5 Attachment Eglin Base Access Request.pdf

CUI/PII

DEPARTMENT OF THE AIR FORCE

AIR FORCE TEST CENTER – AFTC/PZ

EGLIN AIR FORCE BASE, FLORIDA

NOTICE: Under the Privacy Act of 1974, you must safeguard personnel information retrieved through this system.

Disclosure of information is governed by Title 5, United States Code. Section 552a Public Law 93-579, DoDD 5400.11, DoDR 5400.11-R and the applicable service directives.

MEMORANDUM FOR: 96 SFS/S-5B

FROM: Contractor

SUBJECT: Request for Badge/Pass

1. The following individuals require access to Eglin AFB FL to perform official duties at an official site-visit to view the place of performance for this requirement at Bldg 351, Eglin Air Force Base, Valparaiso, FL 32542 . Site-visit is scheduled June 27, 2024, at 10am Central Time (CT). The Solicitation number is

FA282324Q0037.

2. The individuals listed have been briefed that while on the installation they must comply with all local laws and policies. The failure to comply will result in loss of base access. Each individual understands that they must go to the Security Forces Pass and Registration office to receive their contractor identification badge/pass. They further understand they must have a valid drivers license/Identification card, proof of current registration and insurance while driving on the installation.

3. When first arriving to the installation the following individuals will need no escort before being allowed access to the installation.

4. I understand it is the unit/company responsibility to collect the badges of terminated employees and to collect the badges at the conclusion of the work that was to be accomplished. Further, I understand that we are responsible to turn the badges/passes in to the Security Forces Pass and Registration office as soon as all work is complete.

Last First Days/Hrs

Place of Birth (City & State)

DOB

M/D/YR

Drivers Lic (State & ##)

6-Digit Code

5. The government sponsor of the following individual(s) is:

JaTyler K. Gary Contract Specialist

AFTC/PZIO

Jatyler.gary.1@us.af.mil

Authority: 10 U.S.C.8013, Secretary of the Air Force

Purpose: Used by the Security Forces for issuing ID media. Some organizations may routinely keep copies of the above documentation in order to maintain control over persons authorized entry into certain areas. Accountability documents are used to insure proper control over the various forms utilized in these functions. Routine Use: In addition to those disclosures generally permitted under 5 U.S.C. 552(b) of the Privacy Act, these records or information contained therein may specifically be disclosed outside the DoD as a routine use pursuant to 5 U.S.C.552a(b)(3) as follows: