Att 2.3 Navy DBIDS Contractor Visit Request (SERMC 5220_2 Rev 12_21) (Fillable).xlsx
XLSX spreadsheet 250 KB Posted
- Attached to
- USS LASSEN (DDG-82) HULL PRESERVATION
- Solicitation number
- N4002722R0008
View the file
Other files
Show all 21
On GovTribe
Work with this file
- Download the original file
- Contacts named in this file
- Similar government files
- Ask GovTribe AI about this file
Text version
Instructions (READ FIRST)
CONTRACTOR VISITOR ACCESS REQUEST FORM
UPDATED: JULY 2021
| MINIMUM REQUIREMENTS FOR ACCESS TO U.S. SHIPS AND FACILITIES | SERMC access requests for: | ||
| 1. U.S. Citizen | 1. SERMC Contracts | ||
| 2. Foreign National with appropriate approval | 2. SERMC-Administered Contracts | ||
| 2. Must be 18 Y.O. | 3. Contracts directly supporting SERMC administered Avails/work efforts | ||
| 3. Verifiable requirement to access U.S. ship or facility | Note: Routine Administrative Access (those not associated with a SERMC monitored availability) or requests for access only to shipyards will not be processed. | ||
| INSTRUCTIONS FOR FIELDS 1B THRU 7B: | |||
| 2b | Do not change (Default is SERMC) | ||
| 3b | Enter the name of the Agency | ||
| 4b | Enter the Contract Number. NOTE: This must be the PRIME CONTRACT. DO NOT USE PRIME CONTRACTOR ISSUED PO, etc. | ||
| 5b | Select the type of contract from the pull-down menu. | ||
| 6b | Select the ship or agency to be visited from the pull-down menu. VARIOUS SHIPS CAN BE LISTED HERE. | ||
| 7b | Enter the name of the FSO or Agency Point of Contact. | ||
| 8b | Enter the phone number (XXX-XXX-XXXX) for the point of contact listed in field 5b. | ||
| 9b | Enter the e-mail address for the point of contact listed in field 5b. | ||
| INSTRUCTIONS FOR VISITOR INFORMATION FIELDS (starts from Line 10) FILL OUT ONLY THE BLUE FIELDS. DO NOT USE ANY PUNCTUATION BESIDES HYPHEN | |||
| Last Name (Column A) | Full, Legal Last Name of the Visitor | ||
| Suffix (Column B) | Legal Suffix (II, III, IV, JR, SR, etc.) | ||
| First Name (Column C) | Full, Legal First Name of the Visitor | ||
| Middle Name (Column D) | Must be either; 1) Full Middle Name 2) middle initial, 3) if no middle name, NMN | ||
| Employer (Column E) | Actual employer of the visitor. | ||
| Unique Identifier (Column F) | A unique, Non-PII, element that can identify the employee and issued on the Employeer issued Id Card CAN NOT BE SSN, DRIVERS LICENCE or ANY OTHER PII SENSITIVE ELEMENT | ||
| US CITIZEN (Column G) | Yes or No. (NOTE 1: For naturalized citizens, Select YES.) | ||
| DBIDS ISSUED (Column H) | Yes or No. (NOTE 2: For Naval Station Mayport DBIDS issued only, Select YES.) | ||
| Purpose (Column I) | The purpose of the visit. | ||
| Start Date (Column J) | Start Date of the Visit. NOTE: VISIT REQUEST START DATES CANNOT BE DATED PRIOR TO THE SUBMISSION OF THE REQUEST. Do not backdate visit requests. | ||
| End Date (Column K) | End Date of the Visit. | ||
| Column L | Leave Blank. Reserved for future use. | ||
| NOTE: VISIT REQUESTS WILL ONLY BE GRANTED FOR THE PERIOD OF PERFORMANCE OR ONE CALENDAR YEAR, WHICHEVER IS SHORTER. |
Notice to Industry Facility Security Officers/Security Managers/Agency POC:
By submitting visit requests, FSOs or Agency POC are acknowledging that the proper due diligence has been performed to verify each visitor:
1) meets all legal requirements to work onboard U.S. government facilities
2) is a US CITIZEN. If No, Company FSO or Agency POC validates/verifies that the individual listed is legally allowed to work in the United States and will not be accessing restricted areas.
3) over the age of 18.
4) has not been previously restricted or denied eligibility for access to perform maintenance onboard US Navy vessels or at SERMC.
| ACCESS LIST SUBMISSION GUIDELINES |
| E-mail the request to: sermc_mypt_security@navy.mil. NOTE: ONLY ONE ACCESS REQUEST PER E-MAIL. ENSURE separate e-mails for: 1) Initial request 2) Deletions/Removals 3) Additions 4) Changes (i.e. contract or avail extensions) NOTE: For any submissions after the INITIAL, DO NOT CHANGE THE START DATE. |
| Subject Line and Contractor Visit Request must read/save as the same: <ship to be visited>/ <Prime Contractor> (Or state "Multiple Sub-contractors" for multiple subcontractors.)/ <dates of visit>. Industry Example: USS BOXER/AMEE BAY/1Jun20 - 9SEP20 or USS BOXER/Multiple Sub-Contractors/1JUN20 - 1JUN20 VARIOUS SHIPS OR MULTIPLE SHIPS/AMEE BAY/1Jun20 - 9SEP20 |
| NOTE: FOR classified access to Restricted Areas: DISS Visit Request is required. ALL Classified Access Requests must be submitted to the ship (not SERMC) via the Defense Information System of Security (DISS). |
SERMC 5510/2 (Rev. 12/21)
DO NOT add any spaces/or press tab after you enter your information for Lines 2-9.
