Attachment 6 - Base Pass.docx
DOCX document 34 KB Posted
- Attached to
- Integrated Solid Waste Management (ISWM)
- Solicitation number
- FA485524R0007-ISWM
About this file
The provided document is a request for a background check and base pass to access Cannon AFB in order to perform contract work. It details the required information for the contract employee, including their name, social security number, date of birth, employer, contact information, and driver's license details. The pass requested is valid for up to one year, with specified authorized days and hours, and is solely for the purpose of completing contract work assignments. The document also outlines the responsibilities of the sponsoring agency in managing and returning the passes upon contract or employee termination.
The related federal contract opportunity is a solicitation for Integrated Solid Waste Management (ISWM) services at Cannon AFB, New Mexico. The requirement is for a 100% Women-Owned Small Business set-aside, with a projected period of performance from July 2024 to April 2029. The contractor will be responsible for providing all personnel, equipment, and services necessary to perform municipal solid waste collection and recycling services. The solicitation includes a Performance Work Statement, wage determination, and instructions for submitting proposals, with a due date of May 22, 2024 and a site visit scheduled for May 14, 2024.
View the file
Other files
Show all 11
On GovTribe
Work with this file
- Download the original file
- Contacts named in this file
- Similar government files
- Ask GovTribe AI about this file
Text version
REQUEST FOR BACKGROUND CHECK AND/OR BASE PASS
| TO: |
| FROM: (CONTRACTOR PROVIDE PHONE NUMBER) |
| DATE: |
27 SOSFS/S5P
27 SOCONS/PKA
Date completed
1. Request the individual and vehicle (if applicable) listed below be granted access to Cannon AFB for the performance of contract work. The following actions are requested (please check the applicable blocks below).
| US Citizen: |
| x |
| Worker Pass |
Sponsor Pass
Renewal
2. CONTRACT EMPLOYEE AND VEHICLE INFORMATION
CONTRACT EMPLOYEE’S NAME
SSAN
DOB (MMDDYYYY)
EMPLOYER (CONTRACTOR COMPANY)
COMPLETE ADDRESS
HOME PHONE or CELL (TO INCLUDE AREA CODE)
WORK PHONE (TO INCLUDE AREA CODE)
DRIVER’S LICENSE OR ID NUMBER (State DL or ID)
STATE OF ISSUE
PLACE OF BIRTH
Enhanced? Y or N
3. PASS INFORMATION
PASS DATES (NOT TO EXCEED 1 YEAR)
(00 XXX 2017)
| AUTHORIZED DAYS (i.e., Mon-Fri) |
| AUTHORIZED HOURS (i.e., 0700-1600) |
| DESTINATION (i.e., Bldg xxx, R/W xxx) |
The above named individual was instructed that this pass is to be used for entry onto Cannon AFB for the sole purpose of completing contract work assignments only. He/she was further instructed that this pass does not authorize any base privileges (i.e., Base Exchange, Shoppette, Golf etc.).
At the time of requesting above pass, the individual must have in their possession their social security card and a valid state, or federal form of picture identification. If requesting to drive on CAFB the individual must have a valid driver's license, insurance documents, and vehicle registration.
All sponsoring agencies are responsible for passes issued under their contract. When a contract is terminated or an employee is terminated or quits, the pass is to be recovered by the sponsoring agency and returned to Pass & Registration. In the event the sponsor is unable to retrieve the pass from a terminated employee, the sponsor must notify Pass & Registration in writing the next duty day.
| FULL NAME OF PERSON AUTHORIZED TO SIGN REQUESTS |
| DUTY PHONE |
| SIGNATURE |
| DATE (00 xxx 2016) |
4. ENDORSER (TO BE COMPLETED BY PASS & REGISTRATION PERSONNEL)
| CLERK WHO FILLED PASS |
| PASS NUMBER |
| DATE ISSUED |
Please fill out below if the pass is a second issue (to be completed by Pass & Registration clerk).
| SECOND ISSUE: CLERK WHO FILLED PASS |
| PASS NUMBER |
| DATE ISSUED |
PRIVACY ACT NOTICE
Privacy Act 1974 as Amended may apply--this communication contains personal information which must be protected IAW DOD 5400.11R, and is FOR OFFICIAL USE ONLY (FOUO)
11 Jul 14
File details come from the government source that posted it. Updated .