Attachment Q - DoO Form 5-6 - Base Access Request.xlsx
XLSX spreadsheet 40 KB Posted
- Solicitation number
- W5168W23R0004
- Issued by
-
Department of the Army
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| File | Type | Posted |
|---|---|---|
| Attachment R - DoO 5-6 step by step Instructions.docx | DOCX document |
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Extended Pass Request
| COMPANY NAME | FULL LAST NAME | FULL FIRST NAME & MIDDLE NAME | DATE OF BIRTH | STATE DL | DRIVER LICENSE (DL) # | FULL SSN# | LOCATION OF BIRTH - CITY, STATE/COUNTRY | PROXIMITY CARD REQUIRED YES/NO | SIGNATURE AUTHORITY FROM FM 5-8 | PHONE # | ACCESS DATE FROM: | ACCESS DATE TO: | GATES: HCA/WCA/KCA/LAAF |
| (EXAMPLE) CORPORATION | SMITH RAMIREZ | JOHN DOE | MM/DD/YYYY | AZ | D12345678 | 123-45-6789 | NEW ORLEANS, LA, USA | NO | PLANT, ROBERT | 928-328-XXXX | MM/DD/YYYY | MM/DD/YYYY | HCA/LAAF |
O26
| FOUO | &"-,Bold"USAG YUMA PROVING GROUND |
| UNCLEARED CONTRACTOR/ EMPLOYEE/ TEACHER REQUEST | &D |
| &"-,Bold"DOO FORM 5-6 | &"-,Bold"&8Confidentiality and Nondisclosure Notice:&"-,Regular" |
| &10This document contains confidential/privileged information. Any unauthorized use, disclosure or distribution is strictly prohibited. | FOUO |
**Instructions for completing extended pass form as provided in example above:
Company Name: Name of Company employee represents Last Name: As it is written on the driver license First Name and Middle : As is it written on the driver license Date of Birth: Self-Explanatory State of Driver's License: Self-Explanatory Driver's License Number: Self-Explanatory Full Social Security Number: Self-Explanatory Location of Birth City and State or Country: Self-Explanatory Signature Authority from FM 5-8: Only personnel with a completed DOO FORM 5-8, authorizied signature card, can submit an Extended Access Request.
Proximity Card Required: Yes or No (Fill out by YPG Official only) Phone: Phone number of Company/Organizaton number Access From: Date access needs to be granted Access To: Date access is to be terminated. Passess will not be granted to contractors for longer than 365 days at a time.
Gates: gate(s) that need to be access (Fill out by YPG Official only)
Once the DOO 5-6 Form is filled out by the contractor, the contractor must email it to the Yuma Proving Ground (YPG) Point of Contact. The YPG Authorized Personnel will then email or forward the form to the Visitor Control Center Officials. Please provide the Visitor Control Center Officials at least a week noticed
Email completed form to the Directorate of Emergency Services, Visitor Control Center by Yuma Proving Ground Authroized Personnel:
usarmy.ypg.imcom.list.doo-vcc@army.mil
Office Number: 928-328-6668/ 6689/ 6691 Fax: 928-328-2681
File details come from the government source that posted it. Updated .