5512-47 DBIDS BADGE APPLICATION RECORD V 3.pdf

PDF 53 KB Posted

Attached to
Indefinite Delivery/Indefinite Quantity (IDIQ) Multiple Award Construction Contract (MACC) for Minor Construction, Renovation, and Repair Projects at NSA Crane, IN and Glendora Test Facility, Sullivan, IN
Solicitation number
N4008521R0071
Issued by

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Written by GovTribe AI ·

This document contains a badge application record template for individuals requiring access to Naval Support Activity Crane facilities and a related federal contract opportunity notice. The badge application record outlines the process for obtaining a badge, including completion of highlighted fields by a government sponsor activity agent and approval by an authorized facility contact. It provides spaces for up to 16 applicants to include name, signature, badge information, and security check dates.

The related federal contract opportunity is a solicitation for an Indefinite Delivery/Indefinite Quantity Multiple Award Construction Contract for minor construction, renovation, and repair projects at Naval Support Activity Crane in Indiana and the Glendora Test Facility in Sullivan, Indiana. It will be awarded as a total small business set-aside to multiple awardees for design-build and design-bid-build project delivery methods. The solicitation is issued by the Department of the Navy Naval Facilities Engineering Command.

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DBIDS BADGE APPLICATION RECORD

NSA CRANE 5512/47

Sponsoring Activity agent (SA):

Service Contractor Adminstrator (company POC name and phone) DATE: Approved Facility Contact (AFC) Installation Security Officer or designee

DATE BADGE DATE

ISSUED NO. RETURNED

INSTRUCTIONS: 1. GOVERNMENT SPONSOR ACTIVITY AGENT (SA) MUST COMPLETE HIGHLIGHTED INFORMATION AND FORWARD TO APPROVED FACILITY CONTACT (AFC) FOR APPROVAL

2. SECNAV 5512 ACCESS FORM, NCIC VETTING AND IDENTITY PROOFING WILL BE COMPLETED BEFORE BADGE IS ISSUED.

3. INDIVIDUAL SIGNS AND DATES FOR BADGE

NAME (LAST, FIRST, M.I.)

TYPED OR PRINTED

SIGNATURE

Recipient

NCIC VET

DATE/

SECNAV 5512

DATE Valid Through: NOT TO EXCEED ONE

YEAR OR LENGTH OF CONTRACT

COMPANY NAME AND PURPOSE FOR ACCESS:

Access Requested:

COMPANY NAME AND PURPOSE FOR ACCESS:
Sponsoring Activity agent SA:
DATE Valid Through NOT TO EXCEED ONE YEAR OR LENGTH OF CONTRACT:
Service Contractor Adminstrator company POC name and phone:
DATE:
Approved Facility Contact AFC Installation Security Officer or designee:
NAME LAST FIRST MI TYPED OR PRINTEDRow1:
SIGNATURE RecipientRow1:
DATE ISSUEDRow1:
BADGE NORow1:
NCIC VET DATE SECNAV 5512Row1:
DATE RETURNEDRow1:
NAME LAST FIRST MI TYPED OR PRINTEDRow2:
SIGNATURE RecipientRow2:
DATE ISSUEDRow2:
BADGE NORow2:
NCIC VET DATE SECNAV 5512Row2:
DATE RETURNEDRow2:
NAME LAST FIRST MI TYPED OR PRINTEDRow3:
SIGNATURE RecipientRow3:
DATE ISSUEDRow3:
BADGE NORow3:
NCIC VET DATE SECNAV 5512Row3:
DATE RETURNEDRow3:
NAME LAST FIRST MI TYPED OR PRINTEDRow4:
SIGNATURE RecipientRow4:
DATE ISSUEDRow4:
BADGE NORow4:
NCIC VET DATE SECNAV 5512Row4:
DATE RETURNEDRow4:
NAME LAST FIRST MI TYPED OR PRINTEDRow5:
SIGNATURE RecipientRow5:
DATE ISSUEDRow5:
BADGE NORow5:
NCIC VET DATE SECNAV 5512Row5:
DATE RETURNEDRow5:
NAME LAST FIRST MI TYPED OR PRINTEDRow6:
SIGNATURE RecipientRow6:
DATE ISSUEDRow6:
BADGE NORow6:
NCIC VET DATE SECNAV 5512Row6:
DATE RETURNEDRow6:
NAME LAST FIRST MI TYPED OR PRINTEDRow7:
SIGNATURE RecipientRow7:
DATE ISSUEDRow7:
BADGE NORow7:
NCIC VET DATE SECNAV 5512Row7:
DATE RETURNEDRow7:
NAME LAST FIRST MI TYPED OR PRINTEDRow8:
SIGNATURE RecipientRow8:
DATE ISSUEDRow8:
BADGE NORow8:
NCIC VET DATE SECNAV 5512Row8:
DATE RETURNEDRow8:
NAME LAST FIRST MI TYPED OR PRINTEDRow9:
SIGNATURE RecipientRow9:
DATE ISSUEDRow9:
BADGE NORow9:
NCIC VET DATE SECNAV 5512Row9:
DATE RETURNEDRow9:
NAME LAST FIRST MI TYPED OR PRINTEDRow10:
SIGNATURE RecipientRow10:
DATE ISSUEDRow10:
BADGE NORow10:
NCIC VET DATE SECNAV 5512Row10:
DATE RETURNEDRow10:
NAME LAST FIRST MI TYPED OR PRINTEDRow11:
SIGNATURE RecipientRow11:
DATE ISSUEDRow11:
BADGE NORow11:
NCIC VET DATE SECNAV 5512Row11:
DATE RETURNEDRow11:
NAME LAST FIRST MI TYPED OR PRINTEDRow12:
SIGNATURE RecipientRow12:
DATE ISSUEDRow12:
BADGE NORow12:
NCIC VET DATE SECNAV 5512Row12:
DATE RETURNEDRow12:
NAME LAST FIRST MI TYPED OR PRINTEDRow13:
SIGNATURE RecipientRow13:
DATE ISSUEDRow13:
BADGE NORow13:
NCIC VET DATE SECNAV 5512Row13:
DATE RETURNEDRow13:
NAME LAST FIRST MI TYPED OR PRINTEDRow14:
SIGNATURE RecipientRow14:
DATE ISSUEDRow14:
BADGE NORow14:
NCIC VET DATE SECNAV 5512Row14:
DATE RETURNEDRow14:
NAME LAST FIRST MI TYPED OR PRINTEDRow15:
SIGNATURE RecipientRow15:
DATE ISSUEDRow15:
BADGE NORow15:
NCIC VET DATE SECNAV 5512Row15:
DATE RETURNEDRow15:
NAME LAST FIRST MI TYPED OR PRINTEDRow16:
SIGNATURE RecipientRow16:
DATE ISSUEDRow16:
BADGE NORow16:
NCIC VET DATE SECNAV 5512Row16:
DATE RETURNEDRow16:

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