Attachment 3- EAL Form 12 Visitor Access.pdf

PDF 113 KB Posted

Attached to
Replace Lift Station Bldg 16 Federal contract opportunity
Solicitation number
W50S8W23R0004
Issued by
Department of the Army National Guard

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This document is an Entry Authority List (EAL) form used by the 153rd Airlift Wing to collect information for entry control purposes. The form requires description of the business/function, location, inclusive dates, point of contact information including name, phone number, and unit. It also includes fields for up to 12 visitor names, dates of birth, driver's license numbers, and states of issue to be filled in and authenticated by security forces personnel. No other salient details are provided.

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Replace Lift Station Bldg 16. Contractor Questions.pdf PDF
Original Pump Submittal.pdf PDF
Attachment 1 - SOW - Replace Lift Station Bldg 16.pdf PDF
W50S8W-23-R-0004 Repair Lift Station Bldg 16 Solicitation.pdf PDF
Attachment 2 - Wage Determination 6 Jan 23.pdf PDF

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ENTRY AUTHORITY LIST (EAL)

PRIVACY ACT STATEMENT: 1. AUTHORITY: USC Title 10, 8013 2. PURPOSE: Used to collect information needed for entry control to the 153d Airlift Wing.

3. ROUTINE USES: This information will not be disclosed outside the Department of Defense. 4. DISCLOSURE: Voluntary. However, failure to provide information results in the denial of entry to the 153d Airlift Wing. Mail to:153.AW.Entry.Authority.List@us.af.mil

The following individuals will be on the installation for the listed function/business and dates stated. All individuals listed will be escorted at all times by the Point of Contact for this EAL. This EAL is used for business/functions not associated with contracts.

DESCRIPTION OF BUSINESS/FUNCTION: LOCATION OF BUSINESS/FUNCTION INCLUSIVE DATES:

POINT OF CONTACT: (Last, First, MI) PHONE #: UNIT: DATE SUBMITTED:

#1. NAME: (Last, First, MI) DATE OF BIRTH: DRIVER LICENSE #: STATE OF ISSUE:

#2. NAME: (Last, First, MI) DATE OF BIRTH: DRIVER LICENSE #: STATE OF ISSUE:

#3. NAME: (Last, First, MI) DATE OF BIRTH: DRIVER LICENSE #: STATE OF ISSUE:

#4. NAME: (Last, First, MI) DATE OF BIRTH: DRIVER LICENSE #: STATE OF ISSUE:

#5. NAME: (Last, First, MI) DATE OF BIRTH: DRIVER LICENSE #: STATE OF ISSUE:

#6. NAME: (Last, First, MI) DATE OF BIRTH: DRIVER LICENSE #: STATE OF ISSUE:

#7. NAME: (Last, First, MI) DATE OF BIRTH: DRIVER LICENSE #: STATE OF ISSUE:

#8. NAME: (Last, First, MI) DATE OF BIRTH: DRIVER LICENSE #: STATE OF ISSUE:

#9. NAME: (Last, First, MI) DATE OF BIRTH: DRIVER LICENSE #: STATE OF ISSUE:

#10. NAME: (Last, First, MI) DATE OF BIRTH: DRIVER LICENSE #: STATE OF ISSUE:

#11. NAME: (Last, First, MI) DATE OF BIRTH: DRIVER LICENSE #: STATE OF ISSUE:

#12. NAME: (Last, First, MI) DATE OF BIRTH: DRIVER LICENSE #: STATE OF ISSUE:

AUTHENTICATED BY SFS: (LAST, FIRST, MI) AUTHENTICATED BY SFS: (SIGNATURE) DATE:

153AW FORM 12, 20200701 PREVIOUS EDITIONS OBSOLETE

mailto:153.AW.Entry.Authority.List@us.af.mil mailto:153.AW.Entry.Authority.List@us.af.mil

ENTRY AUTHORITY LIST EAL:
The following individuals will be on the installation for the listed functionbusiness and dates stated All individuals listed will be escorted at all times by the Point of Contact for this EAL This EAL is used for businessfunctions not associated with contractsRow1:
DESCRIPTION OF BUSINESSFUNCTIONRow1:
LOCATION OF BUSINESSFUNCTIONRow1:
INCLUSIVE DATESRow1:
POINT OF CONTACT Last First MIRow1:
PHONE Row1:
UNITRow1:
DATE SUBMITTEDRow1:
1 NAME Last First MI:
1 NAME Last First MIRow1:
DATE OF BIRTHRow1:
DRIVER LICENSE Row1:
STATE OF ISSUERow1:
2 NAME Last First MIRow1:
DATE OF BIRTHRow1_2:
DRIVER LICENSE Row1_2:
STATE OF ISSUERow1_2:
3 NAME Last First MIRow1:
DATE OF BIRTHRow1_3:
DRIVER LICENSE Row1_3:
STATE OF ISSUERow1_3:
4 NAME Last First MIRow1:
DATE OF BIRTHRow1_4:
DRIVER LICENSE Row1_4:
STATE OF ISSUERow1_4:
5 NAME Last First MIRow1:
DATE OF BIRTHRow1_5:
DRIVER LICENSE Row1_5:
STATE OF ISSUERow1_5:
6 NAME Last First MIRow1:
DATE OF BIRTHRow1_6:
DRIVER LICENSE Row1_6:
STATE OF ISSUERow1_6:
7 NAME Last First MIRow1:
DATE OF BIRTHRow1_7:
DRIVER LICENSE Row1_7:
STATE OF ISSUERow1_7:
8 NAME Last First MIRow1:
DATE OF BIRTHRow1_8:
DRIVER LICENSE Row1_8:
STATE OF ISSUERow1_8:
9 NAME Last First MIRow1:
DATE OF BIRTHRow1_9:
DRIVER LICENSE Row1_9:
STATE OF ISSUERow1_9:
10 NAME Last First MIRow1:
DATE OF BIRTHRow1_10:
DRIVER LICENSE Row1_10:
STATE OF ISSUERow1_10:
11 NAME Last First MIRow1:
DATE OF BIRTHRow1_11:
DRIVER LICENSE Row1_11:
STATE OF ISSUERow1_11:
12 NAME Last First MIRow1:
DATE OF BIRTHRow1_12:
DRIVER LICENSE Row1_12:
STATE OF ISSUERow1_12:
AUTHENTICATED BY SFS LAST FIRST MI:
AUTHENTICATED BY SFS LAST FIRST MIRow1:
DATERow1:
153AW FORM 12 20200701:

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