06a - DBIDs Roster.xlsx
XLSX spreadsheet 135 KB Posted
- Solicitation number
- N6247321R3429
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Cover Sheet
Roster
MCB CAMP PENDLETON DBIDS SPONSORED EMPLOYEE ROSTER
| PRIVACT ACT STATEMENT |
| SORN DMDC 10 DoD |
AUTHORITY: 10 U.S.C. 113, Secretary of Defense; 10 U.S.C. 136, Under Secretary of Defense for Personnel and Readiness; DoD Directive 1000.25, DoD Personnel Identity Protection (PIP) Program; DoD Instruction 5200.08, Security of DoD Installations and Resources and the DoD Physical Security Review Board (PSRB); DoD 5200.08-R, Physical Security Program; and E.O. 9397 (SSN), as amended.
PRINCIPLE PURPOSE: The records support DoD physical security programs, to issue individual facility/installation access credentials, and for identity verification purposes. The system also is used to record personal vehicles and property registered with the DoD and for producing facility management reports. The records may be accessed by other physical access control systems for further verification at other sites. Records may also be used for law enforcement purposes.
ROUTINE USES: In addition to those disclosures generally permitted under 5 U.S.C. 552a(b) of the Privacy Act of 1974, as amended, the records contained herein may specifically be disclosed outside the DoD as a routine use pursuant to 5 U.S.C. 552a(b)(3) as follows: Law Enforcement Routine Use, Congressional Inquiries Disclosure Routine Use, Disclosures Required by International Agreements Routine Use, Disclosure to the Department of Justice for Litigation Routine Use, Disclosure of Information to the National Archives and Records Administration Routine Use, Data Breach Remediation Purposes Routine Use. The DoD Blanket Routine Uses set forth at the beginning of the Secretary of Defense (OSD) compilation of systems of records notices may apply to this system. DISCLOSURE: Disclosure of this information is voluntary; however, failure to provide the requested information may impede, delay or prevent processing of sponsorship.
| COMPANY REPRESENTATIVE / SPONSOR'S STATEMENT OF UNDERSTANDING |
| I ACKNOWLEDGE THAT I AM SUBMITTING/SPONSORING THE BELOW INDIVIDUAL(S) AS EMPLOYEES FROM MY COMPANY FOR ACCESS TO MARINE CORPS BASE, CAMP PENDLETON (MCB CAMPEN). I UNDERSTAND ALL PERSONS DESIRING ACCESS TO THE INSTALLATION ARE SUBJECT TO ALL SECURITY AND BASE ACCESS REQUIREMENTS, INCLUDING A BACKGROUND CHECK. |
I UNDERSTAND THE LISTED PERSONS WILL BE ALLOWED ACCESS TO MCB CAMPEN FOR A PERIOD NOT TO EXCEED 1 YEAR. IF AN EXTENSION IS DESIRED, AN UPDATED SPONSORSHIP REQUEST MUST BE SUBMITTED TO THE PROVOST MARSHAL'S OFFICE (PMO) .
I UNDERSTAND THIS SPONSORSHIP IS FOR INSTALLATION ACCESS PURPOSES ONLY FOR WORK, SUCH AS IN FULFILLMENT OF A CONTRACT. I WILL NOTIFY THE PMO WHEN I AM OR MY COMPANY ARE NO LONGER INTERESTED IN SPONSORING THE BELOW PERSON(S) ABOARD MCB CAMPEN.
I UNDERSTAND THIS REQUEST WILL BE REJECTED IF THE INFORMATION IS INCOMPLETE, INCORRECT, OR ILLEGIBLE. I UNDERSTAND THAT ADDITIONAL INFORMATION IS AVAILBLE AT: https://www.pendleton.marines.mil/Base-Access/
| INSTRUCTIONS |
| 1. COMPLETE THE SPONSOR DATA SECTION (B25:L25). 2. COMPLETE THE EMPLOYEE DATA SECTION (A30:L30) FOR EACH EMPLOYEE, FOLLOWING THE GUIDELINES IN RED. 3. USING A PREVIOUSLY AUTHORIZED EMAIL ADDRESS, SUBMIT THIS ROSTER TO: PNDL_CPENDBIDS@usmc.mil. DO NOT ALTER THE ROSTER OR CONVERT IT TO PDF. 4. TO ALLOW FOR PROCESSING TIME, DIRECT YOUR EMPLOYEE(S) TO WAIT FOUR (4) BUSINESS DAYS (MON-THUR) FROM THE DATE THIS ROSTER IS SUBMITTED AND THEN REPORT TO BASE ACCESS CONTROL (BLDG 41501T) FOR PASS ISSUANCE. 5. THIS ROSTER MUST BE SUBMITTED IN MICROSOFT® EXCEL® FORMAT. OTHER FORMATS WILL BE REJECTED. QUESTIONS - CALL (760) 763-7604/7605. |
| SPONSOR DATA | Sponsor Company | Sponsor Last Name | Sponsor First Name | Sponsor Phone ###-###-#### | Reason / Type of Work Performed | Contract Number | Contract End Date | Government Sponsor Last Name | Government Sponsor First Name | Government Sponsor Organization | Government Sponsor DOD ID (10 digit) |
| Site Walk | 21R3429 PTO X001 | 7/29/21 | Krause | Kellee | NAVFAC SW FEAD Camp Pendleton | 1147351689 |
| EMPLOYEE DATA | State Driver's License or ID Card Issued By | State Credential Identifier / Passport Number | Expiration Date of Sponsorship | Mon Hours (USE DROPDOWN) | Tue Hours (USE DROPDOWN) | Wed Hours (USE DROPDOWN) | Thur Hours (USE DROPDOWN) | Fri Hours (USE DROPDOWN) | Sat Hours (USE DROPDOWN) | Sun Hours (USE DROPDOWN) | |
| Name Last | Name First | Two letter abbreviation of State or Province where Driver License or Identificaiton Card issued from. Examples: California = CA / Passport = USA | State DL or ID Number or Passport Number. Please include any hyphens or other punctuation. | Date the sponsorship ends. Example: 7/31/2021. Maximum duration = 1 year. | Time Range (e.g. 0600-1900) the Contractor requires access from available dropdown list. | Time Range (e.g. 0600-1900) the Contractor requires access from available dropdown list. | Time Range (e.g. 0600-1900) the Contractor requires access from available dropdown list. | Time Range (e.g. 0600-1900) the Contractor requires access from available dropdown list. | Time Range (e.g. 0600-1900) the Contractor requires access from available dropdown list. | Time Range (e.g. 0600-1900) the Contractor requires access from available dropdown list. | Time Range (e.g. 0600-1900) the Contractor requires access from available dropdown list. |
| 7/29/21 | 0600-1900 | ||||||||||
| 7/29/21 | 0600-1900 |
(Rev. 8/20)
Hours DropDown
| 0000-2359 |
| 0430-2230 |
| 0600-1900 |
| 0700-1730 |
| 0900-1600 |
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