BASE ACCESS MEMO Template.doc

DEPARTMENT OF THE AIR FORCE

HEADQUARTERS 96TH TEST WING (AFMC)

EGLIN AIR FORCE BASE FLORIDA

Date: XX/XX/2021

MEMORANDUM FOR: 96 SFS/S-5B

FROM: XXXXXXXXXXXXXXXXXXX

SUBJECT: Request for Badge/Pass

1. The following individuals require access to Eglin AFB/Hangar B1412 to perform official duties. Their duties will be to attend a site visit for Solicitation FA282321R0016 – Renovate Hangar B1412, Eglin AFB. Site Visit will begin on XX/XX/XXXX and will be accomplished by XX/XX/XXXX.

2. The individuals listed have been briefed that while on the installation they must comply with all local laws and policies. The failure to comply will result in loss of base access. Each individual understands that they must go to the Security Forces Pass and Registration office to receive their contractor identification badge/pass. They further understand they must have a valid drivers license/Identification card, proof of current registration and insurance while driving on the installation.

3. When first arriving to the installation the following individuals will need no escort to area of work or visit, before being allowed access to the installation.

4. I understand it is the unit/company responsibility to collect the badges of terminated employees and to collect the badges at the conclusion of the work that was to be accomplished. Further, I understand that we are responsible to turn the badges/passes in to the Security Forces Pass and Registration office as soon as all work is complete.

(LAST 4)

(STATE&#)

M – F 0700-1600

5. The government sponsor of the following individual(s) is: David Clark, Contract Specialist Rachel Tilley, 1362825047

Rachel Tilley, 1362825047

Contract Specialist

Contract Specialist

AFTC/PZIOC

AFTC/PZIOC

882-9247

882-9247

Sponsor Signature

Security Manager Signature

Authority: 10 U.S.C.8013, Secretary of the Air Force

Purpose: Used by the Security Forces for issuing ID media. Some organizations may routinely keep copies of the above documentation in order to maintain control over persons authorized entry into certain areas. Accountability documents are used to insure proper control over the various forms utilized in these functions. Routine Use: In addition to those disclosures generally permitted under 5 U.S.C. 552(b) of the Privacy Act, these records or information contained therein may specifically be disclosed outside the DoD as a routine use pursuant to 5 U.S.C.552a(b)(3) as follows:

NOTICE: Under the Privacy Act of 1974, you must safeguard personnel information retrieved through this system. Disclosure of information is governed by Title 5, United States Code. Section 552a Public Law 93-579, DoDD 5400.11, DoDR 5400.11-R and the applicable service directives.