23 CONS Base Pass (Template).pdf
PDF 415 KB Posted
- Attached to
- 41 RGS Carpet Replacement
- Solicitation number
- FA483025Q0013
About this file
This is a base access pass request template form for contractors needing to visit Moody Air Force Base in Georgia, issued by the 23D Contracting Squadron (ACC). The form requires contractors to provide personnel information including full name, SSN/DOB, and organization/company for each individual needing base access. The example shown is filled out for a Military & Family Readiness Center Office Carpet Site Visit scheduled for February 14, 2025, under contract number FA483025Xxxxx with prime contractor ABCD. The form notes that SSN/DOB information is required for base access and will be requested by Security Forces at the Visitor's Center if not provided on the form. The template includes fields for contract number, duration of pass (not to exceed 1 year), purpose of visit, and sponsor information including rank, name, duty title, email, and duty phone.
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Other files
| File | Type | Posted |
|---|---|---|
| FAQ-RGS-Carpet.pdf | ||
| Combo-Synopsis.pdf | ||
| SOW 41RGS Carpet SOW.pdf | ||
| CarpetSelectionPictures.pdf | ||
| FLOOR PLAN BLDG.661.pdf | ||
| 41RGS.BaseMap.pdf |
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Text version
FOR OFFICIAL USE ONLY
DEPARTMENT OF THE AIR FORCE
23D CONTRACTING SQUADRON (ACC)
MOODY AIR FORCE BASE GEORGIA
Attack ∙ Rescue ∙ Prevail The information herein is For Official Use Only (FOUO) which must be protected under the Freedom of Information Act of 1996 and Privacy Act of 1974, as amended. Unauthorized disclosure or misuse of this PERSONAL INFORMATION may result in criminal and/or civil penalties
MEMORANDUM FOR 41 RGS/CCQ
FROM: 23 CONS
SUBJECT: Request for Installation Access Personnel Pass
1. Request pass for the following person(s) to Moody AFB:
2. If you have any questions or concerns, please contact the undersigned:
Contract Number:
Prime Contractor:
Duration of Pass:
(NTE 1 Year)
Purpose:
Full Name Organization/CompanySSN/DOB*
*Write N/A if contractor declined to provide information. Be advised that SSN/DOB information is required for base access.
Security Forces will ask for it at the Visitor's Center if not detailed in this form.
Sponsor Info: Rank, Name; Duty Title; Email; Duty Phone
| Date1_af_date: 11-Feb-2025 |
| Contract #: FA483025Xxxxx |
| Contractor Name: ABCD |
| Duartion of Pass: 14 February 2025 - 14 February 2025 |
| Contract Purpose: Military & Family Readiness Center Office Carpet Site Visit |
| FullName1: John Doe Jr |
| FullName2: John Does Sr |
| FullName3: |
| FullName4: |
| FullName5: |
| SSNDOB1: 123-45-6789/ 1 Jul 2022 |
| SSNDOB2: 678-91-2345/ 1 Jan 2023 |
| SSNDOB3: |
| SSNDOB4: |
| SSNDOB5: |
| Org1: ABCD |
| Org2: ABCD |
| Org3: |
| Org4: |
| Org5: |
| SponsorInfo: SSgt June Alba, Contract Specialist, june.alba@us.af.mil, 257-2053 |
| Clear Form: |
File details come from the government source that posted it. Updated .