PERFORMANCE WORK STATEMENT (PWS)

FOR

LAUNDRY SERVICE

BEALE AIR FORCE BASE (AFB), CA

1. BACKGROUND. The 9th Reconnaissance Wing (9 RW) requires regular, comprehensive, and professional laundry and linen services across multiple squadrons, tenant units, and designated mission partners operating at Beale Air Force Base (BAFB). Current operational activities requiring support encompass a wide variety of installation missions, including but not limited to the 9th Aircraft Maintenance Squadron (9 AMXS), 9th Force Support Squadron (9 FSS), 9th Maintenance Squadron (9 MXS), 940th Maintenance Group (940 MXG), and 940th Aircrew Readiness Facility (ARW). Due to the fluid nature of national defense posture, operational surges, tenant organization realignments, and shifting training requirements across Beale AFB, the laundry support envelope is intentionally structured to accommodate multiple agencies under or affiliated with the 9 RW. Maintaining an unbroken, sanitary supply chain of clean linens, shop rags, and related textile items directly underpins continuous 24/7 high-altitude intelligence, surveillance, and reconnaissance (ISR) flightline operations, temporary lodging management, and overall warfighter readiness.

2. SCOPE. The Contractor shall provide all personnel, equipment, tools, materials, supervision, transportation, and facilities necessary to perform comprehensive, regular, and emergency Laundry Services for all designated units, squadrons, and tenant agencies operating under or supported by the 9th Reconnaissance Wing (9 RW) at Beale AFB. This includes, but is not limited to, the 9th Aircraft Maintenance Squadron (9 AMXS), 9th Force Support Squadron (9 FSS), 9th Maintenance Squadron (9 MXS), 940th Maintenance Group (940 MXG), and 940th Aircrew Readiness Facility (ARW). The Contractor shall manage the entire laundry lifecycle to ensure a continuous, uninterrupted supply of sanitary laundry items critical to supporting active flightline operations, lodging services, and general base readiness. Logistical execution under this scope demands a secure, reliable, and highly coordinated pickup and delivery system. The Contractor is responsible for executing simultaneous pickup of soiled items and delivery of clean items at designated times and physical locations across the installation, maintaining positive custody control through signed government-joint count tickets. To support the diverse mission tempos of the various squadrons, the Contractor must remain agile enough to execute routine weekly and quarterly schedules, while maintaining the capability to rapidly scale operations to fulfill accelerated 24-hour emergency turnaround requests. To ensure the safety, health, and professional appearance of base personnel, all processing must adhere strictly to federal, state, and industry sanitation standards. The Contractor must maintain rigorous quality control protocols that prevent the co-mingling of Beale AFB property with other commercial clients, enforce complete physical segregation between soiled and clean items during transport and processing, and treat wet or moist items immediately to prevent mildew, staining, or degradation. Ultimately, the Contractor must return all processed articles in the correct quantities, packaged and folded in strict accordance with the specified methods of finish, completely free of dirt, debris, odors, and chemical residues.

3. DESCRIPTION OF SERVICE. The Contractor shall provide all plant facilities, labor, equipment, tools, materials, supervision, transportation, and other items or services necessary to perform Laundry Services at Beale AFB. This encompasses the secure pick-up, loading, transport, processing, unloading, and return of all installation Laundry Items. Throughout execution, the Contractor must strictly ensure that soiled items do not contact clean items, and that any items received wet or moist are immediately processed to prevent mildew, rust, or staining. Ultimately, all processed Laundry Items must be returned to Beale AFB in the correct quantities, properly finished and packaged, and completely free of dirt, debris, dampness, odors, mildew, and cleansing chemical residue to maintain a uniform appearance.

3.1 COUNT OF ARTICLES. Laundry Items being turned into the Contractor will be counted by a government representative before the number counts are permanently affixed to the laundry ticket/count sheet.

3.2 SPECIAL WASH. Special wash items are defined as items that have been stained while in the

Government's possession and will need special attention. Government personnel will separate special wash items and mark with a tag stating the items is a special wash item. Contractor shall ensure special wash items are segregated from other laundry items during wash, are readily identifiable upon return to the Government as special wash items. For example, items may be labeled with a tag stating "special wash".

