Attach 3.2_Base Access Instructions.pdf
PDF 8 MB Posted
- Attached to
- EOY_Unfunded_Holloman AFB Dormitory CCTVs Federal contract opportunity
- Solicitation number
- FA480123Q0491
About this file
This document contains a template for a Visit Access Request (VAR) used by Holloman Air Force Base (HAFB) to process contractor employee installation access.
The VAR collects employees' full names, dates of birth, social security numbers, citizenship status, and company information for background checks to determine eligibility for base access. It outlines requirements such as providing valid identification, vehicle registration if driving on base, and briefing escorted personnel. The sponsoring unit reviews and approves VARs before the HAFB Security Forces process requests within 3-5 days. Approved personnel receive Defense Biometric Identification System credentials not exceeding one year or the contract end date. The sponsoring organization must return all credentials when individuals no longer require access.
View the file
Other files for this federal contract opportunity
| File | Type | Posted |
|---|---|---|
| Q_A.pdf | ||
| Revised_Performance Work Statement (PWS).pdf | ||
| Revised_Attach 3.3_Building Locations.PNG | PNG image | |
| Performance Work Statement (PWS).pdf | ||
| Combined Synopsis_Solicitation.pdf | ||
| 52.212-2 Addendum.pdf | ||
| Attach 3.1_Floor Plans.pdf | ||
| 52.212-1 Addendum.pdf | ||
| Attach 3.3_Building Locations.pdf |
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Text version
CUI
HOLLOMAN AFB
VISIT ACCESS REQUEST (VAR)
MEMORANDUM FOR: 49 SFS/S5AV (49 SFS Pass and Registration) (UDG_49SFS_VARandEAL@us.af.mil)
FROM:
SUBJECT: Contractor Visit Access Request (VAR) References:
a. Contract Number: ______________ Contract Title: ______________
b. Start Date: ____________________ End Date: __________________
c. Requesting Office: _______________________
d. Requesting Office Phone: _________________
e. HAFB Point of Contact:
Name______________________________________________ Telephone #_________________________________________ E-mail address _______________________________________
VAR's may be used for multiple contracts for the same company and may take up five (5) days to process.
Request that a visitor pass be issued to the contractor(s) listed below. All employees will be briefed on and shall comply with HAFB security requirements. All employees have signed the government provided consent form authorizing the U.S. Government (United States Air Force) to conduct a background check to confirm their eligibility to be granted access to HAFB, NM. Contractors denied unescorted entry as a result of their background check may be approved for escorted entry by the 49 SFS/CC. Escort authority will ONLY be granted to the project manager or project superintendent (maximum of three (3) three escorts per VAR designated by asterisk on a VAR and has completed a Escort Responsibility Form), or a contractor with a valid DoD Common Access Card (CAC) may also escort employees approved for escorted entry. Contractor escort authority is limited to ONLY those employees approved for escorted entry. EXCEPTION: The project manager or project superintendent, or a contractor with a valid DoD CAC may escort non-routine pickups and deliveries. Pickup/delivery drivers will provide a bill of lading at the time of pass issuance; passes will not exceed six (6) hours. Routine pickups and deliveries require the contractor add the driver(s) to a VAR to undergo the appropriate background check. All VARS must be typed and emailed to the Welcome Center.
Contractors shall report to the 49 SFS Welcome Center (Bldg. 1) with photo identification issued by a federal/ state activity. Employees requesting to operate a company or privately owned vehicle on the installation shall provide a valid driver’s license, current vehicle registration, and proof of current vehicle insurance or car rental agreement.
All Foreign Nationals requesting access to HAFB (for official and unofficial visits) must provide three
(3) valid forms of ID consisting of: A state issued drivers license/ID card, Social Security card, Resident alien card, Employment Authorization Document, or Passport/Birth certificate.
NCIC
Current as of 5 April 2023 The information herein is Controlled Unclassified Information (CUI) which must be protected under the Freedom of Information Act of 1966 and Privacy Act of 1974, as amended. Unauthorized disclosure or misuse of this PERSONAL INFORMATION may result in criminal and/or civil penalties.
