Attachment J - DBIDS Access Request Form.docx

DBIDS ACCESS REQUEST FORM (NAVSHIPYD PTSMH 5500)

SUBMISSION INFORMATION

1. Access Requested For (Full Name):

2. Title:

3. Phone Number :

4. COMPANY NAME :

DBIDS INFORMATION

Is the company requesting access to the installation the primary Contractor Yes☐ No☐ If no, who do they subcontract for:

(IF REQUEST IS FOR MORE THAN ONE PERSON PLEASE ATTACH EMPLOYEE LIST)

COMPANY REQUESTING ACCESS INFORMATION

Company Name (Corporate Legal name):

Company Address :

Company Phone Number (Corporate Office):

Company Local POC:

Email and Phone:

Are Any Personnel Foreign Nationals?

Yes ☐ No ☒ (If Yes provide separate list of Names)

For access to: PORTSMOUTH NAVAL SHIPYARD

Timeframe of Access Required: ☒ 0600-1800 ☐ 1400-2300 ☐ 24 Hours

☐ All Week ☒ M-F only ☐ Weekends Only

SPONSOR INFORMATION (MUST BE SHIPYARD PERSONNEL)

Sponsor Name: Deborah Peabody

Sponsor Organization: NAVFAC

Sponsor Title: Administrative Support Specialist

Sponsor Phone Number: 757-994-5818

Sponsor Email Address: Deborah.a.peabody2.civ@us.navy.mil

Contract or project number: BUILDING 14 New Stair/Life Safety/Power Improvements, RM22-1206 PRE AWARD SITE VISIT

Contract or Project ACCESS EXPIRATION Date: NO DATE / PRE AWARD

Only ONE request for Company access should be submitted to; PNSDBIDS@navy.mil (all requests for employees are on the 5512 and are carried by the employee to pass and ID once the company is approved) Revision 12/16/19 image1.jpeg