Attachment 08_Contractor Access form.pdf

285 KB Posted

Attached to
Mobile Fencing, Base Signage, Gazebos
Solicitation number
W50S8R26Q0037
Issued by

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This is a Contractor Access Request Form used by the 179th Security Forces Squadron Installation Access Section to process unescorted base entry for contractor personnel. The form must be submitted a minimum of five (5) duty days prior to the project start date, with a submission deadline enforced to allow adequate processing time.

The form requires comprehensive information for each contractor employee requesting access, including full legal name, date of birth, social security number or passport/visa information, driver's license details, and REAL ID validation status. The requesting contractor must sign a Declaration of Responsibility acknowledging that they have informed all listed personnel of installation policies prohibiting illegal drugs, weapons (including for CCW holders and state-certified police officers unless on official duty), and that all vehicles, equipment, and personal belongings are subject to search upon entry and exit. The contractor must notify the Installation Access Section if any individual no longer requires access prior to expiration and must submit a new form at least five days before hiring additional workers. Individuals requiring escorts must be escorted by assigned military personnel, not contractor staff. The 179 SFS retains final authority to deny access without providing specific reasons, and denial decisions are not subject to appeal. The form includes a Privacy Act statement restricting disclosure of collected information to those with direct need-to-know, with routine use limited to local law enforcement, and is governed by DAFMAN 31-101v3.

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RFI and Response Document (as of 15 Sep 26).pdf PDF
RFI and Response Document (as of 10 Sep 26).pdf PDF
Attachment 01_RFQ_Mobile Fencing_Base Signage_Gazebos_rev02.pdf PDF
Attachment 03_Mobile Fencing_Statement of Requirement_rev02.pdf PDF
Attachment 04_Base Signage_Statement of Requirement_rev02.pdf PDF
Attachment 06_Gazebos_Statement of Requirement_rev01.pdf PDF
RFI and Response Document (as of 08 Sep 26).pdf PDF
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Attachment 03_Mobile Fencing_Statement of Requirement_rev01.pdf PDF
Attachment 04_Base Signage_Statement of Requirement_rev01.pdf PDF
Attachment 07_Gazebos_Map Location_rev01.pdf PDF
RFI and Response Document (as of 02 Sep 26).pdf PDF
Attachment 02_Provisions and Clauses_rev01.pdf PDF
Attachment 01_RFQ_Mobile Fencing_Base Signage_Gazebos_rev01.pdf PDF
RFI and Response Document (as of 31 Aug 26).pdf PDF
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Attachment 03_Mobile Fencing_Statement of Requirement.pdf PDF
Attachment 04_Base Signage_Statement of Requirement.pdf PDF
Attachment 02_Provisions and Clauses.pdf PDF
Attachment 01_RFQ_Mobile Fencing_Base Signage_Gazebos.pdf PDF
Attachment 07_Gazebos_Map Location.pdf PDF
Attachment 06_Gazebos_Statement of Requirement.pdf PDF
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CUI

Contractor Access Request Form

179th Security Forces Squadron Installation Access Section

*MUST BE DELIVERED A MINIMUM OF FIVE (5) DUTY DAYS PRIOR TO PROJECT START DATE*

Project Number Project Location Start Date End Date Last Name First Name DOB Social Security # DL State-Number Phone Number Email Address

DECLARATION OF RESPONSIBILITY: By signing below, I agree to take full responsibility for those individual(s) that I have requested unescorted entry for. I have advised the individuals listed below that the possession of illegal drugs or substances will result in prosecution by local authorities, and that no weapons are allowed onto the installation by any contractor. Weapons restrictions apply to CCW holders as well as State certified police officers unless on official duty. Violations of these prohibitions as well as base policies and procedures could result in the individual’s base access being revoked. I have advised the individuals listed below that their vehicles to include equipment, toolboxes, and personal bags such as duffel bags, backpacks, lunch boxes, etc. are subject to search upon entering and exiting the installation.

If any of the individuals listed below no longer require access prior to expiration I will notify the 179 SFS Installation Access Section. If new workers are hired, I will submit another Contractor Access Request Form no later than five (5) days prior to their start date. I understand that neither I nor any other member of my staff may escort any individual onto the installation. Individuals requiring escorts must be escorted by a military member assigned to oversee the project. I understand decisions made by the 179 SFS to deny access to any individuals listed below are final and not subject to appeal and that Security Forces will not provide specific causes for denial.

SIGNATURE:

Contractor Information (All information below is required. Omitting any information will result in the individual being denied access)

** For Pass & ID Use Only** Last Name First Name MI Date of Birth U.S. Citizen

(Y/N) Social Security No./ Passport/Visa No.