We wil be unable to approve your request until all corrections have been made.
Personnel Info
| AGENCY INFORMATION | E-mail the request to: sermc_mypt_security@navy.mil NOTE: ONLY ONE ACCESS REQUEST PER E-MAIL: 1) Initial request 2) Deletions/Removals 3) Additions 4) Changes (i.e. contract or Avail extensions) NOTE: Visit Requests cannot exceed a year. VISIT REQUESTS WILL ONLY BE GRANTED FOR THE PERIOD OF PERFORMANCE OR ONE YEAR, WHICHEVER IS SHORTER. (CANNOT SELF REQUEST ACCESS) | |||||||||
| Contract Support Region: | SERMC | |||||||||
| Contracting Prime: | ||||||||||
| Contract Number: | ||||||||||
| Type of Contract | Select from Pulldown Menu: | |||||||||
| Naval Vessel or SERMC: | ||||||||||
| Facility Security Officer (FSO)/Agency POC: | ||||||||||
| FSO/Agency POC Telephone Number: | ||||||||||
| FSO/Agency POC Email: | ||||||||||
| Last Name | Suffix | First Name | Middle Initial | Employer | Unique Identifier | U.S. Citizen | DBIDS ISSUED (YES/NO) | Purpose | Start Date | End Date |
SERMC_Ships (DO NOT DELETE TAB)
| Select Ship | Suffix Field Data | Citizenship | Type of Contract | Yes |
| SERMC | JR | YES | Select from Pulldown Menu: | |
| NECC PATROL BOAT | SR | NO | MACMO | No |
| USNS HUNTER NS 8102 | I | LCS MAC | ||
| USS BILLINGS LCS 15 | II | MSMO | ||
| USS CARNEY DDG 64 | III | AIT | ||
| USS DELBERT D BLACK DDG 119 | IV | CIS | ||
| USS DETROIT LCS 7 | OTHER | |||
| USS DONAL COOK DDG 75 | ||||
| USS FARRAGUT DDG 99 | ||||
| USS INDIANAPOLIS LCS 17 | ||||
| USS IWO JIMA LHD 7 | ||||
| USS JASON DUNHAM DDG 109 | ||||
| USS LASSEN DDG 82 | ||||
| USS LITTLE ROCK LCS 9 | ||||
| USS MILWAUKEE LCS 5 | ||||
| USS PAUL IGNATIUS DDG 117 | ||||
| USS PHILIPPINE SEA CG 58 | ||||
| USS SAINT LOUIS LCS 19 | ||||
| USS SIOUX CITY LCS 11 | ||||
| USS THE SULLIVANS DDG 68 | ||||
| USS THOMAS HUDNER DDG 116 | ||||
| USS WICHITA LCS 13 | ||||
| USS WINSTON CHURCHILL DDG 81 |
Example
| INDUSTRY/GOVERNMENT AGENCY INFORMATION | E-mail the request to: sermc_mypt_security@navy.mil NOTE: ONLY ONE ACCESS REQUEST PER E-MAIL: 1) Initial request 2) Deletions/Removals 3) Additions 4) Changes (i.e. contract or Avail extensions) NOTE: Visit Requests cannot exceed a year. VISIT REQUESTS WILL ONLY BE GRANTED FOR THE PERIOD OF PERFORMANCE OR ONE YEAR, WHICHEVER IS SHORTER. (CANNOT SELF REQUEST ACCESS) | |||||||||
| Contract Support Region: | SERMC | |||||||||
| Agency: | BAE Systems Jacksonville Ship Repair | |||||||||
| Contract Number: | N40027-20-F-0320; N40027-20-D-0320 | |||||||||
| Type of Contract | AIT | |||||||||
| SERMC or Ship: | USNS HUNTER NS 8102; USS NEVERSAIL FFG 50 | |||||||||
| Facility Security Officer (FSO)/Agency POC: | Jane Doe | |||||||||
| FSO/Agency POC Telephone Number: | 904-777-9311 | |||||||||
| FSO/Agency POC Email: | john.doe@baesystems.com | |||||||||
| Last Name | Suffix | First Name | Middle Initial | Employer | Unique Identifier | U.S. Citizen | DBIDS ISSUED (YES/NO) | Purpose | Start Date | End Date |
| Doe | SR | John | W | BAE Systems Jacksonville Ship Repair | 44567 | NO | YES | Welding | 4/13/20 | 4/14/20 |
File details come from the government source that posted it. Updated .