12 - Base Access Instructions.pdf

Site Visit Instructions

1.) An organized site visit has been scheduled for XX July 2023 at 10:00 a.m MST

2.) Participants will meet at:

Holloman AFB Welcome Center Building 1 (right outside the main entrance, off US Highway 70) Holloman AFB, NM 88330 For additional Information: (575) 572-3993 or (575) 572-3048

*Should a larger venue be required the revised location shall be posted to this notice as well as at the location above. Please ensure that you arrive 15 minutes early as we will begin promptly at 10:00 a.m.

3.) In order to access Holloman AFB to attend the site visit, the contractor must provide a completed Visitor Access Request Form (Attachment 10) to the Holloman AFB Contracting Office via email to Mr.

John Seamon at 49cons.pkb.macc24@us.af.mil. This form will be filled out following all instructions contained within and at Attachment 11 (NCIC Base Access). This information must be provided no later than XX July 2023 by 12:00 p.m. MST. Please ensure that all attendees have a Photo Identification Card (e.g. driver’s license) available when processing through the gate.

PLEASE NOTE: The Holloman AFB Contracting Office is not responsible for failure on the part of a potential offeror to complete this process as required for base access.

4.) IMPORTANT DATES:

-XX July 2023, by 12:00 PM MST: Completed VAR provided to Contracting Office -XX July 2023, by 12:00 PM MST: Written QUESTIONS pertaining to RFP provided to the Contracting Office -XX July 2023, at 10:00 AM MST: SITE VISIT held -XX July 2023, at 3:00 PM MST: Additional written QUESTIONS generated as a result of the site visit provided to the Contracting Office.

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CUI

HOLLOMAN AFB

VISIT ACCESS REQUEST (VAR)

MEMORANDUM FOR: 49 SFS/S5AV (49 SFS Pass and Registration) (UDG_49SFS_VARandEAL@us.af.mil)

FROM:

SUBJECT: Contractor Visit Access Request (VAR) References:

a. Contract Number: ______________ Contract Title: ______________

b. Start Date: ____________________ End Date: __________________

c. Requesting Office: _______________________

d. Requesting Office Phone: _________________

e. HAFB Point of Contact:

Name______________________________________________ Telephone #_________________________________________ E-mail address _______________________________________

VAR's may be used for multiple contracts for the same company and may take up five (5) days to process.

Request that a visitor pass be issued to the contractor(s) listed below. All employees will be briefed on and shall comply with HAFB security requirements. All employees have signed the government provided consent form authorizing the U.S. Government (United States Air Force) to conduct a background check to confirm their eligibility to be granted access to HAFB, NM. Contractors denied unescorted entry as a result of their background check may be approved for escorted entry by the 49 SFS/CC. Escort authority will ONLY be granted to the project manager or project superintendent (maximum of three (3) three escorts per VAR designated by asterisk on a VAR and has completed a Escort Responsibility Form), or a contractor with a valid DoD Common Access Card (CAC) may also escort employees approved for escorted entry. Contractor escort authority is limited to ONLY those employees approved for escorted entry. EXCEPTION: The project manager or project superintendent, or a contractor with a valid DoD CAC may escort non-routine pickups and deliveries. Pickup/delivery drivers will provide a bill of lading at the time of pass issuance; passes will not exceed six (6) hours. Routine pickups and deliveries require the contractor add the driver(s) to a VAR to undergo the appropriate background check. All VARS must be typed and emailed to the Welcome Center.

Contractors shall report to the 49 SFS Welcome Center (Bldg. 1) with photo identification issued by a federal/ state activity. Employees requesting to operate a company or privately owned vehicle on the installation shall provide a valid driver’s license, current vehicle registration, and proof of current vehicle insurance or car rental agreement.

All Foreign Nationals requesting access to HAFB (for official and unofficial visits) must provide three

(3) valid forms of ID consisting of: A state issued drivers license/ID card, Social Security card, Resident alien card, Employment Authorization Document, or Passport/Birth certificate.