3.3 RE-PERFORMANCE OF LAUNDERING/DRY CLEANING. Any Laundry Item found to have been unsatisfactorily laundered as determined by the Government Point of Contact (POC) shall be re-cleaned at no additional cost to the Government. Such Laundry Items will be identified by the Government POC to the contractor's representative after the unsatisfactory condition is discovered.

The Laundry Item(s) shall be re-cleaned and returned to the same exchange point the next scheduled normal delivery day. The Contractor shall ensure re-cleaned Laundry Items are segregated from other Laundry Items and other types of Laundry Items to be re-washed, such as sheets and blankets, when returned. The Contractor shall also ensure that Laundry Items are readily identifiable upon return to the government as re-cleaned Laundry Items, to include the date and load number with which they were originally returned. For example, Laundry Items may be labeled with a tag stating, "re- wash".

3.4 WORKMANSHIP AND SANITATION. Delivered finished articles shall conform to the generally accepted industry standards and Department of Health regulations for quality of cleanliness, finish and appearance. All Laundry Item shall be delivered in a sanitary condition after being thoroughly laundered and properly dried. The Contractor shall comply with the International Fabricare Institute, Joint Commission on Accreditation of Health Care Organization (JCAHO) Manual, Infection Control Committee, American Institute of Laundering, and the Institute of Launderers, Washington DC Standards. The Contractor's facility shall be open to inspection of sanitary conditions at any time by a representative of the Government. The Government reserves the right to conduct, or have conducted, any testing necessary to verify that the Contractor's delivered Laundry Items meet required sanitary and cleanliness standards. The Contractor shall ensure that at no time Beale AFB/Government Owned Laundry Items co-mingle with items of other customers.

3.5 MISSING ITEMS. If any Laundry Item is missing from a delivery, the Contractor shall on the same day the shortage occurs, issue an IOU (shortage) ticket to be redeemed in the next regularly scheduled delivery at no cost to the Government. All Laundry Item not delivered within 24 hours of the original scheduled delivery date shall be considered as lost. If a lost Laundry Item is not delivered by thirty (30) calendar days from the date of loss, the Contractor shall reimburse to the Government the replacement cost of the lost Laundry Item as determined by the Government. That cost will be offset as a deduction to the appropriate invoice.

3.6 DAMAGED LAUNDRY ITEMS. The Contractor shall be liable for damage to Government-furnished Laundry Items beyond fair wear and tear according to the clause of the contract. The amount of compensation due the Government shall be the actual cost of replacing. That cost will be offset as a deduction to the appropriate invoice.

3.7 PACKING AND BUNDLING OF LAUNDRY ITEMS. Laundry Items delivered to Beale AFB shall be wrapped in accordance with method of finish codes and bundled as follows:

TABLE 3.1 METHOD OF FINISH CODES

WDF Wash, dry, fold WP Wrap finished work in clear film seal I Pressed on flatwork ironing equipment WK Wrap finished work in kraft paper P Pressed on commercial pressing equipment PB Return in plastic garment bag

D Tumbled Dry W Wash in warm water T Tie items with twine/string R Roll S Starch F Fold NS No Starch WO Wash & Dry HS Heavy Starch BB Bleached MS Medium Starch NB No Bleach LS Light Starch FB Folded and bundled OH Return finished work on hanger SC Sorted by Color CF Clear film sealed DC Dry Cleaned

3.7.1 WRAPPING. All wrapping shall be accomplished with plastic film unless otherwise specified in this PWS. All items shall be packaged separately according to Table 3.1 Method of Finish Codes. Sheets shall be packaged separately by fitted or flat, by color, by size and with size clearly marked on outside of each package.

3.7.2 FLATWORK IRONING. The Contractor shall ensure flatwork is processed so that surfaces are smooth, without rough dried spots, or wrinkling that is noticeable and significant in area affected, such as that achieved by machine finishing. Flatwork shall be folded to ensure a neat and uniform appearance that is not marred by excessive loose ends.

3.8 EMERGENCY SERVICE. Approximately twice a year the government may require an accelerated delivery for emergency Laundry Items(s). This shall require delivery within 24 hours of pick up.

4. GENERAL LAUNDRY REQUIREMENTS

4.1 GENERAL. Unless specified in paragraph 5, the Contractor shall accomplish Laundry Services for the 9th Aircraft Maintenance Squadron (9 AMXS), 9th Force Support Squadron (9 FSS), 9th Maintenance Squadron (9 MXS), 940th Maintenance Group (940 MXG), and 940th Aircrew Readiness Facility (ARW) as follows:

4.2 PICKUP. The Contractor shall pick up items stated in Attachment 1 in accordance with the schedule and locations in Attachment 2. Pickup and delivery should be accomplished simultaneously.

