Attachment 9 DL1818 Visit Notification Form.pdf

PDF 130 KB Posted

Attached to
SP3300-24-Q-0020 ESS Maintenance at DLA Anniston AL
Solicitation number
SP3300-24-Q-0020
Issued by

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This document is a visit notification form for Defense Logistics Agency facilities. The form collects contact information for the requestor and point of contact at the visited facility, as well as visitor details including name, rank or grade, social security number, date of birth, security clearance information, and purpose of the visit. An accompanying federal contract opportunity is for essential maintenance services at the Defense Logistics Agency distribution center in Anniston, Alabama. The solicitation number is SP3300-24-Q-0020 and seeks to maintain essential services at the facility.

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PRIVACY ACT STATEMENT

VISIT NOTIFICATION

1. ACTIVITY TO BE VISITED

AUTHORITY:

PRINCIPAL PURPOSE:

ROUTINE USES:

DISCLOSURE:DEFENSE LOGISTICS AGENCY

8725 JOHN J. KINGMAN ROAD

FT BELVOIR, VA 22060-6220

Section 21, 50 U.S.C. 781 et seq.; Executive Order 10450.

To control access to and movement on DoD installations, buildings, or facilities.

Used by General Services Administration Protective Service Personnel for access control and for any of the Blanket Routine Uses published by DLA.

Voluntary. However, failure to provide all the requested information may result in refusal to grant access to the installation, building, or facility.

DLA PRIVACY ACT SYSTEM NOTICE S500.50 DLA-I APPLIES

SECTION I

2. NAME OF REQUESTOR/PREPARER 4. TELEPHONE3. OFFICE CODE

5. DATE(S) OF VISIT 6. POINT OF CONTACT (at facility to be visited) 7. POC TELEPHONE

8. PURPOSE OF VISIT

SECTION II

9.

NAME(S) OF VISITOR(S)

(Last, First, MI)

10.

GRADE/RANK

11.

SSN

12.

DATE OF BIRTH

13.

STATE /COUNTRY OF

BIRTH

14.

CLEARANCE/DATE

GRANTED

15.

TYPE OF INVESTIGATION/

DATE

16. TYPED NAME OF SECURITY REPRESENTATIVE

SECTION III

18. ACTIVITY 19. TELEPHONE NUMBER 20. DATE17. SIGNATURE OF SECURITY REPRESENTATIVE

DLA FORM 1818, JUL 96 (EG)

FROM: TO:

PDF (DLA)

RequesterName:
OfficeCode:
FacPOC:
Phone:
POCPhone:
VisitedActivity:
VisitPurpose:
DateTo:
Visitor:
0:
1:
2:
3:
4:
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8:
GradeRank:
0:
1:
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8:
SSN:
0:
1:
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8:
DOB:
0:
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StateCountry:
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ClearDate:
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InvestDate:
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DateFrom:
SecRepName:
Activity:
ActPhone:
SecRepDate:
tVisitor:
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tGradeRank:
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tClearDate:
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tInvestDate:
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tcsControl:
addcsBtn:
ResetMe:
resetBtn:

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