NCIC

Current as of 5 April 2023 The information herein is Controlled Unclassified Information (CUI) which must be protected under the Freedom of Information Act of 1966 and Privacy Act of 1974, as amended. Unauthorized disclosure or misuse of this PERSONAL INFORMATION may result in criminal and/or civil penalties.

The requestor will ONLY request access for job duration not to exceed one year or contract end date. The requesting company/organization will retrieve all credentials from employees when job is completed or employee is terminated. The requesting company/organization will then return collected terminated access credentials to sponsoring agency in turn the sponsoring agency will return all credentials to the issuing office, 49 SFS/S5AV.

1039059181C Typewritten Text

1039059181C Typewritten Text

SFS USE

ONLY #

FULL LEGAL NAME

LAST, FIRST, MI AND

ISSUING STATE OF ID

OR DL

SSN DOB

(DD MMM YYYY)

CITIZENSHIP/

PERM RESIDENT

#(REQUIRED)

STATUS NAME, State of ID/DL SSN DOB CITIZENSHIP

1 NAME SSN DOB

2 NAME SSN DOB

3 NAME SSN DOB

4 NAME SSN DOB

5 NAME SSN DOB

6 NAME SSN DOB

7 NAME SSN DOB

8 NAME SSN DOB

9 NAME SSN DOB

10 NAME SSN DOB

11 NAME SSN DOB

12 NAME SSN DOB

13 NAME SSN DOB

14 NAME SSN DOB

15 NAME SSN DOB

16 NAME SSN DOB

17 NAME SSN DOB

18 NAME SSN DOB

19 NAME SSN DOB

20 NAME SSN DOB

21 NAME SSN DOB

22 NAME SSN DOB

23 NAME SSN DOB

24 NAME SSN DOB

25 NAME SSN DOB

26 NAME SSN DOB

27 NAME SSN DOB

28 NAME SSN DOB

29 NAME SSN DOB

30 NAME SSN DOB

31 NAME SSN DOB

32 NAME SSN DOB

33 NAME SSN DOB

34 NAME SSN DOB

35 NAME SSN DOB

36 NAME SSN DOB

37 NAME SSN DOB

Company Name:_____________________________________

2 Current as of 5 April 2023 The information herein is Controlled Unclassified Information (CUI) which must be protected under the Freedom of Information Act of 1966 and Privacy Act of 1974, as amended. Unauthorized disclosure or misuse of this PERSONAL INFORMATION may result in criminal and/or civil penalties.

HOLLOMAN AFB

VISIT ACCESS REQUEST

(VAR) cont.

CONTRACTOR VISIT INFORMATION:

* Visitor passes will NOT exceed contract performance period or 1 year, whichever is less. Badges will only be issued within three (3) duty days prior to the start date.

Period of visit: ___________________ to ___________________ (Dates Requested) Visiting hours: ___________________ to ___________________ (ex. 0600-1730)

Reason for visit: ________________________________________

Visit location: ______________________________________ (Be specific; bldg/room(s), etc.)

Sponsoring Organizations WILL return ALL issued access credentials to 49 SFS/S5AV once the contract has been completed and/or the individual no longer requires access.

Please direct any questions to me (company official) at _________________.

By selecting "YES" you certify the attached information is true and correct.

Signature of Company Official _________________________ Date _____________

Typed/Printed Name _________________________

Job Title/Company Name _________________________

I have reviewed and approved this visit access request.

Signature of Sponsoring Unit __________________________ Date _____________

CC/Unit Security Manager/

Designated Contracting Official

Typed/Printed Name __________________________

Duty Title __________________________

SPONSORING UNIT PLEASE READ BELOW

All civilian contractor identified on a VAR are going to be issued a Defense Biometric Identification System (DBIDS) credential from the Holloman AFB Welcome Center. All credentials issued will not exceed Force Protection Condition (FPCON) Bravo. If the sponsoring unit that has reviewed and approved a VAR and finds it necessary for a civilian contractor to have access at a higher FPCON not to exceed Charlie, the sponsoring unit commander will need to complete, sign and submit a FPCON Charlie access memorandum to the Holloman AFB Welcome Center. The memorandum must contain the civilian contractor’s name, duty title and a brief description of his/her specific duties that require access during FPCON Charlie. At no time will a civilian contractor listed on a VAR be eligible for FPCON Delta Access.

