Attach 5 - 153AW Form 10 Contractor EAL.pdf
PDF 156 KB Posted
- Attached to
- CES - Repair Roof B37
- Solicitation number
- W50S8W26RA001
- Issued by
-
Department of the Army National Guard
About this file
This is a template form for the Contractors Entry Authority List used by the 153d Airlift Wing to manage contractor access to the installation. The form (153AW FORM 10, version 20220622) collects contractor personnel information for entry control purposes and requires submission to 153.AW.Entry.Authority.List@us.af.mil.
The form captures project details including project name, project manager name, company/organization name, start and end dates, and notes. Contractor personnel must be listed alphabetically by name with corresponding date of birth (in DDMMMYY format), state of driver's license issue, and driver's license number. The form requires review and signature by a Contracting Officer's Representative (COR) and authentication by Security Forces Squadron (SFS) personnel with date. Access may be denied based on specified disqualifying factors including terrorist affiliations, inability to verify identity, previous federal installation bars, wanted status by law enforcement, convictions for espionage, sabotage, treason, terrorism, murder, firearms/explosives violations, sexual assault, armed robbery, rape, child molestation, drug distribution, or attempts to overthrow the U.S. Government. The 153d Airlift Wing Commander has final authority on access appeals, which must be submitted in writing through the contractor sponsor to the 153 Security Forces Squadron. Redress options include providing additional biographic or biometric information to clarify identity mismatches.
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Text version
CONTRACTORS ENTRY AUTHORITY LIST
PROJECT NAME:
PROJECT MANAGER: (LAST, FIRST, MI)
START DATE: END DATE:
COMPANY/ORGANIZATION NAME:
REVIEWED BY CE: (LAST, FIRST, MI) REVIEWED BY CE: (SIGNATURE)
AUTHENTICATED BY SFS: (LAST, FIRST, MI) AUTHENTICATED BY SFS: (SIGNATURE) DATE:
NAME: (LAST, FIRST, MI) DOB (DDMMMYY) DRIVERS LICENSE NUMBERSTATE OF ISSUE** MUST BE ALPHABETIZED
PRIVACY ACT STATEMENT: 1. AUTHORITY: USC Title 10, 8013 2. PURPOSE: Used to collect information needed for entry control to the 153d Airlift Wing. 3.
ROUTINE USES: This information will not be disclosed outside the Department of Defense. 4. DISCLOSURE: Voluntary. However, failure to provide information results in the denial of entry to the 153d Airlift Wing.
153AW FORM 10, 20220622 PREVIOUS EDITIONS OBSOLETE
NOTES:
Mail to:153.AW.Entry.Authority.List@us.af.mil
(1) The individual is known to be or reasonably suspected of being a terrorist or belongs to an organization with known terrorism links/support.
(2) The installation is unable to verify the individual's claimed identity.
(3) The individual has previously been barred from access to a federal installation or stand-alone facility.
(4) The individual is wanted by Federal, State, Local, or other civil law enforcement authorities, regardless of offense or violation.
(5) The individual has any conviction for espionage, sabotage, treason, terrorism, or murder.
(6) The individual’s name appears on any Federal or State agency’s watch list or hit list for criminal behavior or terrorist activity.
(7) The individual has been convicted of a firearms or explosive violation.
(8) The individual has been convicted of sexual assault, armed robbery, rape, child molestation, child pornography, trafficking in humans, drug possession with intent to sell, or drug distribution.
(9) The individual has knowingly and willfully engaged in acts or activities designed to overthrow the U.S.
Government by force.
REDRESS & APPEAL POLICY:
Visitors who have been denied access to the 153 AW may request redress and/or appeal by requesting the on-duty Security Forces Supervisor or Operations Superintendent.
Redress can be accomplished by providing additional biographic information to distinguish between the identities (such as a date of birth or social security number) or biometric information (such as fingerprints).
Redress allows the proper identity to be evaluated for fitness.
Appeals can be conducted for an individual with accurately identified derogatory information that prevents individuals from establishing either historic or current fitness to seek an exception due to their specific circumstances, allowing them to be granted unescorted access. Appeals must be submitted in writing through the sponsor to the 153 SFS. The appeal should capture the applicants personal information, their specific need to access the installation, and any other pertinent information. The 153 AW/CC has final authority on appeals.
153D AIRLIFT WING INSTALLATION ACCESS REQUIREMENTS
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:
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| AUTHENTICATED BY SFS LAST FIRST MI: |
| NAME LAST FIRST MI: |
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| undefined_54: |
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| DOB: |
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| Project Name: |
| results in the denial of entry to the 153d Airlift Wing: |
| PROJECT MANAGER LAST FIRST MI: |
| START DATE: |
| END DATE: |
| REVIEWED BY CE LAST FIRST MI: |
| DATE: |
| Drivers License State of Issue: |
| Drivers License Number: |
| Text1: |
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