Attachment_E___AMAG_Base_Access_Form.xls
XLS spreadsheet 35 KB Posted
- Solicitation number
- N6945024R0005-0005
About this file
This document appears to be an AMAG Access Management System form to request base access for a site visit to the P9837 Ambulatory Care Center at Naval Air Station Jacksonville. The form requests standard personal information such as name, citizenship, driver's license, and contact details. It also requires a civilian sponsor and purpose of the visit, which is indicated as a 1-day site visit. The form cites the relevant Privacy Act authority and routine uses for collecting this information to identify and account for personnel accessing the naval station. This form appears to be a required attachment for the P9837 Ambulatory Care Center solicitation, which is an amendment to an ongoing procurement by the Department of the Navy Naval Facilities Engineering Command for construction of an ambulatory care center at Naval Station Guantanamo Bay, Cuba. The solicitation is limited to offerors previously selected for the second phase of this procurement.
View the file
Other files
| File | Type | Posted |
|---|---|---|
| 01 31 23.13 20.pdf | ||
| N6945024R0005 Amendment 0005.pdf |
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
Sheet1
| AMAG | ||
| Access Management System | ||
| This information will be entered into AMAG in preparation for your arrival - passes picked up at BLDG. 9. | ||
| "FOR OFFICIAL USE ONLY" | ||
| Last Name: | First Name (no nicknames): | Middle Name (mandatory): |
| Are you a US Citizen? | Card Number | |
| 5425841 (leave # in here) | ||
| Company Name: | Drivers License No: | Telephone number |
| Home Address: | ||
| City: | State: | Zip Code: |
| NAVFAC SE CIVILIAN SPONSOR (NAME AND DOD ID #): Joseph Higgins/ | ||
| PHONE NUMBER: (904) 542-6822 | ||
| Purpose of Pass: Site Visit P9837 Ambulatory Care Center | ||
| Start Date: | End Date: | |
| 6/25/24 | 6/25/24 | |
| ***Maximum of 30 days | ||
| SIGNATURE:____________________________ DATE:_____________ | ||
| ***Typed name in Signature line will suffice*** | ||
| Authority: 5 U.S.C. 522A, and Privacy Act of 1974 | ||
| Principle Purpose: To readily identify all personnel via numerical system of records that list individuals who are | ||
| allowed to access the military reservation, known as Naval Air Station, Jacksonville in furtherance of the stations | ||
| mission; and to comply verify and update the stations authorized user list in support of administrative and security | ||
| measures. | ||
| Routine Uses: To numerically identify and account for persons aboard Naval Air Station Jacksonville, their | ||
| entrance, exit and authorized locations. | ||
| "For Official Use Only" | ||
| Revised: November 14, 2012 |
Sheet2
Sheet3
File details come from the government source that posted it. Updated .