3 Current as of 5 April 2023 The information herein is Controlled Unclassified Information (CUI) which must be protected under the Freedom of Information Act of 1966 and Privacy Act of 1974, as amended. Unauthorized disclosure or misuse of this PERSONAL INFORMATION may result in criminal and/or civil penalties.

National Crime Information Center (NCIC) – Visit Access Request (VAR), Holloman AFB, NM

For contracts awarded/administered by the 49th Contracting Squadron.

Be advised: IAW REAL ID Act, All Identification cards marked "Not Valid for Federal Purposes";

"Federal Limits May Apply" are NOT authorized unescorted access to Holloman AFB. Those individuals will be vetted and need a valid sponsor with escort authority present. Those individuals will receive an

ESCORTED visitor pass and the escort official will be responsible for them at all times while on the installation.

Request that a visitor pass be issued to all contractor employees to gain access to Holloman AFB, NM.

All employees will be briefed on and shall comply with Holloman AFB security requirements. The VAR will consist of employees FULL Name, Date of Birth, Social Security Number, Place of Birth and

Citizenship, and/or a residential alien card. The format for a Visit Access Request Form will be provided upon request. By submitting this information on the VAR the employee is authorizing the U.S.

Government (United States Air Force) to conduct a background check to confirm their eligibility or ineligibility to gain access to Holloman AFB, New Mexico. Fitness determinations for civilian contractors will be conducted by vetting these individuals through NCIC, NMLETS, TSDB and HAFB debarment, suspension, revocation roster, and the HAFB Base Access Eligibility Matrix. Contractors will ensure that the VAR is provided to the 49 SFS Welcome Center (Bldg. 1) at least 3-5 business days prior to requested installation access for processing and 7 business days prior for foreign nationals. Foreign nationals will not be granted unescorted entry to the installation. Civilian contractors requiring base access are not, at any time, authorized unescorted access to sensitive areas or access to government information networks.

Delivery drivers will provide a bill-of-lading or delivery receipt at the time of pass issuance; passes will not exceed 6 hours. Routine deliveries require the contracting company to add the driver(s) to a VAR to undergo the appropriate background check. Contractor employees shall report to the 49 SFS Pass and

Registration Office (Bldg. 1) with photo identification issued by a federal/state activity. Contractor employees requesting to operate a contractor or privately owned vehicle on the installation shall provide a valid driver’s license, current vehicle registration, and proof of current vehicle insurance or car rental agreement. Contractor personnel requesting to operate a motorcycle on Holloman AFB shall provide proof they have completed a motorcycle safety course (i.e. motorcycle safety course certificate/card) prior to being authorized to ride on the installation.

All Contracting Organizations:

(a) Ensure contract provisions are included requiring contractors to return all local access credentials to the WC when contract is completed or when a contractor employee no longer requires access to the installation. The sponsoring organization of the contract will ultimately be responsible for the conduct of contractors. Ensures contracting organizations include commercial vehicle inspection requirements are included in Statements of Work.

End NCIC REQUIREMENTS

Sol # FA480123R0001

13 July 2023 Attachment 3 Page 1 of 4

Sol # FA480123RR0001

Base Access/Contractor Background Checks Inquiry (December 2015)

1. Base access waiver request and instructions documents (Appeal Process/Instruction): If an individual contractor was denied installation access as a result of an unfavorable background check and cross referenced with the attached matrix, the individual and contractor are advised that the individual in question, has received an unfavorable background check and that the information in the check cannot be released outside of Law Enforcement agencies. They are then advised how to obtain information concerning their record and the appeal process and provided written step-by-step instructions on how to do same.