The requestor will ONLY request access for job duration not to exceed one year or contract end date. The requesting company/organization will retrieve all credentials from employees when job is completed or employee is terminated. The requesting company/organization will then return collected terminated access credentials to sponsoring agency in turn the sponsoring agency will return all credentials to the issuing office, 49 SFS/S5AV.
1039059181C Typewritten Text
1039059181C Typewritten Text
SFS USE
ONLY #
FULL LEGAL NAME
LAST, FIRST, MI AND
ISSUING STATE OF ID
OR DL
SSN DOB
(DD MMM YYYY)
CITIZENSHIP/
PERM RESIDENT
#(REQUIRED)
STATUS NAME, State of ID/DL SSN DOB CITIZENSHIP
1 NAME SSN DOB
2 NAME SSN DOB
3 NAME SSN DOB
4 NAME SSN DOB
5 NAME SSN DOB
6 NAME SSN DOB
7 NAME SSN DOB
8 NAME SSN DOB
9 NAME SSN DOB
10 NAME SSN DOB
11 NAME SSN DOB
12 NAME SSN DOB
13 NAME SSN DOB
14 NAME SSN DOB
15 NAME SSN DOB
16 NAME SSN DOB
17 NAME SSN DOB
18 NAME SSN DOB
19 NAME SSN DOB
20 NAME SSN DOB
21 NAME SSN DOB
22 NAME SSN DOB
23 NAME SSN DOB
24 NAME SSN DOB
25 NAME SSN DOB
26 NAME SSN DOB
27 NAME SSN DOB
28 NAME SSN DOB
29 NAME SSN DOB
30 NAME SSN DOB
31 NAME SSN DOB
32 NAME SSN DOB
33 NAME SSN DOB
34 NAME SSN DOB
35 NAME SSN DOB
36 NAME SSN DOB
37 NAME SSN DOB
Company Name:_____________________________________
2 Current as of 5 April 2023 The information herein is Controlled Unclassified Information (CUI) which must be protected under the Freedom of Information Act of 1966 and Privacy Act of 1974, as amended. Unauthorized disclosure or misuse of this PERSONAL INFORMATION may result in criminal and/or civil penalties.
HOLLOMAN AFB
VISIT ACCESS REQUEST
(VAR) cont.
CONTRACTOR VISIT INFORMATION:
* Visitor passes will NOT exceed contract performance period or 1 year, whichever is less. Badges will only be issued within three (3) duty days prior to the start date.
Period of visit: ___________________ to ___________________ (Dates Requested) Visiting hours: ___________________ to ___________________ (ex. 0600-1730)
Reason for visit: ________________________________________
Visit location: ______________________________________ (Be specific; bldg/room(s), etc.)
Sponsoring Organizations WILL return ALL issued access credentials to 49 SFS/S5AV once the contract has been completed and/or the individual no longer requires access.
Please direct any questions to me (company official) at _________________.
By selecting "YES" you certify the attached information is true and correct.
Signature of Company Official _________________________ Date _____________
Typed/Printed Name _________________________
Job Title/Company Name _________________________
I have reviewed and approved this visit access request.
Signature of Sponsoring Unit __________________________ Date _____________
CC/Unit Security Manager/
Designated Contracting Official
Typed/Printed Name __________________________
Duty Title __________________________
SPONSORING UNIT PLEASE READ BELOW
All civilian contractor identified on a VAR are going to be issued a Defense Biometric Identification System (DBIDS) credential from the Holloman AFB Welcome Center. All credentials issued will not exceed Force Protection Condition (FPCON) Bravo. If the sponsoring unit that has reviewed and approved a VAR and finds it necessary for a civilian contractor to have access at a higher FPCON not to exceed Charlie, the sponsoring unit commander will need to complete, sign and submit a FPCON Charlie access memorandum to the Holloman AFB Welcome Center. The memorandum must contain the civilian contractor’s name, duty title and a brief description of his/her specific duties that require access during FPCON Charlie. At no time will a civilian contractor listed on a VAR be eligible for FPCON Delta Access.
3 Current as of 5 April 2023 The information herein is Controlled Unclassified Information (CUI) which must be protected under the Freedom of Information Act of 1966 and Privacy Act of 1974, as amended. Unauthorized disclosure or misuse of this PERSONAL INFORMATION may result in criminal and/or civil penalties.
