Attachment 5 - Base Pass Request.pdf

140 KB Posted

Attached to
HAAS/OMAX PREVENTATIVE MAINTENANCE
Solicitation number
FA483025Q0079
Issued by

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This document is a Memorandum for Installation Access from the 23rd Security Forces Squadron at Moody Air Force Base in Georgia. The memorandum requests access passes for individuals who will be assessing maintenance machinery for contracted requirements. The form provides a template for listing personnel details, including full name, last 6 digits of SSN/DOB, organization/company, and an expiration date (not to exceed 1 year). The brief synopsis indicates that the listed individual(s) will be conducting maintenance machinery assessments related to contracted work. The document is marked as Controlled Unclassified Information (CUI) and includes a warning about unauthorized disclosure of personal information, with potential disciplinary, criminal, or civil penalties.

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Other files

File Type Posted
Solicitation Amendment - FA483025Q00790001.pdf PDF
Solicitation Amendment FA483025Q00790001 SF 30.pdf PDF
Solicitation Questions with Answers.pdf PDF
Attachment 1 - Performance Work Statement.pdf PDF
Attachment 2 - Wage Determination Rev 29.pdf PDF
Solicitation - FA483025Q0079.pdf PDF
Attachment 3 - Required Insurance Compliance.pdf PDF
Attachment 4 - Pricing Schedule.xlsx XLSX spreadsheet
Attachment 7 - PP Information.pdf PDF
Attachment 6 - Base Map.pdf PDF
Attachment 8 - PP Questionnaire.pdf PDF
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CCUI

DEPARTMENT OF THE AIR FORCE

23D SECURITY FORCES SQUADRON (ACC)

MOODY AIR FORCE BASE GEORGIA

MEMORANDUM FOR 23 SFS

FROM: 23 CONS

SUBJECT: Request for Installation Access

1. I am requesting a pass for the following individuals access Moody AFB for the purpose of completing contracted requirements.

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:

SAMANTHA M. ELIA, SSgt, USAF NCOIC, Services

Attack · Rescue · Prevail

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:
Text1:
Text2: Listed individual(s) will be assessing maintenance machinery for contracted related requirements.

File details come from the government source that posted it. Updated .