Attachment 6 - Base Entry Request.pdf

PDF 390 KB Posted Jul 2, 2024

Attached to: Install Communication Ducts Federal contract opportunity
Solicitation number: W50S8Q-24-Q-0012
Issued by: Department of the Army National Guard

About this file

Written by GovTribe AI · Jul 2, 2024

This document is an Authorized Base Entry Request form to be used for unescorted base entry at the 178th Security Forces Squadron, Springfield OHANG Base. The form collects personal information about visitors, including their name, date of birth, driver's license details, and the duration and purpose of their visit. The sponsor, who is a military or civilian representative, must verify the visitors' identities and vouch for their need to access the base. The sponsor agrees to take responsibility for the visitors and acknowledges the base's policies regarding weapons and illegal substances.

The related federal contract opportunity is for the installation of communication ducts at the Springfield OHANG Base. The solicitation number is W50S8Q-24-Q-0012, and the estimated value of the project is between $100,000 and $250,000. The contract is set aside for small businesses, and the NAICS code is 236220. Proposals must be submitted via email, and the project is subject to Davis-Bacon wage rates. Funding for the contract is expected to become available in mid-July, and the award will be made to the offeror who represents the best value to the government.

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Other files for this federal contract opportunity

Other files attached to Install Communication Ducts, newest first.
File	Type	Posted
Attachment 1 - SOW WAAR232015.pdf	PDF	Jul 2, 2024
Attachment 2 - Drawings Combined.pdf	PDF	Jul 2, 2024
Attachment 5 - RFI Template.docx	DOCX document	Jul 2, 2024
W50S8Q-24-Q-0012 Comm Ducts.pdf	PDF	Jul 2, 2024
Attachment 3 - Springfield Base Facility Standards - FINAL - Jul 2021.pdf	PDF	Jul 2, 2024
Attachment 4 - Material Submittals WAAR232015.xlsx	XLSX spreadsheet	Jul 2, 2024

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**FOR PASS & ID USE ONLY*** **FOR PASS & ID USE ONLY***DATE RECEIVED:

178th Security Forces Squadron/Pass & ID Email: 178SFS.S5.Pass-ID@us.af.mil/ Phone: 937-525-2550

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

Authorized Base Entry Request

PRIVACY ACT STATEMENT

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.

AUTHORITY: AFMAN 31-113, Para 1.3.1 PRINCIPLE PURPOSE: Collection of information to identity proof and vet for unescorted base entry. All information is for unescorted base entry purposes only.

ROUTINE USE: Local Law Enforcement DISCLOSURE IS VOLUNTARY: Disclosing is voluntary, however, failure to provide the requested information may prevent, and /or cause delay regarding a request.

Military / Civilian Sponsor Information Rank

E-Mail Address Last Name First Name

Contact Number

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

DECLARATION OF RESPONSIBILITY

I agree to take full responsibility for those individual(s) that I have requested unescorted entry for. I have verified a valid reason for entry. I have briefed the visitors listed above that the possession of illegal drugs or substances will result in the prosecution, and that no weapons are allowed onto the installation. Weapons restrictions apply to CCW holders as well as State certified police officers unless on offical duty. If the individuals listed below no longer require access prior to expiration I will notify the 178 SFS/S5 Pass & ID office.

SIGNATURE OF SPONSOR:

SANGB FORM 3, 9 March 2022 Previous Editions Are Obsolete

CUI

Reason for Request

Authorized Base Entry Request(continuation page)

PRIVACY ACT STATEMENT

AUTHORITY: AFMAN 31-113, Para 1.3.1 PRINCIPLE PURPOSE: Collection of information to identity proof and vet for unescorted base entry. All information is for unescorted base entry purposes only.

ROUTINE USE: Local Law Enforcement DISCLOSURE IS VOLUNTARY: Disclosing is voluntary, however, failure to provide the requested information may prevent, and /or cause delay regarding a request.

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

SANGB FORM 3, 9 March 2022 - Page 2 Previous Editions Are Obsolete

SANGB Form 3(EAL ONLY).pdf

QR.pdf

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File details come from the government source that posted it. Updated Jul 2, 2024.