5a - SOW Attachments.pdf

Attachment 1

Contractor Hazardous Material Identification Form

Date: ________ Part I

This part is to be completed by Contractor prior to start date, and shall be maintained on the job site.

Contractor Company: __________ Proposed work term: ________to_________ Contractor Point of Contact: ____________ Phone number: ___________

HM to be used:

MFG./Product

M.S.D.S Attached

Quantity used

Disposal Procedures Used/Unused material removed from ANG installation

Note: This form is for a one-month period and is to be submitted to the hazardous material pharmacy (HMP). All HM (hazardous material) used thereafter will be identified to Contacting Officer's Technical Representative for approval by the HMP. See Part II for Contractor close out procedures. HMP phone number is (816) 236-3573.

HMP Approval Signatures: _______________________________________________________

BEE (Base Environmental Officer) _________________________________________________

ENV (Environmental Manager) ____________________________________________________

Safety Officer: __________________________________________________________________

Attachment 2 Contractor HM Identification Form

(Close Out Procedures)

Part II

Attach this part to Part I The Contractor shall accompany the Environmental Manager on the closeout inspection to ensure all used/unused HM was removed from the installation.

Date: ________

Closeout Signatures:

ENV (Environmental Manager) _____________________________________________________________

Contracting Officer's Technical Representative _________________________________________________

Contractor ______________________________________________________________________________

POLICE RECORD CHECK

Project: __________________________

Government POC: _________________________

DATE OF REQUEST: _____________________

Name:

(First) (Middle) (Last)

Social Security Number:

Drivers License #:_______________________ State of Issue: __________________

Date of Birth: Sex: Race:__________

Company: _____________________________________________

I HEREBY CONSENT TO RELEASE FROM MY FILES THE INFORMATION REQUESTED

BELOW.

Signature:

(TO BE COMPLETED BY POLICE AGENCY)

Request a Criminal History and Nationwide Check be conducted to provide the following information.

1. Has the individual listed above a Police record, to include minor traffic violations? Yes No (If YES, what was the offense or charge, date, disposition and sentence?)

2. Is the individual listed above now undergoing court action of any kind? Yes No (If YES, give details)

THIS IS TO CERTIFY THAT THE ABOVE DATA AS CORRECTED ARE TRUE AND

CORRECT ACCORDING TO THE RECORD ON FILE IN THIS OFFICE. THIS

INFORMATION IS CONFIDENTIAL AND CANNOT BE USED IN ANY OTHER MANNER

EXCEPT FOR OFFICIAL PURPOSES.

DATE:

TITLE:

VERIFIED BY:

(Signature)

Return to: 139 SFS/SFO 705 Memorial Drive St Joseph, MO 64503

This document may contain information or attachments which must be protected IAW AFI 33-332 and DoD Regulation

5400.11. The Privacy Act of 1974 (as amended) applies, and this document and any attachments thereto are For Official Use

Only (FOUO). Information from this document or any attachments thereto must not be introduced into another system of records unless that system of records is described in the Federal Register IAW AFI 37-120.

Attachment 4

Missouri Air National Guard

HEADQUARTERS 139TH AIRLIFT WING

705 MEMORIAL DRIVE, ST. JOSEPH, MISSOURI 64503-9307

19 July 2024 TO: Primary Contractor and Subcontractor Employees

FROM: 139th Security Forces Squadron (SFS)

RE: Contractor Responsibilities While at Rosecrans Air National Guard Base

1. BASE ENTRY REQUIREMENTS: All personnel requesting access to 139th Airlift Wing must abide by the following requirements:

A. Shall possess a valid State or Government picture identification card. Furthermore, individuals presenting identification cards from a state that is non-compliant with the REAL ID Act will require additional documentation to gain unescorted base access.

Additional documentation includes a valid U.S. or foreign government issued passport, an employment authorization document that contains a photograph, or identification cards issued by federal state or local government agencies that include a photo and biographic information. A full list of REAL ID Act compliant and non-complaint states can be found at https://www.dhs.gov/current-status-states-territories.

B. Personnel requesting vehicle access to 139th AW shall provide a valid driver's license, current vehicle registration, and valid vehicle insurance.

C. All contractor vehicles entering the installation are subject to search daily at the commercial vehicle inspection tent and individual vehicles may be searched at random.

2. ESCORTING: Only individuals that possess a Common Access Card (CAC) are allowed to escort personnel on the installation under trusted traveler or if Police Record Check is complete but pass has not yet been issued

3. CRIMINAL BACKGROUND CHECK: All contractors working on the installation are required to have a favorable police background check completed prior to working on the installation. The 139th Civil Engineering Squadron (CES) will provide a Police Background Form which needs to be completed and provided to Security Forces two (2) weeks prior to being considered for unescorted access. Provide this information for all primary and subcontractor employees. For resident aliens, please include a photocopy of the resident alien identification card. Failure to complete the background check will result in the necessity for escorts.

The 139th SFS will conduct both local and nation-wide criminal background checks using the Back Ground Check Consent Form provided by CES project managers. Both open-source websites as well as information provided by local agencies will be reviewed.

Individuals may be denied access and access credentials based on information obtained during identity vetting that indicates the individual may present a threat to the good order, discipline and morale of the installation, including, but not limited to the following:

(a) The individual is known to be or reasonably suspected of being a terrorist or belongs to an organization with known terrorism links/support.

(b) The installation is unable to verify the individual's claimed identity.

(c) The individual has previously been barred from access to a federal installation or stand-alone facility.