The process is as follows; if past criminal history is unknown: The individual must send a written request to the Federal Bureau of Investigations, Criminal Justice Information Services Division and attach an

$18.00 check. Additionally, they must submit a complete set of (rolled inked fingerprint impressions), with name, date, and place of birth which can be obtained from the local police departments. Once the individual receives the information pertaining to their background from the FBI, they must then submit a letter of memorandum explaining the negative information identified in the background check and justification as to why the decision to be denied access should be reconsidered. Furthermore, a character reference letter will be required by their immediate supervisor along with a letter from the sponsoring unit commander requesting the contractor employee be authorized access.

2. Procedures for contractors to submit access requests for pre-approval (prior to work): Contractors are able to proceed with contractor employee installation access paperwork when given the order to proceed at the final preconstruction meeting. The final preconstruction meeting occurs 14-30 days prior to the project start date. At that time, the contractor is provided all the paperwork and instructions required for their employees to be granted installation access. The background checks are then completed by

Holloman AFB (HAFB) Security Forces (SF). The background checks are completed an average of 3 business days upon receipt but will not exceed 5 business days. Contractors will re-submit and vetting re-accomplished at least every 12 months for the duration of the specified contract. Contracting units

(CONS/MICC) ensure contractors are aware of the 49 WG contractor vetting requirements and the potential effects of revealed unfavorable information.

13 July 2023 Attachment 3 Page 2 of 4

a. Holloman AFB Access Eligibility Matrix July 2023

b. Only personnel delegated by the Installation Commander in writing shall perform fitness determination. Delegation will be in writing, either by position/office or name designation and codified in local guidance. (T-1).

c. Installation commanders may deny access and issuance of access credentials based upon information obtained during the vetting process that indicates the individual may present a threat to the good order, discipline, and morale of the installation. Behavior or criminal records that pose unacceptable risk are listed below:

IAW DAFMAN 31-101, Vol 3, Installation Perimeter Access Control

Access eligibility determination will be decided by the on-duty flight chief, or the operations superintendent.

All individuals who are denied access are entitled to an appeal process. They should be directed to the

Visitor Control Center for any information regarding the appeal process.

Conviction of:

Access will be denied if the presence of ANY conviction exists, regardless of when the violation occurred

Terroristic Acts/Belonging to a Terrorist Organization Access Denied

Firearms/Explosives Violations Access Denied

Assault with a Deadly Weapon Access Denied Armed Robbery Access Denied Vehicular Homicide/Manslaughter Access Denied Homicide/Murder Access Denied Sabotage Access Denied Treason Access Denied Espionage Access Denied Any type of Sexual Crimes/Offenses Access Denied Child Molestation Access Denied Child Pornography Access Denied Voyeurism/Peeping Tom Activities Access Denied Human Trafficking/Smuggling/Harboring illegal aliens Access Denied

Drug Possession with Intent to Sell/Distribution Access Denied Registered Sex Offender Access Denied

Violent Persons/Offender File Access Denied Organized Criminal Activity/Active Criminal Gang Member Access Denied Watch List/Hit List/Any Active Warrant (Both Extraditable/Non-Extraditable)

Access Denied

Any Pending Charges/Missing/Unknown Dispositions Access Denied

Any Unconfirmed SSN/Unable to Confirm Identity Access Denied

Any Additional Offense(s) with a Felony Conviction Not Specified in the list Above

Access Denied if Offense Occurred Within the Last 10 years.

Misdemeanor Offenses with Convictions Access Denied if Three or More Occurred Within the Last 10 Years

13 July 2023 Attachment 3 Page 3 of 4

13 July 2023 Attachment 3 Page 4 of 4

DEPARTMENT OF THE AIR FORCE

HEADQUARTERS 49TH WING (AETC)

HOLLOMAN AIR FORCE BASE NEW MEXICO

(Date)

MEMORANDUM FOR 49 SFS/S5AV

FROM:

49 XX/CC

SUBJECT: Force Protection Condition (FPCON) Charlie Access

1. The following personnel with (COMPANY), Tracking # XXX-XX-XX are being identified as requiring access to Holloman AFB, NM during FPCON Charlie measures. These individuals are considered mission essential to the (LOCATION(S)) and provide the necessary access to ensure mission essential requirements are met.

