Attachment 04 - Base Access Template (CAO Jul 24).docx
DOCX document 78 KB Posted
- Attached to
- NDI Lab Pen Line B1510 Federal contract opportunity
- Solicitation number
- FA480325B0010
About this file
The document is a Base Access Template for the Department of the Air Force 20th Fighter Wing at Shaw Air Force Base in South Carolina, designed to process Criminal Background History Checks for base access. The template requires comprehensive personal identification information including full legal name, date of birth, social security number, driver's license details, citizenship status, and requires the sponsor to take responsibility for ensuring proper pass management and deactivation when individuals no longer require base access.
This template is associated with Solicitation Number FA480325B0010 for an NDI Lab Pen Line B1510 project, which involves removing existing wiring from panel to equipment and installing new wiring that is code compliant. A mandatory site visit is scheduled for 16 April 2025 at 9:00AM EST, with interested parties required to review, complete, and return attachments 4-7 by 15 April 2025. All questions or clarification requests must be submitted to the specified Point of Contact (POC) no later than 18 April 2025, and the solicitation is issued by the Department of the Air Force Air Combat Command.
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Text version
DEPARTMENT OF THE AIR FORCE
20th FIGHTER WING (ACC)
SHAW AIR FORCE BASE SOUTH CAROLINA
DATE:
FROM:
SUBJECT:
WHO:
WHAT FOR:
WHERE:
If base wide give justification:
WHEN:
SPONSOR NAME:
DOD EDPI:
CONTACT INFO:
The information below is protected under Privacy Act 1974 and will only be used to process Criminal Background History Checks to grant or deny access to Shaw AFB. It is further understood that anyone abusing approved privileges could, at a minimum, lose said privilege and possibly face criminal charges.
Full Legal Name (Last, First MI) Date Of Birth (Year/Mo/Day) Social Security Number
ST-DL #
(REAL ID Y/N)
U.S.
Citizen (Y/N)
I UNDERSTAND THAT AS THE SPONSOR I AM RESPONSIBLE FOR THE PERSON(S) LISTED ON THIS FORM, AND FOR ENSURING THE ABOVE NAME INDIVIDUAL(S) TURNS IN THE DBIDS PASS OR RETRIEVE THE PASS ONCE THE INDIVIDUAL(S) ARE TERMINATED, QUIT, OR NO LONGER REQUIRES ACCESS. IF I AM NOT ABLE TO RETRIEVE THE PASS, I WILL NOTIFY SECURITY FORCES TO HAVE THE INDIVIDUAL(S) PASS DEACTIVATED IN DBIDS.
This form must be sent by the sponsor from their government email and received at the email addresses/fax number listed above in the 20 SFS/S-5V section.
CUI
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File details come from the government source that posted it. Updated .