Attachment 3 - 316TH Unofficial Visitor Request Form.pdf

PDF 154 KB Posted

Attached to
Wash Rack Removal Federal contract opportunity
Solicitation number
FA286024Q4013
Issued by
Department of the Air Force Headquarters District Washington

About this file

This document is an Unofficial Visitor Base Pass Request form for the 316th Security Support Squadron/Visitor Control Center at Joint Base Andrews. It outlines the privacy and security requirements for visitors, including the need to provide a government email address, identification that is valid for federal purposes, and to submit the request form at least 72 hours prior to the visit. The form captures visitor information such as name, contact details, date of birth, driver's license, and visit dates and destination.

The related federal contract opportunity is a solicitation for the removal and disposal of a wash rack at Building 3356 on Joint Base Andrews, set aside for Service-Disabled Veteran-Owned Small Businesses (SDVOSB). A site visit is scheduled for June 18, 2024, and interested offerors must submit the completed Attachment 3 visitor request form by June 13, 2024 to attend. The successful offeror shall provide all personnel, equipment, and services necessary to perform the removal in accordance with the Performance Work Statement (PWS).

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Text version

CCH TRACKER:

JTC JTC

Rank Last Name First Name

E-Mail Address Contact Number

Last Name First Name Middle Name DOB DL State/Number Start Date End Date

***FOR VCC USE ONLY******FOR VCC USE ONLY*** DATE RECEIVED:

B.A.L.:CCH: NOTIFIED BY/DATE:

Military / Civilian Sponsor Information

316th Security Support Squadron/Visitor Control Center Unofficial Visitor Base Pass Request

Destination

Revised 10 Dec 2015

DO NOT SEND THIS REQUEST FORM WITH DOB AND DL NUMBER FROM A COMMERCIAL/PERSONAL EMAIL ACCOUNT (E.G.

YAHOO); IF YOU CANNOT SEND FROM GOVERNMENT EMAIL ADDRESS, PLEASE DROP OFF FORM AT VCC.

Visitor Control Center email: 316.SPT.Visitor.Center@us.af.mil, If identification states “Not Valid for Federal Purposes,” “Not for Use as Federal Identification,” “Federal Limits May Apply” or any other similar phrase, a US Passport OR Birth Certificate AND Social Security card in conjunction with your current ID will be required.

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. *MUST BE DELIVERED A MINIMUM OF 72 HOURS PRIOR TO VISIT*

Visitor Information

DATE RECEIVED:
CCH TRACKER:
CCH:
BAL:
NOTIFIED BYDATE:
First Name:
Last NameEMail Address:
Contact Number:
EMail AddressRow1:
Last NameRow1:
First NameRow1:
Middle NameRow1:
DOBRow1:
DL StateNumberRow1:
Start DateRow1:
End DateRow1:
DestinationRow1:
Last NameRow2:
First NameRow2:
Middle NameRow2:
DOBRow2:
DL StateNumberRow2:
Start DateRow2:
End DateRow2:
DestinationRow2:
Last NameRow3:
First NameRow3:
Middle NameRow3:
DOBRow3:
DL StateNumberRow3:
Start DateRow3:
End DateRow3:
DestinationRow3:
Last NameRow4:
First NameRow4:
Middle NameRow4:
DOBRow4:
DL StateNumberRow4:
Start DateRow4:
End DateRow4:
DestinationRow4:
Last NameRow5:
First NameRow5:
Middle NameRow5:
DOBRow5:
DL StateNumberRow5:
Start DateRow5:
End DateRow5:
DestinationRow5:
Last NameRow6:
First NameRow6:
Middle NameRow6:
DOBRow6:
DL StateNumberRow6:
Start DateRow6:
End DateRow6:
DestinationRow6:
Last NameRow7:
First NameRow7:
Middle NameRow7:
DOBRow7:
DL StateNumberRow7:
Start DateRow7:
End DateRow7:
DestinationRow7:
Last NameRow8:
First NameRow8:
Middle NameRow8:
DOBRow8:
DL StateNumberRow8:
Start DateRow8:
End DateRow8:
DestinationRow8:
Last NameRow9:
First NameRow9:
Middle NameRow9:
DOBRow9:
DL StateNumberRow9:
Start DateRow9:
End DateRow9:
DestinationRow9:
Last NameRow10:
First NameRow10:
Middle NameRow10:
DOBRow10:
DL StateNumberRow10:
Start DateRow10:
End DateRow10:
DestinationRow10:
Text1:
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