National Crime Information Center (NCIC) – Visit Access Request (VAR), Holloman AFB, NM
For contracts awarded/administered by the 49th Contracting Squadron.
Be advised: IAW REAL ID Act, All Identification cards marked "Not Valid for Federal Purposes";
"Federal Limits May Apply" are NOT authorized unescorted access to Holloman AFB. Those individuals will be vetted and need a valid sponsor with escort authority present. Those individuals will receive an
ESCORTED visitor pass and the escort official will be responsible for them at all times while on the installation.
Request that a visitor pass be issued to all contractor employees to gain access to Holloman AFB, NM.
All employees will be briefed on and shall comply with Holloman AFB security requirements. The VAR will consist of employees FULL Name, Date of Birth, Social Security Number, Place of Birth and
Citizenship, and/or a residential alien card. The format for a Visit Access Request Form will be provided upon request. By submitting this information on the VAR the employee is authorizing the U.S.
Government (United States Air Force) to conduct a background check to confirm their eligibility or ineligibility to gain access to Holloman AFB, New Mexico. Fitness determinations for civilian contractors will be conducted by vetting these individuals through NCIC, NMLETS, TSDB and HAFB debarment, suspension, revocation roster, and the HAFB Base Access Eligibility Matrix. Contractors will ensure that the VAR is provided to the 49 SFS Welcome Center (Bldg. 1) at least 3-5 business days prior to requested installation access for processing and 7 business days prior for foreign nationals. Foreign nationals will not be granted unescorted entry to the installation. Civilian contractors requiring base access are not, at any time, authorized unescorted access to sensitive areas or access to government information networks.
Delivery drivers will provide a bill-of-lading or delivery receipt at the time of pass issuance; passes will not exceed 6 hours. Routine deliveries require the contracting company to add the driver(s) to a VAR to undergo the appropriate background check. Contractor employees shall report to the 49 SFS Pass and
Registration Office (Bldg. 1) with photo identification issued by a federal/state activity. Contractor employees requesting to operate a contractor or privately owned vehicle on the installation shall provide a valid driver’s license, current vehicle registration, and proof of current vehicle insurance or car rental agreement. Contractor personnel requesting to operate a motorcycle on Holloman AFB shall provide proof they have completed a motorcycle safety course (i.e. motorcycle safety course certificate/card) prior to being authorized to ride on the installation.
All Contracting Organizations:
(a) Ensure contract provisions are included requiring contractors to return all local access credentials to the WC when contract is completed or when a contractor employee no longer requires access to the installation. The sponsoring organization of the contract will ultimately be responsible for the conduct of contractors. Ensures contracting organizations include commercial vehicle inspection requirements are included in Statements of Work.
End NCIC REQUIREMENTS
Sol # FA480123R0001
13 July 2023 Attachment 3 Page 1 of 4
Sol # FA480123RR0001
Base Access/Contractor Background Checks Inquiry (December 2015)
1. Base access waiver request and instructions documents (Appeal Process/Instruction): If an individual contractor was denied installation access as a result of an unfavorable background check and cross referenced with the attached matrix, the individual and contractor are advised that the individual in question, has received an unfavorable background check and that the information in the check cannot be released outside of Law Enforcement agencies. They are then advised how to obtain information concerning their record and the appeal process and provided written step-by-step instructions on how to do same.
The process is as follows; if past criminal history is unknown: The individual must send a written request to the Federal Bureau of Investigations, Criminal Justice Information Services Division and attach an
$18.00 check. Additionally, they must submit a complete set of (rolled inked fingerprint impressions), with name, date, and place of birth which can be obtained from the local police departments. Once the individual receives the information pertaining to their background from the FBI, they must then submit a letter of memorandum explaining the negative information identified in the background check and justification as to why the decision to be denied access should be reconsidered. Furthermore, a character reference letter will be required by their immediate supervisor along with a letter from the sponsoring unit commander requesting the contractor employee be authorized access.
2. Procedures for contractors to submit access requests for pre-approval (prior to work): Contractors are able to proceed with contractor employee installation access paperwork when given the order to proceed at the final preconstruction meeting. The final preconstruction meeting occurs 14-30 days prior to the project start date. At that time, the contractor is provided all the paperwork and instructions required for their employees to be granted installation access. The background checks are then completed by
Holloman AFB (HAFB) Security Forces (SF). The background checks are completed an average of 3 business days upon receipt but will not exceed 5 business days. Contractors will re-submit and vetting re-accomplished at least every 12 months for the duration of the specified contract. Contracting units
(CONS/MICC) ensure contractors are aware of the 49 WG contractor vetting requirements and the potential effects of revealed unfavorable information.
