Attachment 16_AFRC10735 Visit Request Form.pdf
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- Solicitation number
- 80AFRC22R0003
About this file
This draft request for proposal solicits facilities operations and maintenance services for the NASA Armstrong Flight Research Center in Edwards, California. The selected contractor will provide all facility operations, maintenance, repair, janitorial services, grounds-keeping services, and other directly related miscellaneous services for all infrastructure, facilities, buildings, utilities, structures, utility systems, and equipment assets. Interested parties are invited to submit any questions by April 26, 2022 to help finalize the RFP. The services procurement will support NASA's mission to provide infrastructure and asset management for its research operations.
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Visit Request - U.S. Citizen AFRC 10735Rev:4.5Only the current revision will be accepted.
Page of
INSTRUCTIONS
Instructions
1. Seventy-two (72) hours advance notice is required for all visit requests.2. For unescorted access please fax (661-276-2732) proof of your security clearance or verification of a completed background investigation (NACI).3. All personal visits must be escorted. All visits are subject to a National Crime History Check.4. ALL visits must be approved by the Employee's Branch Chief (BC), Project Manager (PM), or the Contract Employee's CO, COR, or TM.
5. Distribution list for electronic submission: AFRC-VCC-VISITOR REQUESTS Instructions - 1. Seventy two (72) hours advance notice is required for all visit requests.
2. For unescorted access please fax (661-276-2732) proof of your security clearance or verification of a completed background investigation (NACI).
3. All personal visits must be escorted.
4. ALL visits must be approved by the Employee's Branch Chief or higher, or the Contract Employee's CO, COTR or TM.
TYPE OF VISIT
Type of Visit
SITE TO BE VISITED
Site To Be Visited
VISITOR INFORMATION
Visitor Information 1.
Visitor Information - #1 2.
Visitor Information - #2 3.
Visitor Information - #3
APPROVAL
Approval
1. Visitors must show picture identification on arrival.2. Sponsors are responsible for visitors while at AFRC.3. Visit requests that do not indicate escorted or unescorted will be assigned an escorted visit.4. For classified visits,visitors are required to have their clearance sent in advance to: Armstrong Flight Research Center Attn: Visitor Control, P.O. Box 273 Edwards, CA 93523-0273 or FAX to 661- 276- 2732
1. Visitors must show picture identification on arrival.
2. Sponsors are responsible for visitors while at AFRC.
3. Visit requests that do not indicate escorted or unescorted will be assigned an escorted visit.
4. For classified visits,visitors are required to have their clearance sent in advance to:
Armstrong Flight Research Center Attn: Visitor Control, P.O. Box 273 Edwards, CA 93523-0273 or FAX to 661- 276- 2732
* SUBJECT TO PRIVACY ACT OF 1974
When not under the continuing control and supervision of a person authorized access to such material, it must be, as a minimum, maintained under locked condition.
* SUBJECT TO PRIVACY ACT OF 1974
When not under the continuing control and supervision of a person authorized access to such material, it must be, as a minimum, maintained under locked condition.
When completed this form contains PII (Personal Identification Information). This information must be encrypted when electronically transmitted. If the form is printed, it must be covered by a SBU (Sensitive But Unclassified) coversheet, form number NF1686.
Paperwork Reduction Act Statement This information collection meets the requirements of 44 U.S.C. § 3507, as amended by section 2 of the Paperwork Reduction Act of 1995. You do not need to answer these questions unless we display a valid Office of Management and Budget (OMB) control number. The OMB control number for this collection is 2700-0158 and expires on 11/30/2020. We estimate that it will take five (5) minutes to read the instructions, gather the facts, and answer the questions. Send only comments regarding the time estimate to: james.p.nicholas@nasa.gov.
PRIVACY ACT STATEMENT
Pursuant to the Privacy Act of 1974, 5 U.S.C § 552a, this Privacy Act Statement serves to inform individuals of the following concerning the collection of information on this form.
Authority: The authority for collecting this information comes from 42 U.S.C 2451, et seq., the National Aeronautics and Space Act of 1958, as amended, and other laws and executive orders.
Purpose: The information in this form or system will enable Office of Protective Services officials to accredit individuals seeking access to NASA facilities.
Routine Uses: NASA may routinely disclose this information to other entities for security, law enforcement, and governmental oversight purposes. Elaboration and conditions of information disclosure may be found under “Routine Uses” of the full System of Records Notice at https://www.govinfo.gov/content/pkg/PAI-2013-NASA/xml/PAI-2013-NASA.xml#10secr and in Appendix B at http://www.gpo.gov/fdsys/pkg/PAI-2013-NASA/xml/PAI-2013-NASA.xml#appb.
Disclosure: Providing the information to NASA is voluntary, however, access to NASA facilities will not be permitted if it is not submitted.
8.2.1.3144.1.471865.466429
| CurrentPage: |
| PageCount: |
| Type of Visit - Escorted: |
| Type of Visit - Unescorted: |
| Type of Visit - Classified: |
| Visitor Information - #1 - Full Name of Visitor: |
| Visitor Information - #1 - Date of Birth: |
| Visitor Information - #1 - Company Name: |
| Visitor Information - #1 - Dates of Visit: |
| Visitor Information - #1 - Place of Birth (City, State, Country): |
| Visitor Information - #1 - Country of Citizenship: |
| Visitor Information - #1 - Driver License Number and State of Issue: |
| Visitor Information - #2 - Full Name of Visitor: |
| Visitor Information - #2 - Date of Birth: |
| Visitor Information - #2 - Company Name: |
| Visitor Information - #2 - Dates of Visit: |
| Visitor Information - #2 - Place of Birth (City, State, Country): |
| Visitor Information - #2 - Country of Citizenship: |
| Visitor Information - #2 - Driver License Number and State of Issue: |
| Visitor Information - #3 - Full name of visitor: |
| Visitor Information - #3 - Date of Birth: |
| Visitor Information - #3 - Company Name: |
| Visitor Information - #3 - Dates of Visit: |
| Visitor Information - #3 - Place of Birth (City, State, Country): |
| Visitor Information - #3 - Country of Citizenship: |
| Visitor Information - #3 - Driver License Number and State of Issue: |
| Visitor Information - Name of Sponsor to be Visited: |
| Visitor Information - Sponsor Extension: |
| Visitor Information - Name of Sponsor to be Visited - Driver License Number and State of Issue: |
| Visitor Information - Date of Request: |
| Purpose of Visit: |
| Approval: BC or higher, PM, CO, COR, OR TM (print name):: |
| Approval - BC or higher, PM, CO, COR, OR TM SIGNATURE:: |
| Approval - Branch Chief (or higher), CO, COTR or TM Date: |
| Site To Be Visited - AFRC: |
| Site To Be Visited - Bldg. 703: |
| Approval - Special Instruction: |
| Visitor Information - Name of Requestor (if different than sponsor): |
| Visitor Information - Name of Requestor Extension: |
| Visitor Information - Name of Requestor Date: |
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