18-2. Visitor Badge Request Form Rev. 3 05-27-2022.pdf
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- Solicitation number
- PNC2132196C1
- Issued by
- Broward County, Fort Lauderdale City, Florida
About this file
This is a Visitor Badge Request Form issued by the Broward County Aviation Department Security Division at Fort Lauderdale-Hollywood International Airport (FLL). The form documents visitor access procedures for individuals requiring escort into secured areas of the airport. The specific visitor request documented on this form pertains to a site visit related to the T3 Generator Replacement Project, with the visitor being escorted by Vilmaida Rodriguez (Credential holder) on a date specified in the form. The form requires collection of signatory information, visitor identification details, escort information, and purpose of visit documentation to facilitate controlled access to restricted airport areas including the Secured Area, Sterile Area, and Airport Operations Area.
The form establishes critical security protocols and compliance requirements for all escorted visitors, including mandatory consent to inspections and searches per 49 CFR Part 1542, adherence to TSA prohibited item lists, and restrictions on firearms in passenger terminals per Florida Statute Section 790.06. Visitors are limited to no more than five escorts within a 365-day period, and visitor badges must be returned within 24 hours of issuance. The escort is responsible for maintaining continuous supervision of the visitor, ensuring the visitor accesses only authorized areas, and reporting any unauthorized activities to BCAD Security at (954) 359-1201 or 911. Non-compliance with these requirements may result in revocation of Secured Area access privileges and civil penalties. The form was revised on May 27, 2022, and represents standard airport security procedures required for site visits related to capital projects such as equipment replacement initiatives at FLL.
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Text version
FORT LAUDERDALE-HOLLYWOOD
INTERNATIONAL AIRPORT
BROWARD COUNTY AVIATION DEPARTMENT – SECURITY DIVISION
320 Terminal Drive, Suite 200 • Fort Lauderdale, Florida 33315 • (954) 359-6100
Visitor Badge Request Form Signatory Information
Purpose of VisitFirst Name Last Name
Phone Number E-mail
Company Represented
Date of Escort
Visitor Information
First Name Last Name Company
Identification Type
Identification Number
Phone Number
Issuing Country or Territory (If other than United States)
ID
Expiration Date
Identification Issuing State (If issued in the United States)
Escort Information
First Name Last Name Credential Number
Escort Signature Date Signed
• Have the Escort Authority designator (‘E’) on the FLL Issued Identification Credential Media when conducting an escort (media without the ‘E’ designator are not authorized to conduct escorts)
• Escort only as many visitors as can be properly controlled
• Escort must accompany the visitor at all times while in the Secured Area, Sterile Area, and Airport Operations Area (AOA)
• Be able to see and give verbal instruction at all times while under escort
• Only escort a visitor to an area where you, the escort, has authorized access
• Immediately call BCAD Security at (954) 359-1201 or 911 Emergency in the event that a visitor under escort engages in activities other than those for which the escort was granted.
• Visitors may not be escorted more the 5 times in a 365-day period from the first issuance.
• Visitor Badge must be returned when no longer needed or within 24 hours of issuance. Return to the Credentialing Center during operational hours, or during non-operational hours, contact the AOCC at 954-359-1201.
• Comply with all Visitor Badge requirements set forth in the BCAD Airport Security Program and Broward County Code of Ordinance
Chapter 2 1/2 Section 2-39(a)(6) for escorted access in the Secured Area. Failure to comply may result in the revocation of Secured Area access privileges and a civil pentalty.
The escort is hereby required to convey the below conditions/requirements to the visitor prior to accessing the Secured Area:
• Pursuant to 49 Code of Federal Regulations, Part 1542, I voluntarily consent, as a condition to entering, exiting, or being in the SIDA, Secured Area, Sterile Area or AOA, to being inspected and/or searched, and that any vehicle, bag, box, parcel, etc., in my possession may also be subject to such inspection and/or search at any time that I am on, entering, or exiting the SIDA, Secured Area, Sterile Area or AOA.
• I understand that items found on TSA’s Prohibited Item list are not allowed in Sterile Area or Secured Area of the airport unless necessary to perform job related functions. Firearms are expressly prohibited in the inside of passenger terminals and sterile areas as per Florida Statute Section 790.06 and possession will be subject to Federal, State, and local violations.
Date of Birth
By signing this form, you agree to the following:
Phone Number
Rev. 3 / May 27, 2022
By checking this box, I acknowledge that I have provided the required privacy notice to the visitor.
| Identification Number: |
| Escort First Name: Vilmaida |
| Escort Last Name: Rodriguez |
| Visitor Last Name: |
| Issue Country: [United States] |
| Issue State: [Florida] |
| Signatory E-mail: |
| Date of Escort: |
| Company Represented: |
| Signatory Phone Number: |
| Visitor First Name: |
| ID Type: [State Driver License] |
| Signatory First Name: |
| Signatory Last Name: |
| Date of Birth: |
| Visitor Company: |
| Credential Number: |
| Visitor Date Signed: |
| Visitor Signature: |
| Submit: |
| Expiration Date: |
| Purpose of Visit: T3 Generator Replacement Project, Site Visit |
| Visitor Phone Number: |
| Escort Phone Number: 954.359.7244 |
| Privacy Notice: Off |
File details come from the government source that posted it. Updated .