13 July 2023 Attachment 3 Page 2 of 4
a. Holloman AFB Access Eligibility Matrix July 2023
b. Only personnel delegated by the Installation Commander in writing shall perform fitness determination. Delegation will be in writing, either by position/office or name designation and codified in local guidance. (T-1).
c. Installation commanders may deny access and issuance of access credentials based upon information obtained during the vetting process that indicates the individual may present a threat to the good order, discipline, and morale of the installation. Behavior or criminal records that pose unacceptable risk are listed below:
IAW DAFMAN 31-101, Vol 3, Installation Perimeter Access Control
Access eligibility determination will be decided by the on-duty flight chief, or the operations superintendent.
All individuals who are denied access are entitled to an appeal process. They should be directed to the
Visitor Control Center for any information regarding the appeal process.
Conviction of:
Access will be denied if the presence of ANY conviction exists, regardless of when the violation occurred
Terroristic Acts/Belonging to a Terrorist Organization Access Denied
Firearms/Explosives Violations Access Denied
Assault with a Deadly Weapon Access Denied Armed Robbery Access Denied Vehicular Homicide/Manslaughter Access Denied Homicide/Murder Access Denied Sabotage Access Denied Treason Access Denied Espionage Access Denied Any type of Sexual Crimes/Offenses Access Denied Child Molestation Access Denied Child Pornography Access Denied Voyeurism/Peeping Tom Activities Access Denied Human Trafficking/Smuggling/Harboring illegal aliens Access Denied
Drug Possession with Intent to Sell/Distribution Access Denied Registered Sex Offender Access Denied
Violent Persons/Offender File Access Denied Organized Criminal Activity/Active Criminal Gang Member Access Denied Watch List/Hit List/Any Active Warrant (Both Extraditable/Non-Extraditable)
Access Denied
Any Pending Charges/Missing/Unknown Dispositions Access Denied
Any Unconfirmed SSN/Unable to Confirm Identity Access Denied
Any Additional Offense(s) with a Felony Conviction Not Specified in the list Above
Access Denied if Offense Occurred Within the Last 10 years.
Misdemeanor Offenses with Convictions Access Denied if Three or More Occurred Within the Last 10 Years
13 July 2023 Attachment 3 Page 3 of 4
13 July 2023 Attachment 3 Page 4 of 4
| Attach 11_Site Visit & Base Access Instructions |
| Attach 11_Site Visit & Base Access Instructions |
| Attach 11_Site Visit & Base Access Instructions |
| Attach 11_Site Visit & Base Access Instructions |
| Attach 11_Site Visit Instructions |
| Attach 10_Visitor Access Request |
| Atch 3, 4-pg NCIC_Base access_13Jul23 |
| Attach 11_Site Visit & Base Access Instructions |
| Atch 3, 4-pg NCIC_Base access_13Jul23 |
DEPARTMENT OF THE AIR FORCE
HEADQUARTERS 49TH WING (AETC)
HOLLOMAN AIR FORCE BASE NEW MEXICO
(Date)
MEMORANDUM FOR 49 SFS/S5AV
FROM:
49 XX/CC
SUBJECT: Force Protection Condition (FPCON) Charlie Access
1. The following personnel with (COMPANY), Tracking # XXX-XX-XX are being identified as requiring access to Holloman AFB, NM during FPCON Charlie measures. These individuals are considered mission essential to the (LOCATION(S)) and provide the necessary access to ensure mission essential requirements are met.
2. The individuals listed below require access during FPCON Charlie measures for please provide a brief description of duties of the individuals listed below that require access during FPCON Charlie measures.
a.
Name:
Duty Title:
b.
3. If you have any questions or concerns regarding this matter please feel free to contact (NAME) or at DSN 572-XXXX.
FIRST A. LAST, Rank, USAF
Commander, 49th XXXXXX
Combat Airpower Starts Here
_910175576.doc
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MEMORANDUM FOR ________________
49 SFS
FROM: ________________
SUBJECT: Travel Approval Letter
1. I, ____________________________________ request ________________ travel approval IAW the itinerary listed below. All travelers will adhere to applicable guidance during travel.
