ATTACH15_AF2586 Flightline Driving Request.PDF
PDF 94 KB Posted
- Attached to
- Robins AFB Mechanical/Electrical II IDIQ Federal contract opportunity
- Solicitation number
- FA850124R0001
About this file
This document is an Unescorted Entry Authorization Certificate for an individual supporting a federal contract at Robins Air Force Base. The certificate provides identification details for Louis Bouffard of XXXXXX Company, who is performing under Contract Number XXXXXX from May 16, 2016 through an unspecified end date. Mr. Bouffard's duties requiring unescorted entry into restricted and controlled areas of the base are in support of the Mechanical/Electrical II IDIQ solicitation issued by the Department of the Air Force Materiel Command Air Force Sustainment Center under Solicitation Number FA850124R0001. The certificate is signed by the 78th Civil Engineer Group Security Manager and coordinates Mr. Bouffard's restricted area access and badge issue with officials from the 78th Civil Engineer Group at Robins Air Force Base.
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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: XXXXXX
CONTRACT NUMBER:XXXXXX
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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