NAS_Key_West_DBIDS_Company_Enrollment_Form_0001.xlsx
XLSX spreadsheet 53 KB Posted
- Attached to
- FY23 CYCLIC REPAIRS MV FORT JEFFERSON
- Solicitation number
- 140P5423Q0034
About this file
This document contains a company enrollment form for access to Naval Air Station Key West facilities and the related federal contract solicitation for fiscal year 2023 cyclic repairs to the MV Fort Jefferson. The enrollment form requires company information and details for primary and alternate company administrators seeking base access. It lists facility locations and default access times, and includes sections for active and inactive employee details. The related solicitation is from the Department of the Interior National Park Service Southeast Region for repairs to the MV Fort Jefferson berthed at Dry Tortugas National Park, with a solicitation number of 140P5423Q0034 and opportunity type of solicitation.
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Other files
| File | Type | Posted |
|---|---|---|
| Sol_140P5423Q0034_Amd_0001.pdf | ||
| SCA_Wage_Determination.pdf | ||
| Statement_of_Work.pdf | ||
| Sol_140P5423Q0034.pdf |
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Text version
Company Enrollment Form
| NAS Key West DBIDS Enrollment Form | ||||
| Company Name: | ||||
| Company Phone #: | ||||
| Company Address: | ||||
| (Street Address) (City, State) (Zip Code) | ||||
| Contract Number: | Expiration Date: | |||
| DBIDS Company Administrator (DCA) | ||||
| Primary DCA | Alternate DCA | |||
| Name: | Name: | |||
| Title/Position: | Title/Position: | |||
| Phone Number: | Phone Number: | |||
| Work Email: | Work Email: | |||
| Access Permissions | ||||
| LOCATION | Boca Chica | TIME | Mon - Fri, 0600-1800 (Default) | |
| Sigsbee Park | Mon - Sat, 0600-1800* | |||
| Trumbo Point | Mon - Sun, 0600-1800* | |||
| Truman Annex | 24 HRS / 7 DAYS* (Permanent Party) | |||
| Branch Medical | (Gate Hours: M-F, 0630-1630) | 24 hrs / 7 DAYS* (Non-Permanent Party) | ||
| Mole Pier* (Justification in Remarks) | Other* (Days & Times w/ Justification in Remarks) | |||
| Sponsor Information | ||||
| Name: | ME 1 DALE BULLOCK | |||
| Title/Position: | ME 1 | |||
| Organization/Command: | USCG KEYWEST | |||
| Phone Number: | 305 292 8713 | |||
| Work Email: | dale.j.bullock@uscg.mil | |||
| Remarks | ||||
| *Time and access deviations must be justified/approved by SECO |
Requesting Base Acess to transit to Dry Tortugas National Park aboard the MV Fort Jefferson berthed at D3 USCG KW
Approved by Security Officer: ______________________________ Date: __________
LT David Flake, USN
Active Employees List
| ************* PLEASE INPUT THE INFORMATION FOR ACTIVE EMPLOYEES WHO NEED ACCESS TO NAS KEY WEST BELOW ************* | |||||||||||
| ACTIVE EMPLOYEE LIST | |||||||||||
| LAST NAME | FIRST NAME | M.I. | LAST FOUR OF SS# | DATE OF BIRTH | US CITIZEN? | ALIEN REG # | Country of Birth | DL STATE | DL # | DATE ADDED |
Inactive Employee List ********** PLEASE PUT THE INFORMATION FOR THE EMPLOYEE WHO NO LONGER NEEDS ACCESS OR IS TERMINATED BELOW *********
| TERMINATED or INACTIVE EMPLOYEE LIST | ||||||
| LAST NAME | FIRST NAME | M.I. | LAST FOUR OF SS# | DATE OF BIRTH | DATE OF TERMINATION OR DEACTIVATION |
File details come from the government source that posted it. Updated .