The Contractor shall furnish a signed pickup/delivery ticket that summarizes all Laundry Items counted by article to the Government POC upon pickup. The Government POC shall also sign each pickup ticket to provide positive control of all Laundry Items.

4.3 DELIVERY. The Contractor shall deliver the items stated in Attachment 1 in accordance with the schedule and locations in Attachment 2. Delivery shall be accomplished no later than (NLT) seven (7) calendar days from the date of pickup. Pickup and delivery should be accomplished simultaneously.

The Contractor shall furnish a signed pickup/delivery ticket that summarizes all Laundry Items counted by article to the Government POC upon delivery. The Government POC shall also sign each pickup/delivery ticket as proof of Government acceptance.

4.4 SCHEDULE. The Contractor shall submit a pickup/delivery schedule substantially the same as provided in Attachment 2 for the approval by the Contracting Officer and Government POC prior to the start of performance. Modifications to the pickup/delivery schedule shall be submitted allowing no less than five (5) business days for approval. All schedules ensure all pickup and delivery standards outlined in paragraph 4.2 and 4.3 are met.

4.6 CARTS USED TO TRANSPORT LAUNDRY ITEMS. The contractor shall supply all necessary carts, or similar conveyances, tubs, bags, or similar containers to transport Laundry Items during pickup and delivery. All items used for the transportation of Laundry Items shall be kept clean and serviceable at all times. These same clean containers shall be easily distinguishable by markings and shall never contain any Laundry Items that have not been cleaned IAW this Performance Work Statement. If the government discovers that clean Laundry Items have been delivered in uncleaned vehicles, in accordance with the PWS, the Government shall refuse the respective Laundry Items affected and the contractor shall return the cleaned Laundry Items the next scheduled delivery date.

4.7 ITEM FINISH. The Contractor shall deliver laundry/linen in accordance with the methods of finish described in Attachment 1.

5. SPECIFIC LAUNDRY REQUIREMENTS. Unless otherwise stated in this paragraph or sub-paragraph, all Laundry Services shall be conducted in accordance with paragraph 4, General Laundry Requirements.

5.1 940TH AIRCREW READINESS FACILITY (940 ARW). The following exceptions apply to General Laundry Requirements for the 940th Aircrew Readiness Facility.

5.1.1 PICKUP. The Contractor shall pick up items stated in Attachment 1 for the 940th Aircrew Readiness Facility at a minimum, one (1) week per quarter in accordance with the schedule and location in Attachment 2. The Contractor shall furnish a signed pickup ticket that summarizes all Laundry Items counted by article to the Government POC upon pickup. The Government POC shall also sign each pickup ticket to provide positive control of all Laundry Items.

5.1.2 DELIVERY. The Contractor shall deliver the items stated in Attachment 1 for the 940th

Aircrew Readiness Facility no later than (NLT) seven (7) calendar days from the date of pickup.

The Contractor shall furnish a signed delivery ticket that summarizes all Laundry Items counted by article to the Government POC upon pickup. The Government POC shall also sign each delivery ticket as proof of Government acceptance.

6. SERVICE SUMMARY. The Service Summary outlines the minimum standards with delivery methods and promotes continuous improvement in Contractor performance. The Contractor service requirements are summarized in performance objectives that relate directly to mission essential items. The performance threshold briefly describes the minimally acceptable levels of service required for each performance objective. The SS provides information on contract requirements, the expected level of Contractor performance and the expected method of government validation and confirmation of services provided. These thresholds are critical to mission success. Procedures as set forth in FAR 52.212-4(a), Contract Terms and Conditions - Commercial Items, Inspection/Acceptance, will be used to remedy all deficiencies.

TABLE 6.1 – SERVICE SUMMARY

Performance Objective (PO) PWS Para Performance Threshold

Objective Method of Surveillance

7. DELIVERABLES. The Contractor shall provide the following deliverables. Acceptance of final documents is subject to Government approval. All deliverables shall be submitted via email to the requiring activity’s designated Government POC and Contracting Officer (CO).

