Attachment 21 FMF452 Installation Access Pass Request .pdf
PDF 1 MB Posted
- Attached to
- Facility Maintenance Services at Fort McCoy, WI
- Solicitation number
- W912ES22R0011
About this file
This document contains an Installation Access Pass Request form for Fort McCoy in Wisconsin. The form requires applicants to provide personal identifying information including legal name, dates of access needed, work hours, work area or purpose of visit, employer information, and serves as a request for sponsorship by a Fort McCoy affiliated individual. At the bottom, spaces are designated for a National Crime Information Center background check date as well as signatures from Physical Security personnel.
The related federal contract opportunity is a solicitation from the Department of the Army Corps of Engineers Engineering District St Paul for Facility Maintenance Services at Fort McCoy. The contractor will perform maintenance, repairs, and preventive maintenance across facilities, utilities, equipment, and areas through service orders or a preventive maintenance schedule to ensure full operational capacity and intended purpose. Work includes upkeep of all facility components, devices, equipment, and subsystems per manufacturers' manuals.
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Fort McCoy Form 452 December 2021
AEM6.2 V 8.0
Page of Fort McCoy Form 452 May 2021 Obsolete Fort McCoy Installation Access Pass Request Prescribing Regulation: Army Regulation 190-13, Proponent: Directorate of Emergency Services
PRIVACY ACT STATEMENT AUTHORITY: The Privacy Act of 1974, Title 5 USC 552a. PRINCIPLE PURPOSE(S): To determine suitability of individual(s) requesting access to Fort McCoy. ROUTINE USE(S): Personal information may be disclosed to appropriate military and civilian emergency and investigation agencies to assist in determining suitability for access to Fort McCoy. DISCLOSURE: Voluntary, however failure to provide information will result in a refusal to grant access to Fort McCoy.
Legal Name as Appears on Driver's License or State ID: Example: John Edward Doe 25-Jan-15 24-Jan-16
MON-FRI 0700-1700 HOURS
Bldg 100 Commissary/TCI Example: Plumber/Bagger Last Name First Name Middle Name or NMN if non Begin Date End Date Work Access Hours Work Area/ Visit Location Company Name Employees Position/ Event Remarks Block (At a minimum include: purpose for access; contract number and expiration date) ** Note: If access is for contract purpose, Sponsor will be the COR. In all cases, Sponsor must be affiliated with Fort McCoy. ***NCIC-III Check Date, PS Specialist and PS Specialist Signature for DES USE ONLY**** When complete submit to: usarmy.mccoy.id-readiness.mbx.des-physical-security-iacs-form@army.mil Legal Name as Appears on Driver's License or State ID: Example: John Edward Doe 25-Jan-15 24-Jan-16
MON-FRI 0700-1700 HOURS
Bldg 100 Commissary/TCI Example: Plumber/Bagger Last Name First Name Middle Name or NMN if non Begin Date End Date Work Access Hours Work Area/ Visit Location Company Name Employees Position/ Event 11.0.0.20130303.1.892433.887364 280-4222
DHR ASD
Trudy L. Ward FMF452_Fort McCoy Installation Access Pass Request 20210212 20210212
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File details come from the government source that posted it. Updated .