2. ITINERARY:
3. For questions, please contact _______________________ at _______________________.
1st Ind, ________________
HOLLOMAN AIR FORCE BASE, NEW MEXICO
COMBAT AIRPOWER STARTS HERE
1. I, ____________________________________ request to conduct ________________ travel IAW the itinerary listed below. I will adhere to all pertinent 49 FW and HHQ guidance during travel.
Date: 04 Sep 1949
Req OffSym: Name of Company
Req Name: John A. Doe
Contact: Darlene Y. Simpson
Phone: 575-572-7828
Req Name Blk2: Contract Specialist, 49 CONS/PKA
Auth Name Blk1: FIRST M. LAST, Rank, BRANCH
Auth Name Blk2: Commander, Organization
Auth OffSym: 49 CONS/CC
Itinerary: Travelers: Civilian Contractor / John A. Doe Departing: 09 Nov 2020-El Paso, TX / POV or Company Vehicle Arrival: 09 Nov 2020-Holloman AFB, NM / POV or Company Vehicle.
Departure Final: 08 Nov 2021 / POV or Company Vehicle (See Note Below) Note: Traveler will be conducting work daily per Contract and the entire term of contract on HAFB.
Enter one line for each en route overnight stay, and for any changes in mode of transportation.
Auth Comments: Upon return, member will... Example: Upon arrival to HAFB, visitors will need to check into the Welcome Center. During travel, visitors will comply with all CDC guidelines and adhere to all COVID-19 safety requirements to include social distancing, wearing of face covering and sanitation. No in person dining, do not attend gatherings with more than 10 individuals and minimize close contact within 6' for 15+ minutes.
Trvl Type: [other (Contractor)]
Approval: [Approved]
REQ Sig Blk: DARLENE Y. SIMPSON, Civ, USAF
BACKGROUND CHECK
CONSENT FORM
I, __________________________________________________, (Name – typed/printed)
Hereby authorize the U.S. Government (United States Air Force) to conduct background checks confirming my eligibility or ineligibility to gain access to Holloman Air Force Base, New Mexico.
Examples of conditions that may identify ineligibility to access the installation include, but are not limited to, substantiated misconduct, conviction or arrests for violent behavior, dishonesty, sexually aberrant behavior, warrants for arrest, open investigations, or felony charges.
I do so with full knowledge that this information is confidential and as such protected from unauthorized disclosure by the Privacy Act of 1974, as amended.
It is also my understanding that any information provided shall be treated confidentially and be used solely to determine whether I am eligible to access the installation.
***PRIVACY ACT INFORMATION***
PRINT LEGAL NAME:
SSN:
BIRTH DATE:
SIGNATURE:
US CITIZEN? (Circle One): YES / NO
DATE:
PRIVACY ACT STATEMENT
IAW the Privacy Act of 1974, the contents of this document contain privileged or other confidential information. Unauthorized disclosure may result in civil and criminal sanctions. If you are not the intended recipient, or believe you may have received this communication in error, do not reproduce, retransmit, disseminate, or otherwise use this information.
Current as of: May 2019
Holloman AFB Escort Official Responsibility Form
IAW AFMAN 31-101, v.3 Supplement, 27 FEBRUARY 2020
6.3., h. Commanders may suspend escort authority based upon the local threat or other local stipulations, and may revoke individual escort authority privileges at their discretion. Escort authority privileges are automatically suspended at FPCON Charlie in accordance with this manual and AFI 10-245. Installations will ensure installation access control plans/procedures reflect instances when escort authority is suspended. (T-3).
