPE (If Applicable)

DBIDS Badge

AF75 Visitors pass

Real ID

10. TIME FRAME

From Date: Sunday

From Time: Monday

Tuesday

Wednesday

To Date: Thursday

To Time: Friday

Saturday

11. REASON FOR ACCESS (Be Specific)

12. CONTRACTED COMPANY SPONSORED OR SPECIAL EVENT NAME

13a. DATE OF SIGNATURE 13b. NAME, GRADE/RANK, OFFICE SYMBOL, AND TITLE OF SPONSOR 13d. SIGNATURE

III. VISITOR CENTER USE ONLY

14a. TRACKING NUMBER

14b. RECEIVED DATE

NCIC III

NCIC DQ

NCIC QW

AFJIS

14c. VETTED DATE 14d. POSTED DATE (For EAL Use)

14e. ECP POSTED LOCATION (For EAL Use)

14f. DATE OF SIGNATURE 14g. NAME, GRADE/RANK, OFFICE SYMBOL, AND TITLE OF VERIFIER 14h. SIGNATURE

IV. FOREIGN DISCLOSURE OFFICE (FDO) USE ONLY

15a. CASE NAME 15b. VETTED DATE

Approved Denied

15c. DATE OF SIGNATURE 15d. NAME, GRADE/RANK, OFFICE SYMBOL, AND TITLE OF VERIFIER 15e. SIGNATURE

175 WG Form 113, 20220323 Page 3 of 3

V. GUEST INFORMATION

16. Enter information for all persons 18 years of age or older (in alphabetical order). Refer to page 1 for instructions.

