AF Form 2586 Flightline Driving Request.pdf
PDF 74 KB Posted
- Attached to
- Exterior Construction Contract
- Solicitation number
- FA8501-22-R-0002
About this file
This document contains an unescorted entry authorization certificate and external construction contract solicitation. The unescorted entry authorization certificate is a form used to request and authorize unescorted access to restricted or controlled areas at Robins Air Force Base for contractors performing work. It collects personal information on the individual requesting access and certifies they have been subject to a favorable background investigation meeting security requirements. The external construction contract solicitation is from the Department of the Air Force Materiel Command Air Force Sustainment Center. It seeks to award an indefinite delivery, indefinite quantity firm-fixed price contract to provide all labor, equipment, and materials for site preparation, demolition, repair, replacement, and minor construction projects to facility exteriors at Robins Air Force Base. The contract would consist of one base year and four one-year options.
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Text version
PREVIOUS EDITIONS ARE OBSOLETE.AF IMT 2586, 19 9 81001, V2
UNESCORTED ENTRY AUTH ORIZATION CERTIFICATE
PRIVACY ACT STATEMENT
I. IDENTIFICATION
II. CERTIFICATION OFREQUESTING OFFICIAL
III. DUTY
IV. RESTRICTED/CONTROLLED AREA COORDINATION
NAME
ORGANIZATION OR FIRM
GRADE ControlNumber(Last, First, MiddleInitial)
AUTH O RITY:
PRINCIPALPURPOSE(S):
ROUTINE USE(S):
10 U.S.C. 8013, 44 U.S.C. 3101, andEO 9 39 7.
TorecordpersonalinformationonanindividualwhosedutyperformancerequiresentryintoAirForcerestrictedandcontrolledareasin ordertocoordinatewiththeappropriateofficialanddeterminewhenandwhattypeofentrycredentialtouse.
ControlNumberisusedforindividualidentification. (Mustbefrom government-issuedID suchasCAC, driverlicense, passport, etc.)
None.
DISCLO SURE: Disclosureisvoluntaryhowever, failuretodiscloseinformationandSSN wouldresultinnotbeingallowedentryintotheseareas.
IcertifythattheindividualwhosenameappearsabovehasbeenthesubjectofafavorableinvestigationwhichmeetstherequirementsofAFIs31-101, 31-209 and
31-501, whenapplicable, forunescortedentryintorestrictedorcontrolledareas. Ifurthercertify, intheeventtheabovenamedindividualisanon-US national, that noUS nationalscanbemadeavailabletofillthispositionduringtheperiodindicatedabove, andthatthegrantingofunescortedentryrepresentsanexceptional requirementessentialtotheproperexecutionoftheCommand'smission. SuchunescortedentrywillnotinfringeupontheprohibiteddutiesoutlinedinAFPD 31
-seriesdirectives, andisclearlyconsistentwiththeinterestofnationalsecurity.
CAMPBELL, MARVIN G
78TH CIVIL ENGINEER GROUP
CONTRACTOR
COLOR H AIR
BLACK
CO LO R EYES
BROWN
W EIGH T
H EIGH T
5'10"
CITIZENSH IP (CheckOne)
(Describedutiesthatrequireunescortedentryintotheareasindicated)
US CITIZEN ALIEN IMMIGRANT NON-US NATIONAL
NAME, GRADE AND TITLE (Typed)
LOUIS BOUFFARD, SECURITY MANAGER
COMPANY NAME:
CONTRACT NUMBER:
PERFORMANCE START DATE:
PERFORMANCE END DATE:
PROGRAM MANAGER: TERRY R STINSON
PM OFFICE SYMBOL:78 CEG/CENME
PM DUTY PHONE:478-258-2507
PM BUILDING#280
DATE
05/16/2016
SIGNATURE
NUMBER OFFICIAL
AREA
LASSITER.TONYA.M.1284045382
ESCO RT
TYPE AREA
CONCUR
DATE
OFFICIAL'S SIGNATURE
COORDINATING/APPROVING
YES NO
NAME (Last, First, MiddleInitial)NAMENAME
H EIGH T W EIGH T CO LO R EYES COLOR H AIR
AFIMT2586, 19 9 81001, V2 (REVERSE)
IV. RESTRICTED/CONTROLLED AREA COORDINATION
V. RESTRICTED/CONTROLLED AREA BADGE ISSUE
NUMBER OFFICIAL
AREA
TRANSACTION
BASIC BADGE
EXCH ANGE BADGE #1
EXCH ANGE BADGE #2
CARD NUMBERFO RM TYPE BADGE NUMBER
ESCO RT
TYPE AREA
CONCUR
DATE
OFFICIAL'S SIGNATURE
COORDINATING/APPROVING
YES NO
EXCH ANGE BADGE #3
REISSUE #1
REISSUE #2
REISSUE #3
REISSUE #4
REISSUE #5
BADGE ISSUING OFFICIAL
REMARK S
(TypedNameandSignature) APPLICANT VERIFYING RECEIPT OF BADGE DATE(Signature)
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