1. I understand while performing escort official duties I am responsible to ensure/comply with the following:
a. All escorted personnel will remain with me or another designated/approved escort official at all times while on the installation. I am fully responsible for the actions of the escorted personnel under my control.
b. I fully understand I may only release escorted personnel to another designated/approved escort official.
c. I am limited to only escorting those individuals or deliveries identified as needing an escort; on the specific Visitor Access Request (VAR) I am granted the escort authority privilege. I will escort only those listed on, and directly related to that specific VAR. At no time will I utilize my escort authority to escort any other personnel onto the installation for personal purposes that are not work related or not associated with the work contract.
d. I will ensure escorted personnel are briefed and understand they are required to comply with all HAFB installation security requirements (i.e. speed limits, seatbelt usage, cell phone use while operation a motor vehicle), and that all vehicles are subject to search while on the installation.
e. My escort privileges can be revoked if any personnel I have accepted responsibility to escort are found without a designated/approved escort official. The personnel that are found without an escort will be required to turn-in their access credential to the issuing office and the sponsoring agency will be notified.
f. I will ensure all escorted personnel visitor passes/credentials are returned to the HAFB Welcome Center when visit is complete.
2. By signing this document and initialing each of the above sections, I acknowledge receipt and understanding of my escort official responsibilities as outlined above. I further understand if I violate/abuse any of policies/requirements above, my escort privileges will be permanently revoked.
Escorts Printed Rank/Name: __ _
Company/Organization: ___________________________
Escorts Signature:
Date:
49 SFS/S5AV USE ONLY
TRACKING NUMBER:
image1.jpeg image2.jpeg
HOLLOMAN AIR FORCE BASE NEW MEXICO
(Date)
MEMORANDUM FOR 49 SFS/S5AV
FROM:
49 XX/CC
SUBJECT: Force Protection Condition (FPCON) Charlie Access
1. The following personnel with (COMPANY), Tracking # XXX-XX-XX are being identified as requiring access to Holloman AFB, NM during FPCON Charlie measures. These individuals are considered mission essential to the (LOCATION(S)) and provide the necessary access to ensure mission essential requirements are met.
2. The individuals listed below require access during FPCON Charlie measures for please provide a brief description of duties of the individuals listed below that require access during FPCON Charlie measures.
a.
b.
3. If you have any questions or concerns regarding this matter please feel free to contact (NAME) or at DSN 572-XXXX.
FIRST A. LAST, Rank, USAF
Commander, 49th XXXXXX
Combat Airpower Starts Here
_910175576.doc
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MEMORANDUM FOR ________________
49 SFS
FROM: ________________
SUBJECT: Travel Approval Letter
1. I, ____________________________________ request ________________ travel approval IAW the itinerary listed below. All travelers will adhere to applicable guidance during travel.
2. ITINERARY:
3. For questions, please contact _______________________ at _______________________.
1st Ind, ________________
HOLLOMAN AIR FORCE BASE, NEW MEXICO
COMBAT AIRPOWER STARTS HERE
1. I, ____________________________________ request to conduct ________________ travel IAW the itinerary listed below. I will adhere to all pertinent 49 FW and HHQ guidance during travel.
Date: 04 Sep 1949
Req OffSym: Name of Company
Req Name: John A. Doe
Contact: Darlene Y. Simpson
Phone: 575-572-7828
Req Name Blk2: Contract Specialist, 49 CONS/PKA
Auth Name Blk1: FIRST M. LAST, Rank, BRANCH
Auth Name Blk2: Commander, Organization
Auth OffSym: 49 CONS/CC
Itinerary: Travelers: Civilian Contractor / John A. Doe Departing: 09 Nov 2020-El Paso, TX / POV or Company Vehicle Arrival: 09 Nov 2020-Holloman AFB, NM / POV or Company Vehicle.
Departure Final: 08 Nov 2021 / POV or Company Vehicle (See Note Below) Note: Traveler will be conducting work daily per Contract and the entire term of contract on HAFB.
Enter one line for each en route overnight stay, and for any changes in mode of transportation.
Auth Comments: Upon return, member will... Example: Upon arrival to HAFB, visitors will need to check into the Welcome Center. During travel, visitors will comply with all CDC guidelines and adhere to all COVID-19 safety requirements to include social distancing, wearing of face covering and sanitation. No in person dining, do not attend gatherings with more than 10 individuals and minimize close contact within 6' for 15+ minutes.
Trvl Type: [other (Contractor)]
Approval: [Approved]
REQ Sig Blk: DARLENE Y. SIMPSON, Civ, USAF
BACKGROUND CHECK
CONSENT FORM
I, __________________________________________________, (Name – typed/printed)
Hereby authorize the U.S. Government (United States Air Force) to conduct background checks confirming my eligibility or ineligibility to gain access to Holloman Air Force Base, New Mexico.
