Attachment 08 - Base Access Request Form.pdf
PDF 375 KB Posted
- Attached to
- Bldg 1947 Repair Drop Arms
- Solicitation number
- FA480326QE0030
About this file
This document is a memorandum for background check and base access request submitted to the 20th Security Forces Squadron (20 SFS/S-5V) at Shaw Air Force Base, South Carolina. The request is for a pre-award site visit related to contract FA480326RC008 for replacing ARCENT lights at Building 1947. The site visit is scheduled for 30 June 2026 from 0900-1100 hours. The sponsor is SrA Tariq T. Ellis from 20 CONS/PKB (Air Force Contracting), reachable at 895-9822. The contractor company name is to be provided, and individual visitor information must be completed in the table provided, including full legal name, date of birth, social security number, state driver's license number with REAL ID verification status, and U.S. citizenship status.
The memorandum emphasizes sponsor responsibilities for visitor accountability and pass management through the Defense Biometric Identification System (DBIDS). Sponsors must ensure visitors possess Real ID-compliant identification or Federal ID to receive base access passes from the Visitor Control Center (VCC). Non-U.S. citizens must submit scanned documentation such as foreign visas, permanent resident cards (Form I-551), or employment authorization cards (Form I-766) prior to site visit arrival. All information is protected under the Privacy Act of 1974 and is used solely for criminal background history checks to grant or deny base access.
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Text version
DEPARTMENT OF THE AIR FORCE
20th FIGHTER WING (ACC)
SHAW AIR FORCE BASE SOUTH CAROLINA
CUI
Victory By Valor
DATE: XX/XX/XXXX
MEMORANDUM FOR 20 SFS/S-5V:
(email to: BOTH Ms. Jacqueline Hernandez-Sears jacqueline.hernandez-sears.1@us.af.mil, SSgt Austin Simerly austin.simerly@us.af.mil, and Mr. Joshua
Arbeiter joshua.arbeiter.2@us.af.mil 803-895-9085 or 803-895-9086/ VCC Email: udg_20sfs_vcc@us.af.mil)
This form MUST BE SENT BY THE SPONSOR listed from their government email and received at the email addresses/fax number listed above in the 20 SFS/S-5V section and will receive a confirmation email once completed with instructions.
FROM: (The person requesting background check be conducted and squadron/unit)
SUBJECT: (i.e Contractor/Employee needing access to Shaw AFB)
WHO: (Company or Organization the Contractor/Employee will be working for)
WHAT FOR: (i.e Construction, New Hire, Job Interview, Meeting, New CAC or CAC Renewal, Work order etc.)
WHERE: (Location Contractor/Employee will be working at or needing access to)
If base wide give justification: (i.e Individual needs access to multiple buildings on base)
WHEN: (The exact day/dates and hours the individual will need access to the base (i.e. May 10, 2022, 0800-1700hrs or from May 10, 2022- May 10, 2023 Monday-Saturday, 0700-1900hrs)
SPONSOR: (The CAC holding individual responsible for the individual listed below and their organization) DOD EDPI: The # on the back of you CAC
CONTACT INFO: (Sponsor’s GOV email and PHONE NUMBER W/EXTENSION)
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)
DOE, JOHN E. 1995/01/01 123-45-6789 SC-12345678 Y Y
********IF UNDER THE AGE OF 18, PLEASE COMPLETE A SEPARATE WORK REQUEST. *********
DO NOT FILL THIS PAGE PLEASE USE THE NEXT PAGE
DEPARTMENT OF THE AIR FORCE
20th FIGHTER WING (ACC)
SHAW AIR FORCE BASE SOUTH CAROLINA
CUI
Victory By Valor
DATE: 24-Jun-26
MEMORANDUM FOR 20 SFS/S-5V
FROM: 20 CONS/PKB
SUBJECT: FA480326RC008, B1947 Replace ARCENT Lights Site Visit
WHO: (Company Name)
WHAT FOR: Pre-Award Site Visit
WHERE: B1947
WHEN: 30 June 2026, 0900 – 1100hrs
SPONSOR NAME: ELLIS, TARIQ T SrA USAF ACC 20 CONS/PKB
DOD EDPI:
CONTACT INFO: COMM: 895-9822
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.
PLEASE READ THE STATEMENTS BELOW
1. 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.
2. If you, as the sponsor, filled out the request and answered N for U.S Citizen please make sure you submit scanned in documents before coming to the VCC. **i.e.-FOREIGN VISA, PERMANENT RESIDENT CARD (Form I-551) & EMPLOYMENT AUTHORIZATION CARD (Form I-766) HOLDERS, ETC.
3. AS THE SPONSOR, I will inform my visitors they must have identification in compliance with the Real ID Act OR have a Federal ID in which cases they do not. If they do not, they will not be able to receive a pass from the VCC.
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)
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