2. The individuals listed below require access during FPCON Charlie measures for please provide a brief description of duties of the individuals listed below that require access during FPCON Charlie measures.

a.

Name:

Duty Title:

b.

3. If you have any questions or concerns regarding this matter please feel free to contact (NAME) or at DSN 572-XXXX.

FIRST A. LAST, Rank, USAF

Commander, 49th XXXXXX

Combat Airpower Starts Here

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MEMORANDUM FOR ________________

49 SFS

FROM: ________________

SUBJECT: Travel Approval Letter

1. I, ____________________________________ request ________________ travel approval IAW the itinerary listed below. All travelers will adhere to applicable guidance during travel.

2. ITINERARY:

3. For questions, please contact _______________________ at _______________________.

1st Ind, ________________

HOLLOMAN AIR FORCE BASE, NEW MEXICO

COMBAT AIRPOWER STARTS HERE

1. I, ____________________________________ request to conduct ________________ travel IAW the itinerary listed below. I will adhere to all pertinent 49 FW and HHQ guidance during travel.

Date: 04 Sep 1949

Req OffSym: Name of Company

Req Name: John A. Doe

Contact: Darlene Y. Simpson

Phone: 575-572-7828

Req Name Blk2: Contract Specialist, 49 CONS/PKA

Auth Name Blk1: FIRST M. LAST, Rank, BRANCH

Auth Name Blk2: Commander, Organization

Auth OffSym: 49 CONS/CC

Itinerary: Travelers: Civilian Contractor / John A. Doe Departing: 09 Nov 2020-El Paso, TX / POV or Company Vehicle Arrival: 09 Nov 2020-Holloman AFB, NM / POV or Company Vehicle.

Departure Final: 08 Nov 2021 / POV or Company Vehicle (See Note Below) Note: Traveler will be conducting work daily per Contract and the entire term of contract on HAFB.

Enter one line for each en route overnight stay, and for any changes in mode of transportation.

Auth Comments: Upon return, member will... Example: Upon arrival to HAFB, visitors will need to check into the Welcome Center. During travel, visitors will comply with all CDC guidelines and adhere to all COVID-19 safety requirements to include social distancing, wearing of face covering and sanitation. No in person dining, do not attend gatherings with more than 10 individuals and minimize close contact within 6' for 15+ minutes.

Trvl Type: [other (Contractor)]

Approval: [Approved]

REQ Sig Blk: DARLENE Y. SIMPSON, Civ, USAF

BACKGROUND CHECK

CONSENT FORM

I, __________________________________________________, (Name – typed/printed)

Hereby authorize the U.S. Government (United States Air Force) to conduct background checks confirming my eligibility or ineligibility to gain access to Holloman Air Force Base, New Mexico.

Examples of conditions that may identify ineligibility to access the installation include, but are not limited to, substantiated misconduct, conviction or arrests for violent behavior, dishonesty, sexually aberrant behavior, warrants for arrest, open investigations, or felony charges.

I do so with full knowledge that this information is confidential and as such protected from unauthorized disclosure by the Privacy Act of 1974, as amended.

It is also my understanding that any information provided shall be treated confidentially and be used solely to determine whether I am eligible to access the installation.

***PRIVACY ACT INFORMATION***

PRINT LEGAL NAME:

SSN:

BIRTH DATE:

SIGNATURE:

US CITIZEN? (Circle One): YES / NO

DATE:

PRIVACY ACT STATEMENT

IAW the Privacy Act of 1974, the contents of this document contain privileged or other confidential information. Unauthorized disclosure may result in civil and criminal sanctions. If you are not the intended recipient, or believe you may have received this communication in error, do not reproduce, retransmit, disseminate, or otherwise use this information.

Current as of: May 2019

Holloman AFB Escort Official Responsibility Form

IAW AFMAN 31-101, v.3 Supplement, 27 FEBRUARY 2020

6.3., h. Commanders may suspend escort authority based upon the local threat or other local stipulations, and may revoke individual escort authority privileges at their discretion. Escort authority privileges are automatically suspended at FPCON Charlie in accordance with this manual and AFI 10-245. Installations will ensure installation access control plans/procedures reflect instances when escort authority is suspended. (T-3).