Examples of conditions that may identify ineligibility to access the installation include, but are not limited to, substantiated misconduct, conviction or arrests for violent behavior, dishonesty, sexually aberrant behavior, warrants for arrest, open investigations, or felony charges.
I do so with full knowledge that this information is confidential and as such protected from unauthorized disclosure by the Privacy Act of 1974, as amended.
It is also my understanding that any information provided shall be treated confidentially and be used solely to determine whether I am eligible to access the installation.
***PRIVACY ACT INFORMATION***
PRINT LEGAL NAME:
SSN:
BIRTH DATE:
SIGNATURE:
US CITIZEN? (Circle One): YES / NO
DATE:
PRIVACY ACT STATEMENT
IAW the Privacy Act of 1974, the contents of this document contain privileged or other confidential information. Unauthorized disclosure may result in civil and criminal sanctions. If you are not the intended recipient, or believe you may have received this communication in error, do not reproduce, retransmit, disseminate, or otherwise use this information.
Current as of: May 2019
Holloman AFB Escort Official Responsibility Form
IAW AFMAN 31-101, v.3 Supplement, 27 FEBRUARY 2020
6.3., h. Commanders may suspend escort authority based upon the local threat or other local stipulations, and may revoke individual escort authority privileges at their discretion. Escort authority privileges are automatically suspended at FPCON Charlie in accordance with this manual and AFI 10-245. Installations will ensure installation access control plans/procedures reflect instances when escort authority is suspended. (T-3).
1. I understand while performing escort official duties I am responsible to ensure/comply with the following:
a. All escorted personnel will remain with me or another designated/approved escort official at all times while on the installation. I am fully responsible for the actions of the escorted personnel under my control.
b. I fully understand I may only release escorted personnel to another designated/approved escort official.
c. I am limited to only escorting those individuals or deliveries identified as needing an escort; on the specific Visitor Access Request (VAR) I am granted the escort authority privilege. I will escort only those listed on, and directly related to that specific VAR. At no time will I utilize my escort authority to escort any other personnel onto the installation for personal purposes that are not work related or not associated with the work contract.
d. I will ensure escorted personnel are briefed and understand they are required to comply with all HAFB installation security requirements (i.e. speed limits, seatbelt usage, cell phone use while operation a motor vehicle), and that all vehicles are subject to search while on the installation.
e. My escort privileges can be revoked if any personnel I have accepted responsibility to escort are found without a designated/approved escort official. The personnel that are found without an escort will be required to turn-in their access credential to the issuing office and the sponsoring agency will be notified.
f. I will ensure all escorted personnel visitor passes/credentials are returned to the HAFB Welcome Center when visit is complete.
2. By signing this document and initialing each of the above sections, I acknowledge receipt and understanding of my escort official responsibilities as outlined above. I further understand if I violate/abuse any of policies/requirements above, my escort privileges will be permanently revoked.
Escorts Printed Rank/Name: __ _
Company/Organization: ___________________________
Escorts Signature:
Date:
49 SFS/S5AV USE ONLY
TRACKING NUMBER:
image1.jpeg image2.jpeg
| Contract Number: |
| Contract Title: HAFB Dormitory CCTV |
| Start Date 1: |
| End Date: |
| Requesting Office: |
| Requesting Office Phone: |
| Name: MSgt Raymond S. Worley |
| Telephone: 575-921-2735 |
| Email address: raymond.worley.2@us.af.mil |
| Check Box1: Off |
| SFS INITALS/DATE: |
| TRACKING NUMBER: |
| Sponsoring org: |
| NAME1: |
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| START: |
| END: |
| START TIME: 0800 |
| END TIME: 1500 |
| Reason for visit: PRE-PROPOSAL SITE VISIT |
| Visit location: DORMITORY AREA |
| PHONE NUMBER: |
| Date: |
| PRINTED NAME: |
| Job TitleCompany Name: |
| Date_2: |
| PRINTED NAME 2: BOBBY L. GREEN, MSgt, USAF |
| DUTY TITLE: Contracting Officer |
| YES: |
| signed: ///signed/// |
| RESET FORM: |
File details come from the government source that posted it. Updated .