TABLE 7.1 – DELIVERABLES

Deliverable PWS Section Frequency Format Submit To IOU (Shortage) Ticket 3.5 The same day that a shortage is identified In writing via email Government POC

Pickup Ticket 4.2/5.1.1 Upon pickup Hand issued Government POC Delivery Ticket 4.3/5.1.2 Upon Delivery Hand issued Government POC

TABLE 7.1 – DELIVERABLES (Continued) Deliverable PWS Section Frequency Format Submit To

Schedule 4.4 Prior to start of performance

In writing via email Government POC and

CO

Entry Access Listing

(EAL)

10 Within five (5) business days prior to the start of work on Beale AFB.

In writing via email Government POC

8. GOVERNMENT FURNISHED SERVICES.

8.1 SERVICES. The Government will provide police and fire protection while on Beale AFB. In the event of a medical emergency, call “911” for transportation of an injured employee by civilian ambulance to a local hospital. The Government shall provide emergency medical treatment for life-threatening emergencies only until civilian ambulances arrive.

8.2 DAMAGE TO GOVERNMENT FACILITIES AND PROPERTY. The Contractor shall reimburse the Government if details of formal investigation of fire or other related or unrelated structural damage result in pecuniary liability assessed to the Contractor. The Contractor shall replace all damaged or lost Government Furnished Facilities, Government Furnished Equipment

PO-1 Pickup and delivery schedules are met.

4.2/4.3/4.4/5.1.1/5.1.2/ Attachment 2

No more than two (2) late deliveries per month for routine deliveries.

100% Inspection

PO-2 Correct quantities of laundry are delivered and properly packaged.

4.2/4.3/5.1.1/5.1.2/ Attachment 2

No more than two (2) errors in quantity and packaging per month.

100% Inspection

PO-3 Laundry is delivered free of all visible dirt, debris, dampness, odor, mildew, cleaning chemical residue, has a uniform appearance and is properly finished.

3 No more than two (2) discrepancies per month.

100% Inspection

PO-4 Lost or damaged Laundry Items are equitably adjusted for within 30 calendar days.

3.5/3.6 No more than two (2) discrepancies per month.

100% Inspection

PO-5 Unsatisfactory laundered items are re-washed at no cost to the Government and are returned by the next scheduled normal delivery date.

3.3 No more than two (2)

discrepancies per month.

100% Inspection and/or Government Furnished Materials at no cost to the Government.

9. GENERAL INFORMATION.

9.1 CONTRACTOR PERSONNEL. Contract personnel shall present a neat appearance.

Contract personnel shall be easily recognizable while on the installation in conjunction with this contract. This shall be accomplished through the wear of distinctive clothing, overcoats, or hats, bearing the company name or logo. The coloring or design of the items selected should be such that identifies personnel easily and quickly for reasons of safety and personal protection.

9.2 SAFETY. The Contractor shall follow all applicable AFOSH standards pertaining to the work being accomplished. The Contractor shall comply with all applicable local, city, county, state, and federal regulations pertaining to grease trap cleaning, waste handling, waste hauling and waste disposal.

10. SECURITY. The Contractor shall comply with all requirements and procedures IAW DAFFARS 5352.242-9000, Contractor Access to Department of the Air Force Installations. The Contractor shall obtain base identification and vehicle passes, if required, for all Contractor personnel who make frequent visits to or perform work on the Department of the Air Force installations cited in the contract. Contractor personnel are required to wear or prominently display installation identification badges or contractor-furnished Contractor identification badges while visiting or performing work on the installation. An Entry Access Listing (EAL) (Attachment 3) shall be turned into the Government POC within five (5) business days prior to the start of work on base. The EAL will be sent to Security Forces who will conduct a background check on each employee. Upon clearance and approval, the Contractor will be notified and will have approximately ten days to get their base passes from Pass & ID. During the performance of the contract, the Contractor shall be responsible for obtaining required identification for newly assigned personnel and for prompt return of credentials and vehicle passes for any employee who has quit, been terminated, or no longer requires access to the work site.

10.1 BASE CLOSURES. Work scheduled, but not accomplished, during a base closure due to weather, exercises, or actual alert, will be accomplished as soon as possible after reopening of the base.