1. I understand while performing escort official duties I am responsible to ensure/comply with the following:

a. All escorted personnel will remain with me or another designated/approved escort official at all times while on the installation. I am fully responsible for the actions of the escorted personnel under my control.

b. I fully understand I may only release escorted personnel to another designated/approved escort official.

c. I am limited to only escorting those individuals or deliveries identified as needing an escort; on the specific Visitor Access Request (VAR) I am granted the escort authority privilege. I will escort only those listed on, and directly related to that specific VAR. At no time will I utilize my escort authority to escort any other personnel onto the installation for personal purposes that are not work related or not associated with the work contract.

d. I will ensure escorted personnel are briefed and understand they are required to comply with all HAFB installation security requirements (i.e. speed limits, seatbelt usage, cell phone use while operation a motor vehicle), and that all vehicles are subject to search while on the installation.

e. My escort privileges can be revoked if any personnel I have accepted responsibility to escort are found without a designated/approved escort official. The personnel that are found without an escort will be required to turn-in their access credential to the issuing office and the sponsoring agency will be notified.

f. I will ensure all escorted personnel visitor passes/credentials are returned to the HAFB Welcome Center when visit is complete.

2. By signing this document and initialing each of the above sections, I acknowledge receipt and understanding of my escort official responsibilities as outlined above. I further understand if I violate/abuse any of policies/requirements above, my escort privileges will be permanently revoked.

Escorts Printed Rank/Name: __ _

Company/Organization: ___________________________

Escorts Signature:

Date:

49 SFS/S5AV USE ONLY

TRACKING NUMBER:

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HOLLOMAN AIR FORCE BASE NEW MEXICO

(Date)

MEMORANDUM FOR 49 SFS/S5AV

FROM:

49 XX/CC

SUBJECT: Force Protection Condition (FPCON) Charlie Access

1. The following personnel with (COMPANY), Tracking # XXX-XX-XX are being identified as requiring access to Holloman AFB, NM during FPCON Charlie measures. These individuals are considered mission essential to the (LOCATION(S)) and provide the necessary access to ensure mission essential requirements are met.

2. The individuals listed below require access during FPCON Charlie measures for please provide a brief description of duties of the individuals listed below that require access during FPCON Charlie measures.

a.

b.

3. If you have any questions or concerns regarding this matter please feel free to contact (NAME) or at DSN 572-XXXX.

FIRST A. LAST, Rank, USAF

Commander, 49th XXXXXX

Combat Airpower Starts Here

_910175576.doc

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MEMORANDUM FOR ________________

49 SFS

FROM: ________________

SUBJECT: Travel Approval Letter

1. I, ____________________________________ request ________________ travel approval IAW the itinerary listed below. All travelers will adhere to applicable guidance during travel.

2. ITINERARY:

3. For questions, please contact _______________________ at _______________________.

1st Ind, ________________

HOLLOMAN AIR FORCE BASE, NEW MEXICO

COMBAT AIRPOWER STARTS HERE

1. I, ____________________________________ request to conduct ________________ travel IAW the itinerary listed below. I will adhere to all pertinent 49 FW and HHQ guidance during travel.

Date: 04 Sep 1949

Req OffSym: Name of Company

Req Name: John A. Doe

Contact: Darlene Y. Simpson

Phone: 575-572-7828

Req Name Blk2: Contract Specialist, 49 CONS/PKA

Auth Name Blk1: FIRST M. LAST, Rank, BRANCH

Auth Name Blk2: Commander, Organization

Auth OffSym: 49 CONS/CC

Itinerary: Travelers: Civilian Contractor / John A. Doe Departing: 09 Nov 2020-El Paso, TX / POV or Company Vehicle Arrival: 09 Nov 2020-Holloman AFB, NM / POV or Company Vehicle.

