Attachment 9 - CBP Short Term Contractor Information Sheet.xls
XLS spreadsheet 55 KB Posted
- Attached to
- Preventative Maintenance (PM) and Repairs for Equipment and Facilities in the Southeast Region
- Solicitation number
- 70B01C23R00000007
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Short Term Contractors Template
| CBP Short Term Contractor Information Sheet | |||||||||||
| Date Submitted: | From: | ||||||||||
| Contract Company Information | CBP Agency Information | ||||||||||
| Contract Company Name | CBP Location Address (Location, Building, Floor, Room #) | ||||||||||
| Contract Company Address | Visitor Escort Full Name (DHS/CBP Employee Only) | ||||||||||
| Contract Company POC (First & Last Name) | Phone Number | ||||||||||
| On Site Contractor POC (First & Last Name) | Phone Number | Phone Office | Phone Mobile | ||||||||
| Date(s) and | |||||||||||
| Time(s) of Visit | From Date | Time | To Date | Time | |||||||
| Purpose of Visit: | |||||||||||
| Provide all below information | |||||||||||
| # | Last Name(s) | First Name | Middle Name | Social Security Number | DOB MM/DD/YYYY | Current Full Address | Occupation | POB (City, State/ Country) | U.S. Citizen (Y/N) | A#, Visa#, Passport # (If NON-USC | |
| Passport # Required) | DL State Issued | Drivers |
License #
| 1 | PASSPORT # REQUIRED! |
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| SUBMISSION: The Office of Professional Responsibility requires a mandatory submission of 72 hours prior to arrival of visitor(s) in order for any visitor to be considered for approval. Email request to SMDSECURITYSERVICESBRANCH@cbp.dhs.gov or fax to the Office of Professional Responsibility, ATTN: Security Management Division at 202-344-1860. |
NOTICE: All visitors must present a U.S. Government issued Photo Identification Card. All visitors must check in at the Security Desk upon arrival and check out at the desk upon departure. Visitor escorts are responsible for constant escort of visitors. The designated escort must accompany visitors at all times, to include returning visitors back to the front desk upon departure. Any visitors found in U.S. Customs and Border Protection space without an escort will be immediately reported to security and escortedout of CBP space. One escort must be provided for every four visitors (1-4), depending on Vetting status one escort may be required for evey person (1-1).
PRIVACY ACT NOTICE: This information is provided to PL 93-579 (Privacy Act of 1974). The purpose of this document is provide information necessary for a minimum security check prior tolimited authorized access to U.S. Customs and Border Protection facility. Failure to provide this information may result in denial of access.
| # | Last Name(s) | First Name | Middle Name | Social Security Number | DOB MM/DD/YYYY | Current Full Address | Occupation | POB (City, State/ Country) | U.S. Citizen (Y/N) | A#, Visa#, Passport # (If NON-USC | |
| Passport # Required) | DL State Issued | Drivers |
License #
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| SUBMISSION: The Office of Professional Responsibility requires a mandatory submission of 72 hours prior to arrival of visitor(s) in order for any visitor to be considered for approval. Email request to SMDSECURITYSERVICESBRANCH@cbp.dhs.gov or fax to the Office of Professional Responsibility, ATTN: Security Management Division at 202-344-1860. |
NOTICE: All visitors must present a U.S. Government issued Photo Identification Card. All visitors must check in at the Security Desk upon arrival and check out at the desk upon departure. Visitor escorts are responsible for constant escort of visitors. The designated escort must accompany visitors at all times, to include returning visitors back to the front desk upon departure. Any visitors found in U.S. Customs and Border Protection space without an escort will be immediately reported to security and escortedout of CBP space. One escort must be provided for every four visitors (1-4), depending on Vetting status one escort may be required for evey person (1-1).
PRIVACY ACT NOTICE: This information is provided to PL 93-579 (Privacy Act of 1974). The purpose of this document is provide information necessary for a minimum security check prior tolimited authorized access to U.S. Customs and Border Protection facility. Failure to provide this information may result in denial of access.
File details come from the government source that posted it. Updated .