Driver’s License State-Number

REAL ID

(Y/N)

VALID

(Y/N) Denial Reason

PRIVACY ACT STATEMENT

PRIVACY ACT 1974: Contents shall not be disclosed, discussed, or shared with individuals unless they have direct need-to-know in the performance of their official duties. Deliver this document directly to the intended recipient. DO NOT drop off with a third-party.

AUTHORITY: DAFMAN 31-101v3 PRINCIPLE PURPOSE: Collection of information to identity proof and vet for unescorted base entry. All information is for unescorted base entry purposes only.

ROUTINE USE: Local Law Enforcement DISCLOSURE IS VOLUNTARY: Disclosing is voluntary, however, failure to provide the requested information may prevent, and /or cause delay regarding a request.

Updated 15 May 2025, Previous Editions Are Obsolete

Pre-Bid Awarded

Contractor Access Request Form Continuation Page, attach additional pages as needed (All information below is required. Omitting any information will result in the individual being denied access)

** For Pass & ID Use Only**

Last Name First Name MI Date of Birth U.S. Citizen (Y/N)

Social Security No./ Passport/Visa No.

Driver’s License State-Number

REAL ID

(Y/N)

VALID

(Y/N) Denial Reason

PRIVACY ACT STATEMENT

PRIVACY ACT 1974: Contents shall not be disclosed, discussed, or shared with individuals unless they have direct need-to-know in the performance of their official duties. Deliver this document directly to the intended recipient. DO NOT drop off with a third-party.

AUTHORITY: DAFMAN 31-101v3 PRINCIPLE PURPOSE: Collection of information to identity proof and vet for unescorted base entry. All information is for unescorted base entry purposes only.

ROUTINE USE: Local Law Enforcement DISCLOSURE IS VOLUNTARY: Disclosing is voluntary, however, failure to provide the requested information may prevent, and /or cause delay regarding a request.