10.2 TRAFFIC LAWS. The Contractor and their employees shall comply with all installation traffic regulations.

11. RECOGNIZED FEDERAL HOLIDAYS. The table below outlines all Federal Holidays observed by Beale AFB. The Contractor is not required to provide service on federal holidays. If any holiday falls on Saturday, the preceding Friday will be observed. If any holiday falls on Sunday, the following Monday will be observed. If a holiday falls on a scheduled service day, the Contractor will be responsible for rescheduling services for the first day post the holiday observance. The following Federal holidays are observed:

TABLE 11.1 – RECOGNIZED FEDERAL HOLIDAYS

New Year's Day 1 January

Martin Luther King’s Birthday Third Monday of January

President's Day Third Monday of February

Memorial Day Last Monday in May

Juneteenth 19 June

Independence Day 4 July

Labor Day First Monday in September

Columbus Day Second Monday in October

Veterans Day 11 November

Thanksgiving Day Fourth Thursday in November

Christmas Day 25 December

12. CLEAN-UP. The Contractor shall keep the work area orderly and, in a hazard free condition. The Contractor shall be responsible for clean-up of the job site including removal of all waste from site areas. All debris and waste shall be properly disposed of properly at an off-base property.

12. ENVIRONMENTAL CONTROL. The Contractor shall comply and assure that all subcontractors comply with all applicable federal, state, and local laws, regulations, ordinances, policies, and standards related to environmental matters.

13. HAZARDOUS MATERIALS AND WASTE. The Contractor is responsible for cleanup of any hazardous materials, spills or waste. The Contractor shall clean-up, containerize, and properly dispose of any spills caused by the Contractor’s employees such as any liquid spills they cause at the work site that might degrade environmental quality. The Contractor shall contact the Hazardous Waste Manager, 9 CES/CEIER, 530-634-2644 for further guidance. All clean up procedures shall follow all Federal, State, and County laws and regulations.

14. GOVERNMENT RESOURCES. Spill cleanup using government resources will be charged to the Contractor at an amount determined by the CO based on actual cost for manpower, supplies, equipment, and any resulting fines levied for the spill clean-up and testing.

Attachment 1

Laundry Item Quantities and Finishes

TABLE A1.1 – 9 AMXS

Item No.

Description Supplied By Counted By Bundled By Quantity of Bundles*

Extended Total of Items*

Method of Finish

Shop Towel Plain (red) 12x12

Contractor Individual 10 35 350 WDF

TABLE A1.2 – 9 FSS LODGING

Item No.

Description Supplied By Counted By Bundled By Quantity of

Bundles/ Year**

Extended Total of Items/ Year**

Method of Finish

Sheet (Single Flat)

Government Individual 10 300 3,000

WDF, P, T,

WP

Sheet (Single Fitter)

Government Individual 10 300 3,000

WDF, P, T,

WP

Sheet (Queen Flat)

Government Individual 10 900 9,000

WDF, P, T,

WP

Sheet (Queen Fitted)

Government Individual 10 900 9,000

WDF, P, T,

WP

005 Pillowcase Government Individual 50 1,012 50,600

WDF, P, T,

WP

006 Blanket Government Individual 5 1,800 9,000 WDF, T, WP 007 Mattress Pad Government Individual 5 140 700 WDF, T, WP

Mattress Cover (Bed Bug Protector)

Government Individual 2 120 240 WDF, T, WP

009 Bath Towel Government Individual 20 2,000 40,000 WDF, T, WP 010 Hand Towel Government Individual 20 2,000 40,000 WDF, T, WP 011 Wash Cloth Government Individual 50 800 40,000 WDF, T, WP 012 Bath Mat Government Individual 20 1,000 20,000 WDF, T, WP

Bedspreads/ Comforters

Government Individual Individual 9,000 9,000

WDF, NB,

T, WP

TABLE A1.3 – 9 MXS

Item No.

Description Supplied By Counted By Bundled By Quantity of Bundles*

Extended Total of Items*

Method of Finish

Bldg 1069, Fairchild St, Beale AFB, CA (Phase)

Shop Towel Plain (red) 12x12

Contractor Individual 25 8 200 WDF

Bldg 1075, Fairchild St, Beale AFB, CA (Fuels)

Shop Towel Plain (red) 12x12

Contractor Individual 25 8 200 WDF

Bldg 1086, Arnold Ave, Beale AFB, CA (Propulsion)

Shop Towel Plain (red) 12x12

Contractor Individual 25 2 50 WDF

Bldg 1086, Arnold Ave, Beale AFB, CA (Wheel & Tire)

Shop Towel Plain (red) 12x12

Contractor Individual 25 3 75 WDF

TABLE A1.3 – 9 MXS (Continued)

Item No.