TRACKING NUMBER

S O R T

Last Name, First Name, MI

DOB YYYMMDD/

Last 4 SSN

Country of Birth

ID

Type

ID

Number

Country of Issue

State of

Issue VCC Use Only

I SPONSOR INFORMATION:
1 TITLE:
2 LAST NAME FIRST NAME MI:
3 DUTY PHONE:
4 ALTERNATE CONTACT NUMBER:
5 DOD ID NUMBER:
6 ORGANIZATIONHOME ADDRESS:
7 EMAIL ADDRESS:
II ACCESS DETAILS:
ContractorVendor: On
Personal Services: On
VisitorVolunteer: On
DBIDS: On
From Date:
undefined:
To Date:
undefined_4:
undefined_5:
Sunday: Off
Monday: Off
Tuesday: Off
Wednesday: Off
Thursday: Off
Friday: Off
Saturday: Off
11 REASON FOR ACCESS Be Specific:
12 CONTRACTED COMPANY SPONSORED OR SPECIAL EVENT NAME:
13a DATE OF SIGNATURE:
13b NAME GRADERANK OFFICE SYMBOL AND TITLE OF SPONSOR:
13d SIGNATURE:
III VISITOR CENTER USE ONLY:
14a TRACKING NUMBER:
14c VETTED DATE:
14d POSTED DATE For EAL Use:
14b RECEIVED DATE:
NCIC III: Off
SFMIS: Off
ALERTS: Off
TSDB: Off
14e ECP POSTED LOCATION For EAL Use:
14f DATE OF SIGNATURE:
14g NAME GRADERANK OFFICE SYMBOL AND TITLE OF VERIFIER:
14h SIGNATURE:
IV FOREIGN DISCLOSURE OFFICE FDO USE ONLY:
15a CASE NAME:
15b VETTED DATE:
Approved: Off
Denied: Off
15c DATE OF SIGNATURE:
15d NAME GRADERANK OFFICE SYMBOL AND TITLE OF VERIFIER:
15e SIGNATURE:
State:
Last Name First Name MI:
DOB DDMMMYY:
Country of Birth:
ID Type:
ID Number:
Country of Issue:
State of Issue:
VCC Use Only:
Last Name First Name MI_2:
DOB DDMMMYY_2:
Country of Birth_2:
ID Type_2:
ID Number_2:
Country of Issue_2:
State of Issue_2:
VCC Use Only_2:
Last Name First Name MI_3:
DOB DDMMMYY_3:
Country of Birth_3:
ID Type_3:
ID Number_3:
Country of Issue_3:
State of Issue_3:
VCC Use Only_3:
Last Name First Name MI_4:
DOB DDMMMYY_4:
Country of Birth_4:
ID Type_4:
ID Number_4:
Country of Issue_4:
State of Issue_4:
VCC Use Only_4:
Last Name First Name MI_5:
DOB DDMMMYY_5:
Country of Birth_5:
ID Type_5:
ID Number_5:
Country of Issue_5:
State of Issue_5:
VCC Use Only_5:
Last Name First Name MI_6:
DOB DDMMMYY_6:
Country of Birth_6:
ID Type_6:
ID Number_6:
Country of Issue_6:
State of Issue_6:
VCC Use Only_6:
Last Name First Name MI_7:
DOB DDMMMYY_7:
Country of Birth_7:
ID Type_7:
ID Number_7:
Country of Issue_7:
State of Issue_7:
VCC Use Only_7:
Last Name First Name MI_8:
DOB DDMMMYY_8:
Country of Birth_8:
ID Type_8:
ID Number_8:
Country of Issue_8:
State of Issue_8:
VCC Use Only_8:
Last Name First Name MI_9:
DOB DDMMMYY_9:
Country of Birth_9:
ID Type_9:
ID Number_9:
Country of Issue_9:
State of Issue_9:
VCC Use Only_9:
Last Name First Name MI_10:
DOB DDMMMYY_10:
Country of Birth_10:
ID Type_10:
ID Number_10:
Country of Issue_10:
State of Issue_10:
VCC Use Only_10:
Last Name First Name MI_11:
DOB DDMMMYY_11:
Country of Birth_11:
ID Type_11:
ID Number_11:
Country of Issue_11:
State of Issue_11:
VCC Use Only_11:
Last Name First Name MI_12:
DOB DDMMMYY_12:
Country of Birth_12:
ID Type_12:
ID Number_12:
Country of Issue_12:
State of Issue_12:
VCC Use Only_12:
Last Name First Name MI_13:
DOB DDMMMYY_13:
Country of Birth_13:
ID Type_13:
ID Number_13:
Country of Issue_13:
State of Issue_13:
VCC Use Only_13:
Last Name First Name MI_14:
DOB DDMMMYY_14:
Country of Birth_14:
ID Type_14:
ID Number_14:
Country of Issue_14:
State of Issue_14:
VCC Use Only_14:
Last Name First Name MI_15:
DOB DDMMMYY_15:
Country of Birth_15:
ID Type_15:
ID Number_15:
Country of Issue_15:
State of Issue_15:
VCC Use Only_15:
Last Name First Name MI_16:
DOB DDMMMYY_16:
Country of Birth_16:
ID Type_16:
ID Number_16:
Country of Issue_16:
State of Issue_16:
VCC Use Only_16:
Last Name First Name MI_17:
DOB DDMMMYY_17:
Country of Birth_17:
ID Type_17:
ID Number_17:
Country of Issue_17:
State of Issue_17:
VCC Use Only_17:
Last Name First Name MI_18:
DOB DDMMMYY_18:
Country of Birth_18:
ID Type_18:
ID Number_18:
Country of Issue_18:
State of Issue_18:
VCC Use Only_18:
Last Name First Name MI_19:
DOB DDMMMYY_19:
Country of Birth_19:
ID Type_19:
ID Number_19:
Country of Issue_19:
State of Issue_19:
VCC Use Only_19:
Last Name First Name MI_20:
DOB DDMMMYY_20:
Country of Birth_20:
ID Type_20:
ID Number_20:
Country of Issue_20:
State of Issue_20:
VCC Use Only_20:
Last Name First Name MI_21:
DOB DDMMMYY_21:
Country of Birth_21:
ID Type_21:
ID Number_21:
Country of Issue_21:
State of Issue_21:
VCC Use Only_21:
Last Name First Name MI_22:
DOB DDMMMYY_22:
Country of Birth_22:
ID Type_22:
ID Number_22:
Country of Issue_22:
State of Issue_22:
VCC Use Only_22:
Last Name First Name MI_23:
DOB DDMMMYY_23:
Country of Birth_23:
ID Type_23:
ID Number_23:
Country of Issue_23:
State of Issue_23:
VCC Use Only_23:
Last Name First Name MI_24:
DOB DDMMMYY_24:
Country of Birth_24:
ID Type_24:
ID Number_24:
Country of Issue_24:
State of Issue_24:
VCC Use Only_24:
Last Name First Name MI_25:
DOB DDMMMYY_25:
Country of Birth_25:
ID Type_25:
ID Number_25:
Country of Issue_25:
State of Issue_25:
VCC Use Only_25:
175 WG Form 113 20220323:
AF75: On
Real ID: On
Special Event: On
Foreign: On

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