A.19 Visitor Request.docx
DOCX document 20 KB Posted
- Attached to
- Chiller Replacement Roybal Campus Federal contract opportunity
- Solicitation number
- 75D301-26-R-73398
About this file
This is a Visitor Request Form for access to CDC campuses related to the Chiller Replacement project at Roybal Campus Building 10. The form documents a site visit scheduled for May 6, 2026, from 10:00 AM to 1:00 PM at the Roybal Campus, Building 10, with entry through the Main Gate. The visit purpose is a site inspection of the Building 10 chiller replacement work. The escorts are Wes Bryan (HSY8) and Harsimerdeep Khera (UKE1), with the PGO contact being Harsimerdeep Khera. The form references Project P202210098 B10 Domestic Water Replacement and the CDC/PCMSO point of contact is Wes Bryan.
The form establishes standard visitor access requirements and security protocols for CDC government property, including that all visitors must be escorted by CDC badge holders at all times, provide a valid photo ID for admission, and obtain visitor badges during normal security office hours. Foreign nationals are required to complete additional security documentation a minimum of ten working days prior to the visit. The form includes statutory warnings regarding penalties for false statements under Title 18, Section 1001 of the U.S. Criminal Code, which provides for fines up to $10,000 and/or imprisonment up to five years.
View the file
Other files for this federal contract opportunity
| File | Type | Posted |
|---|---|---|
| A.1b Statement of Work.pdf | ||
| A19 Solicitation.pdf | ||
| 4 Contractors Non-Disclosure Agreement.docx | DOCX document | |
| A.14 Wage Determination.pdf | ||
| 5 Contractor Employee Non-Disclosure Agreement.docx | DOCX document |
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Text version
VISITOR REQUEST FORM FOR ACCESS TO CDC CAMPUSES
| DATE OF REQUEST: |
| 05/06/2026 |
| PROJECT: |
| P202210098 B10 Domestic Water Replacement |
| CDC/PCMSO POINT OF CONTACT: |
| WES BRYAN HSY8 |
| PRIME CONTRACTOR POC & CELL: |
| N/A |
CAMPUS, BUILDING(S) & FLOOR(S)
WHERE VISIT WILL TAKE PLACE:
Roybal Campus, BLDG 10, ALL
| ENTRY POINT OF VISITOR: |
| Main Gate, Roybal Campus |
| PURPOSE OF VISIT: |
| SITE VISIT BLDG. 10 CHILLER REPLACEMENT |
| ESCORT NAME(S): |
| Wes Bryan (HSY8) Harsimerdeep Khera (UKE1) |
| PGO CONTACT: |
| Harsimerdeep Khera (UKE1) |
VISITOR
FULL NAME/ AND NAME AS SHOWN ON PHOTO ID IF DIFFERENT
| US CITIZEN |
| VISITOR’S COMPANY |
NAME
CELL PHONE
IF AVAILABLE
| DATE OF VISIT |
| TIME AND DURATION OF VISIT |
| NO |
| YES |
X
| 05/06/26 |
| 10:00 AM – 1:00 PM |
PENALTIES FOR INACCURATE OR FALSE STATEMENTS
The US Criminal Code (title 18, section 1001) provides that knowingly falsifying or concealing a material fact is a felony which may result in fines of up to $10,000, and/or 5years imprisonment or both.
EMPLOYEE INFORMATION ON THIS FORM PROVIDED TO THE GOVERNMENT PROJECT OFFICER BY THE PRIME CONTRACTOR
VISITORS:
MUST BE ESCORTED BY PERSON(S) WITH VALID CDC ID BADGE AT ALL TIMES
A PHOTO ID IS REQUIRED FOR VISITOR ADMISSION ON ALL GOVERNMENT PROPERTY
VISITOR BADGES MUST BE OBTAINED DURING THE NORMAL OPERATING HOURS OF THE LOCAL SECURITY OFFICE. THE SECURITY OFFICE IS NOT OPEN ON WEEKENDS AND HOLIDAYS FOREIGN NATIONAL MUST COMPLETE AND TRANSMIT, THE REQUIRED FORM AT http://intranet.cdc.gov/od/aspo/security/foreign_visitor.htm and http://aops-mas-iis.od.cdc.gov/Policy/Doc/policy334.pdf A MINIMUM OF TEN WORKING DAYS BEFORE VISITING ANY
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