Description Supplied By Counted By Bundled By Quantity of Bundles*

Extended Total of Items*

Method of Finish

Bldg 1075, Fairchild St, Beale AFB, CA (Dock 2)

Shop Towel Plain (red) 12x12

Contractor Individual 25 12 300 WDF

TABLE A1.4 – 940 MXG

Item No.

Description Supplied By Counted By Bundled By Quantity of Bundles*

Extended Total of Items*

Method of Finish

Bldg 1076, DOCK 5, 19418 Edison Ave, Beale AFB CA (TOOL CRIB)

Shop Towel Plain (red) 12xl2

Contractor Individual 25 8 200 WDF

11703 Arnold Ave, Beale AFB, CA (Sortie Support – Flight line Shack)

Shop Towel Plain (red) 12xl2

Contractor Individual 25 6 150 WDF

TABLE A1.5 – 940 ARW

Item No.

Description Supplied By Counted By Bundled By Quantity of

Bundles/ Year***

Extended Total of Items/

Year***

Method of Finish

Sheet (Single Flat)

Government Individual 10 16 160

WDF, P, T,

WP

Sheet (Single Fitted)

Government Individual 10 16 160

WDF, P, T,

WP

003 Pillowcase Government Individual 40 8 320

WDF, P, T,

WP

004 Blanket Government Individual 5 32 160

WDF, P, T,

WP

005 Mattress Pad Government Individual 5 32 160

WDF, P, T,

WP

Mattress Cover (Bed Bug Protector)

Government Individual 2 40 80

WDF, P, T,

WP

007 Bath Towel Government Individual 20 16 64

WDF, P, T,

WP

008 Hand Towel Government Individual 20 16 64

WDF, P, T,

WP

009 Wash Cloth Government Individual 50 8 32

WDF, P, T,

WP

010 Bath Mat Government Individual 20 40 160

WDF, P, T,

WP

Bedspreads/ Comforters

Government Individual Individual 160 640

WDF, NB,

T, WP

* Please note that the Extended Total of Items and Quantity of Bundles are estimates for the year of service.

** Please note that the Extended Total of Items and Quantity of Bundles are numbers needed for each week of service.

*** Please note that the Extended Total of Items and Quantity of Bundles are minimums for the year of service.

Attachment 2

Schedules and Addresses

TABLE A2.1 PICK UP/DROP OFF SCHEDULE

PICK-UP DAY(S) DELIVERY DAY(S) TIME(S) ADDRESS

9 AMXS

Monday Monday 0700-1600 19351 McGregor Street, Building 11177, Beale AFB, CA 95903

9 FSS/FSVL – Lodging Monday Monday 0900-1200 Linen Exchange

Bldg 2469, Robert Nicoletti Way Beale AFB, CA 95903

Wednesday Wednesday 0900-1200 Friday Friday 0900-1200

9 MXS

Monday Monday 0700-1600 Multiple locations, see “Table A1.3 – 9

MXS”

940 MXG

Thursday Thursday 0700-1500 Multiple locations, see “Table A1.4 – 940

MXG”

940 ARW

Scheduled with the Government POC

Scheduled with the Government POC

0900-1200 1232 or 1234 Arnold Ave Beale AFB, CA 95903

Attachment 3

Contractor Entry Authorization List (EAL)

CONTRACTOR ENTRY ACCESS LIST FORM

Effective 15 Aug 2016 the USAF will implement REAL ID Act requirements IAW Public Law 109-13 and the Code of Federal Regulations (CFR) Title 6, Part 37

Note: Personnel will be placed on an EAL for no longer than 29 Days and 15 Business days to receive there DBIDS Card. Any longer will require an 1172 form to get a base pass or a memo from contracting. Handwritten/PDF submittals will not be processed.

NOTE: SSN is used to positively identify individuals. Failure to identify individuals is automatic denial to Beale AFB.

Employee's LEGAL Last Name

Employee's LEGAL First Name

DOB Drivers License Number

Issuning State Start Date Expiration Date

Sponsor Name/DOB Sponsor Phone Number Sponsors DOD ID/

EDIPI

Destination Company Name Authorized Entry Times/ Days Contract Number

SSN