Departure Final: 08 Nov 2021 / POV or Company Vehicle (See Note Below) Note: Traveler will be conducting work daily per Contract and the entire term of contract on HAFB.

Enter one line for each en route overnight stay, and for any changes in mode of transportation.

Auth Comments: Upon return, member will... Example: Upon arrival to HAFB, visitors will need to check into the Welcome Center. During travel, visitors will comply with all CDC guidelines and adhere to all COVID-19 safety requirements to include social distancing, wearing of face covering and sanitation. No in person dining, do not attend gatherings with more than 10 individuals and minimize close contact within 6' for 15+ minutes.

Trvl Type: [other (Contractor)]

Approval: [Approved]

REQ Sig Blk: DARLENE Y. SIMPSON, Civ, USAF

BACKGROUND CHECK

CONSENT FORM

I, __________________________________________________, (Name – typed/printed)

Hereby authorize the U.S. Government (United States Air Force) to conduct background checks confirming my eligibility or ineligibility to gain access to Holloman Air Force Base, New Mexico.

Examples of conditions that may identify ineligibility to access the installation include, but are not limited to, substantiated misconduct, conviction or arrests for violent behavior, dishonesty, sexually aberrant behavior, warrants for arrest, open investigations, or felony charges.

I do so with full knowledge that this information is confidential and as such protected from unauthorized disclosure by the Privacy Act of 1974, as amended.

It is also my understanding that any information provided shall be treated confidentially and be used solely to determine whether I am eligible to access the installation.

***PRIVACY ACT INFORMATION***

PRINT LEGAL NAME:

SSN:

BIRTH DATE:

SIGNATURE:

US CITIZEN? (Circle One): YES / NO

DATE:

PRIVACY ACT STATEMENT

IAW the Privacy Act of 1974, the contents of this document contain privileged or other confidential information. Unauthorized disclosure may result in civil and criminal sanctions. If you are not the intended recipient, or believe you may have received this communication in error, do not reproduce, retransmit, disseminate, or otherwise use this information.

Current as of: May 2019

Holloman AFB Escort Official Responsibility Form

IAW AFMAN 31-101, v.3 Supplement, 27 FEBRUARY 2020

6.3., h. Commanders may suspend escort authority based upon the local threat or other local stipulations, and may revoke individual escort authority privileges at their discretion. Escort authority privileges are automatically suspended at FPCON Charlie in accordance with this manual and AFI 10-245. Installations will ensure installation access control plans/procedures reflect instances when escort authority is suspended. (T-3).

1. I understand while performing escort official duties I am responsible to ensure/comply with the following:

a. All escorted personnel will remain with me or another designated/approved escort official at all times while on the installation. I am fully responsible for the actions of the escorted personnel under my control.

b. I fully understand I may only release escorted personnel to another designated/approved escort official.

c. I am limited to only escorting those individuals or deliveries identified as needing an escort; on the specific Visitor Access Request (VAR) I am granted the escort authority privilege. I will escort only those listed on, and directly related to that specific VAR. At no time will I utilize my escort authority to escort any other personnel onto the installation for personal purposes that are not work related or not associated with the work contract.

d. I will ensure escorted personnel are briefed and understand they are required to comply with all HAFB installation security requirements (i.e. speed limits, seatbelt usage, cell phone use while operation a motor vehicle), and that all vehicles are subject to search while on the installation.

e. My escort privileges can be revoked if any personnel I have accepted responsibility to escort are found without a designated/approved escort official. The personnel that are found without an escort will be required to turn-in their access credential to the issuing office and the sponsoring agency will be notified.

f. I will ensure all escorted personnel visitor passes/credentials are returned to the HAFB Welcome Center when visit is complete.

2. By signing this document and initialing each of the above sections, I acknowledge receipt and understanding of my escort official responsibilities as outlined above. I further understand if I violate/abuse any of policies/requirements above, my escort privileges will be permanently revoked.

Escorts Printed Rank/Name: __ _

Company/Organization: ___________________________

Escorts Signature:

Date:

49 SFS/S5AV USE ONLY

TRACKING NUMBER:

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