Attachment H AMAG REQUEST FORM.xls.xlsx
XLSX spreadsheet 15 KB Posted
- Solicitation number
- N6945026R0005
About this file
This is an Access Management System request form for facility pass issuance at Naval Air Station (NAS) Jacksonville. The form is used to register personnel requiring access to the military reservation in support of the P83 Aircraft Engine Repair Facility site visit related to RFP N69450-26-R-0005. The form captures standard identification information including the visitor's name, citizenship status, driver's license number, home address, contact information, and company affiliation. The sponsoring official is identified as Dominic Drdla with DoD ID, and the designated pass holder contact is 813-362-2902. The access request specifies a single-day pass valid from 5/12/26 through 5/12/2026 at 1:00 PM, with a maximum authorized duration of 14 days. The form is issued under authority of 5 U.S.C. 522A and the Privacy Act of 1974, with the stated purpose of identifying authorized personnel accessing NAS Jacksonville and maintaining an updated authorized user list to support administrative and security measures. The form was last revised on June 23, 2023, and is marked "For Official Use Only."
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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 #): Dominic Drdla / DoD # |
| PHONE NUMBER: 813-362-2902 |
| Purpose of Pass: P83 Aircraft Engine Repair Facility, Site Visit for RFP N69450-26-R-0005 |
| Start Date: | End Date: |
| 5/12/26 | 5/12/2026 1:00PM |
| ***Maximum of 14 days |
| SIGNATURE:___________________________ DATE:_____________ | 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: June 23, 2023
Sheet2
Sheet3
File details come from the government source that posted it. Updated .