Attachment 4 -Base Pass Template.pdf
PDF 211 KB Posted
- Attached to
- Local Telecommunication Services Federal contract opportunity
- Solicitation number
- FA483025Q0027
About this file
This document is a Base Pass Request template for the 23d Security Forces Squadron at Moody Air Force Base in Georgia. The form is designed to request installation access for personnel, requiring detailed information including full names, last 6 digits of SSN/DOB, organization, and an expiration date not exceeding one year. The template includes a section for a brief synopsis explaining the reason for requiring base access, and is marked as Controlled Unclassified Information (CUI) that must be protected under the Freedom of Information Act and Privacy Act. The document is part of the Local Telecommunication Services federal contract opportunity (Solicitation Number FA483025Q0027) and will be used by contractors seeking to attend a site visit on 8 April 2025 for a telecommunications services procurement at Moody Air Force Base.
View the file
Other files for this federal contract opportunity
| File | Type | Posted |
|---|---|---|
| Attachment 5 - PPQ Form LTS.pdf | ||
| Questions and Answers.pdf | ||
| Attachment 6 - Past Performance Information.pdf | ||
| Attachment 5 -Past and Present Performance Questionnaire.pdf | ||
| Attachment 3 - Required Insurance Compliance.pdf | ||
| Solicitation - FA483025Q0027.pdf | ||
| Attachement 2 - Performance Work Statement Local Telecommunications Services.pdf | ||
| Attachment 1 -Pricing Schedule.xlsx | XLSX spreadsheet | |
| COMBINED SYNOPSIS.pdf |
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Text version
CONTROLLED UNCLASSIFIED INFORMATION
DEPARTMENT OF THE AIR FORCE
23D SECURITY FORCES SQUADRON (ACC)
MOODY AIR FORCE BASE GEORGIA
MEMORANDUM FOR 23 SFS
FROM: Squadron or Person/Company Requesting Access
SUBJECT: Request for Installation Access
1. I am requesting a pass for the following people to Moody AFB for the purpose of (state reason and location personnel will be traveling to on base, please be specific).
Full Name: as they appear on their valid state ID.
Last 6 of
SSN/DOB
Organization/Company /School Name:
Expiration Date:
(not to exceed 1yr)
2. Brief synopsis of the situation: (explain the situation that requires the individual to have access to the installation).
First M. Last Name, Rank, USAF Duty Title
Attack · Rescue · Prevail The information here is Controlled Unclassified Information (CUI) which must be protected under the Freedom of Information Act of 1996 and Privacy Act of 1974, as amended. Unauthorized disclosure or misuse of this PERSONAL INFORMATION may result in disciplinary action, criminal and/or civil penalties.
| Full Name as they appear on their valid state IDRow1: |
| Last 6 of SSNDOBRow1: |
| OrganizationCompany School NameRow1: |
| Expiration Date not to exceed 1yrRow1: |
| Full Name as they appear on their valid state IDRow2: |
| Last 6 of SSNDOBRow2: |
| OrganizationCompany School NameRow2: |
| Expiration Date not to exceed 1yrRow2: |
| Full Name as they appear on their valid state IDRow3: |
| Last 6 of SSNDOBRow3: |
| OrganizationCompany School NameRow3: |
| Expiration Date not to exceed 1yrRow3: |
| Full Name as they appear on their valid state IDRow4: |
| Last 6 of SSNDOBRow4: |
| OrganizationCompany School NameRow4: |
| Expiration Date not to exceed 1yrRow4: |
| Full Name as they appear on their valid state IDRow5: |
| Last 6 of SSNDOBRow5: |
| OrganizationCompany School NameRow5: |
| Expiration Date not to exceed 1yrRow5: |
| Full Name as they appear on their valid state IDRow6: |
| Last 6 of SSNDOBRow6: |
| OrganizationCompany School NameRow6: |
| Expiration Date not to exceed 1yrRow6: |
File details come from the government source that posted it. Updated .