(d) The individual is wanted by Federal, State, Local, or other civil law enforcement authorities, regardless of offense or violation.

(e) The individual has any conviction for espionage, sabotage, treason, terrorism, or murder.

(f) The individual’s name appears on any Federal or State agency’s watch list or hit list for criminal behavior or terrorist activity.

(g) The individual has been convicted of a firearms or explosive violation.

(h) The individual has been convicted of sexual assault, armed robbery, rape, child molestation, child pornography, trafficking in humans, drug possession with intent to sell, or drug distribution.

(i) The individual has knowingly and willfully engaged in acts or activities designed to overthrow the U.S. Government by force.

Once the temporary credential expires, the person will be fully vetted again and have his or her fitness for installation access revalidated.

Visitor Center hours are Mondays, Wednesdays, and Fridays from 0700-1100

4. CONTRACTOR SECURITY REQUIREMENTS: You and your employees will stay in your immediate work area. Contractors are not be allowed to go “sight-seeing” around the installation.

Photography or videotaping by contractor employees is not permitted, unless prior arrangements have been made through your Sponsor who will contact the 139th Security Forces Squadron and the Public Affairs Office and/or Airfield Management as applicable, and the photography and/or videotaping is associated with the work being done on the installation.

The government assumes NO responsibility for lost or stolen material, equipment, or tools. The security of these items lies solely with the contractor. Any theft or damage of tools and/or equipment must be immediately reported to Security Forces and the contracting officer’s representative.

Contractors who witness any accident, suspicious activity or security incident are required to immediately report the event to Security Forces at the numbers provided below or make contact with any Security Forces personnel.

5. PROHIBITED ITEMS: Except as necessary to accomplish your contract/project, you and your employees shall not bring or possess any of the following items while on the Rosecrans MAP (ANG) Base:

Weapons. In the interest of public safety the items listed below are considered dangerous weapons.

Weapons include, but are not limited to, firearms, tazers, pepper spray, paint ball guns, pellet guns, BB guns, blowguns, bows and arrows, underwater spear guns, hunting slingshots, and throwing spears.

• Knives in excess of 3 inches, spring-loaded knives (switchblades), swords, blackjacks, metal knuckles, "Nunchacku" fighting sticks, kung-fu stars, boomerangs, chains (wrapped), and billy clubs. Possession of these items is expressly prohibited at all times, except when they are in use as part of the bearer's lawful "tools of the trade," such as craftsmen (electricians, carpenters, or other such trades.).

• Explosive Material: Consists of ammunition, gunpowder, firecrackers, and similar items.

Narcotics or drugs in any quantity except for those prescription drugs issued by a licensed pharmacist based on written prescription from a licensed medical doctor for health care purposes.

Drug paraphernalia and any contents contained therein.

Alcohol, which includes but is not limited to beer in open containers no matter what the quantity, is strictly prohibited from being consumed on the base and/or job site.

Remember, all individuals and vehicles are subject to search at any time.

6. ANTITERRORISM/FORCE PROTECTION. Contractor employees may be asked to leave the base at any time depending on Force Protection Condition level changes, security incidents, and potential threats. This will be done in a timely manner. Contact the 139 AW Antiterrorism Office at (816) 236-3585 for additional information. Antiterrorism Level I, Situation Awareness Training is available and may be provided to contractors as required by contract.

7. TRAFFIC/SAFETY REGULATIONS.

• Missouri State Motor Vehicle Law applies to all drivers and is enforced on the Rosecrans MAP (ANG) Base.

• The speed limit on the Missouri Air National Guard Base streets is twenty (20) miles per hour unless otherwise posted.

• Posted traffic signs (speed limit, stop signs, etc.) on the base will be obeyed by you and your employees.

• You and your employees are responsible for maintaining current registration requirements. This means your state vehicle registration, driver’s license, vehicle insurance, etc., must be up to date at all times.

• All vehicle occupants (exceptions - special purpose vehicles) will wear seat belts.

• Installation safety regulations prohibit riding in the bed of pickups.

• Contractors must pay special attention to Foreign Object or Debris (FOD). All streets or roadways must be kept clean so base or contractor vehicles do not track FOD onto the flight line. Contractors are required to complete FOD inspections prior to entering the aircraft parking ramp on the installation.

• Contractors are prohibited from using cellular telephones, without a hands free device, while they operate vehicles on the installation in accordance with Department of Defense guidance. Cellular phones cannot be used on the flight line area. Contractors may use their cellular phones when a vehicle is stopped if no hands free device is available. Contractors found to be operating vehicles in violation of the above criteria will be stopped by 139th

Security Forces personnel or other installation personnel and briefed accordingly.

• All Individuals must have a picture ID (driver’s license or state ID) and visitors pass (if issued) with them at all times.

8. MEDICAL EMERGENCIES. If an employee is injured or has a medical emergency on base call 911 or the Base Defense Operation Center (BDOC) at (816) 236-3394. Contractors may also make contact with any Security Forces patrols or any base personnel to notify of an emergency.

Calling 911 will connected to a tower in Kansas or a tower in Missouri. Either way whomever you reach you must state that you are on the Air National Guard base at Rosecrans Memorial Airport.

9. SEVERE WEATHER. Severe weather watches/warnings and safety instructions are announced over the installation public address system. Contractors are required to listen to these announcements and to follow the directions made over the public address system, made by the contracting officer’s representative, or by Security Forces members.

If you have questions/concerns please call SMSgt Ellis Couch at (816)236-3459 or TSgt Amy Zieber (816)236-3409