Updated 15 May 2025, Previous Editions Are Obsolete

Project Number:
Project Location: Base-wide signage & gazebos
Start Date: 08 Sep 26
End Date: 08 Sep 26
Last Name:
First Name:
DOB:
Social Security:
DL StateNumber:
Phone Number:
Email Address:
SIGNATURE:
Last NameRow1:
First NameRow1:
MIRow1:
Date of BirthRow1:
US Citizen YNRow1:
Social Security No PassportVisa NoRow1:
Drivers License StateNumberRow1:
REAL ID YNRow1:
VALID YNRow1:
Denial ReasonRow1:
Last NameRow2:
First NameRow2:
MIRow2:
Date of BirthRow2:
US Citizen YNRow2:
Social Security No PassportVisa NoRow2:
Drivers License StateNumberRow2:
REAL ID YNRow2:
VALID YNRow2:
Denial ReasonRow2:
Last NameRow3:
First NameRow3:
MIRow3:
Date of BirthRow3:
US Citizen YNRow3:
Social Security No PassportVisa NoRow3:
Drivers License StateNumberRow3:
REAL ID YNRow3:
VALID YNRow3:
Denial ReasonRow3:
Last NameRow4:
First NameRow4:
MIRow4:
Date of BirthRow4:
US Citizen YNRow4:
Social Security No PassportVisa NoRow4:
Drivers License StateNumberRow4:
REAL ID YNRow4:
VALID YNRow4:
Denial ReasonRow4:
Last NameRow5:
First NameRow5:
MIRow5:
Date of BirthRow5:
US Citizen YNRow5:
Social Security No PassportVisa NoRow5:
Drivers License StateNumberRow5:
REAL ID YNRow5:
VALID YNRow5:
Denial ReasonRow5:
Last NameRow6:
First NameRow6:
MIRow6:
Date of BirthRow6:
US Citizen YNRow6:
Social Security No PassportVisa NoRow6:
Drivers License StateNumberRow6:
REAL ID YNRow6:
VALID YNRow6:
Denial ReasonRow6:
Last NameRow7:
First NameRow7:
MIRow7:
Date of BirthRow7:
US Citizen YNRow7:
Social Security No PassportVisa NoRow7:
Drivers License StateNumberRow7:
REAL ID YNRow7:
VALID YNRow7:
Denial ReasonRow7:
Last NameRow1_2:
First NameRow1_2:
MIRow1_2:
Date of BirthRow1_2:
US Citizen YNRow1_2:
Social Security No PassportVisa NoRow1_2:
Drivers License StateNumberRow1_2:
REAL ID YNRow1_2:
VALID YNRow1_2:
Denial ReasonRow1_2:
Last NameRow2_2:
First NameRow2_2:
MIRow2_2:
Date of BirthRow2_2:
US Citizen YNRow2_2:
Social Security No PassportVisa NoRow2_2:
Drivers License StateNumberRow2_2:
REAL ID YNRow2_2:
VALID YNRow2_2:
Denial ReasonRow2_2:
Last NameRow3_2:
First NameRow3_2:
MIRow3_2:
Date of BirthRow3_2:
US Citizen YNRow3_2:
Social Security No PassportVisa NoRow3_2:
Drivers License StateNumberRow3_2:
REAL ID YNRow3_2:
VALID YNRow3_2:
Denial ReasonRow3_2:
Last NameRow4_2:
First NameRow4_2:
MIRow4_2:
Date of BirthRow4_2:
US Citizen YNRow4_2:
Social Security No PassportVisa NoRow4_2:
Drivers License StateNumberRow4_2:
REAL ID YNRow4_2:
VALID YNRow4_2:
Denial ReasonRow4_2:
Last NameRow5_2:
First NameRow5_2:
MIRow5_2:
Date of BirthRow5_2:
US Citizen YNRow5_2:
Social Security No PassportVisa NoRow5_2:
Drivers License StateNumberRow5_2:
REAL ID YNRow5_2:
VALID YNRow5_2:
Denial ReasonRow5_2:
Last NameRow6_2:
First NameRow6_2:
MIRow6_2:
Date of BirthRow6_2:
US Citizen YNRow6_2:
Social Security No PassportVisa NoRow6_2:
Drivers License StateNumberRow6_2:
REAL ID YNRow6_2:
VALID YNRow6_2:
Denial ReasonRow6_2:
Last NameRow7_2:
First NameRow7_2:
MIRow7_2:
Date of BirthRow7_2:
US Citizen YNRow7_2:
Social Security No PassportVisa NoRow7_2:
Drivers License StateNumberRow7_2:
REAL ID YNRow7_2:
VALID YNRow7_2:
Denial ReasonRow7_2:
Last NameRow8:
First NameRow8:
MIRow8:
Date of BirthRow8:
US Citizen YNRow8:
Social Security No PassportVisa NoRow8:
Drivers License StateNumberRow8:
REAL ID YNRow8:
VALID YNRow8:
Denial ReasonRow8:
Last NameRow9:
First NameRow9:
MIRow9:
Date of BirthRow9:
US Citizen YNRow9:
Social Security No PassportVisa NoRow9:
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REAL ID YNRow9:
VALID YNRow9:
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Last NameRow10:
First NameRow10:
MIRow10:
Date of BirthRow10:
US Citizen YNRow10:
Social Security No PassportVisa NoRow10:
Drivers License StateNumberRow10:
REAL ID YNRow10:
VALID YNRow10:
Denial ReasonRow10:
Last NameRow11:
First NameRow11:
MIRow11:
Date of BirthRow11:
US Citizen YNRow11:
Social Security No PassportVisa NoRow11:
Drivers License StateNumberRow11:
REAL ID YNRow11:
VALID YNRow11:
Denial ReasonRow11:
Last NameRow12:
First NameRow12:
MIRow12:
Date of BirthRow12:
US Citizen YNRow12:
Social Security No PassportVisa NoRow12:
Drivers License StateNumberRow12:
REAL ID YNRow12:
VALID YNRow12:
Denial ReasonRow12:
Last NameRow13:
First NameRow13:
MIRow13:
Date of BirthRow13:
US Citizen YNRow13:
Social Security No PassportVisa NoRow13:
Drivers License StateNumberRow13:
REAL ID YNRow13:
VALID YNRow13:
Denial ReasonRow13:
Last NameRow14:
First NameRow14:
MIRow14:
Date of BirthRow14:
US Citizen YNRow14:
Social Security No PassportVisa NoRow14:
Drivers License StateNumberRow14:
REAL ID YNRow14:
VALID YNRow14:
Denial ReasonRow14:
Last NameRow15:
First NameRow15:
MIRow15:
Date of BirthRow15:
US Citizen YNRow15:
Social Security No PassportVisa NoRow15:
Drivers License StateNumberRow15:
REAL ID YNRow15:
VALID YNRow15:
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Last NameRow16:
First NameRow16:
MIRow16:
Date of BirthRow16:
US Citizen YNRow16:
Social Security No PassportVisa NoRow16:
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REAL ID YNRow16:
VALID YNRow16:
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Last NameRow17:
First NameRow17:
MIRow17:
Date of BirthRow17:
US Citizen YNRow17:
Social Security No PassportVisa NoRow17:
Drivers License StateNumberRow17:
REAL ID YNRow17:
VALID YNRow17:
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First NameRow18:
MIRow18:
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US Citizen YNRow18:
Social Security No PassportVisa NoRow18:
Drivers License StateNumberRow18:
REAL ID YNRow18:
VALID YNRow18:
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Check Box2: Off
Check Box3: Off

File details come from the government source that posted it. Updated .