BASE Elizabeth City Visitor Request Form Blank.xlsx
XLSX spreadsheet 107 KB Posted
- Solicitation number
- 70Z08126QELIZ0016
About this file
This is a blank visitor request form template for BASE Elizabeth City. The form is designed to collect required visitor information for base access in accordance with security protocols at USCG Base Elizabeth City, NC.
The form serves as the documentation tool for visitors requiring base entry. All visitors must complete this form prior to site access, unless they possess a valid Military ID or RAPIDGate pass. Required information fields include full name, date of birth, and last four digits of Social Security Number. Visitors must also present a valid Real ID or Passport as identification. This form is particularly relevant to the Vehicle Maintenance Shop Roof Insulation solicitation (70Z08126QELIZ0016), as prospective contractors and their representatives are strongly encouraged to conduct site visits prior to quote submission, with a scheduled site visit occurring on August 4, 2026, at 1000 hours at Building 93. Site visit arrangements must be coordinated with Michael D. Barclift a minimum of three business days in advance via email to Michael.D.Barclift@uscg.mil.
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Text version
Sheet1
| Base Elizabeth City Visitor Request |
| For questions, contact your Command Security Officer or Base Coast Guard Police Dept. at (252) 335-6588. |
***All requests shall be submitted no later than 3 working days prior to visit.*** Reference BASEECITYINST 5512.1B for additional information and requirements.
LAST NAME FIRST NAME MIDDLE INITIAL SUFFIX DATE OF BIRTH DL STATE DL# CITIZENSHIP (US/FOREIGN)
| VISITOR ORGANIZATION: | |
| PURPOSE OF VISIT: | |
| PLACE OF VISIT: | |
| ARRIVAL: | |
| DEPARTURE: | |
| SPONSOR'S NAME: | LT Renee Gasper |
| SPONSOR'S COMMAND/AFFILIATION: | Base FED |
| SPONSOR'S CONTACT INFORMATION | Renee.E.Gasper@uscg.mil |
| COMMENTS BELOW: |
| ***FOREIGN VISITORS MUST BE SUBMITTED NO LESS THAN THIRTY DAYS PRIOR TO AN OFFICIAL VISIT*** | ||
| For more information and/or guidance, contact your Tenant Command Security Officer | ||
| Base Elizabeth City and Tenant Command CSO's: | ||
| Base Elizabeth City: | MEC Kealiinohomoku, Brandonn | (252)335-6855 |
| Aviation Technical Training Center (ATTC): | ASTC Linehan, Michael | (252)335-6917 |
| Aviation Logistics Center (ALC): | Mr. Smith, Stephen | (252)384-7173 |
| Air Station Elizabeth City: | OSC Brancaleone, Paul | (252)335-6761 |
| Boat Station Elizabeth City: | BM1 Jordan, William | (252)335-6086 |
| USCG Aviation Projects Acquisition Center (APAC): | LT Cortez, Miguel | (252)355-6279 |
| ***ALL VISITOR REQUESTS SHALL BE SENT TO THE FOLLOWING EMAIL:*** | ||
| d05-smb-baseecityvisitors@uscg.mil | ||
| Instructions: Left click on the email address and an email will auto-populate. Once all fields are filled out in this visitor request, save to a safe place as this contains PII and attach this form to the email. Once you send off a visitor request you do not need to follow up, all visitor requests are monitored on a daily basis. If a member does not meet Base entry criteria as defined in BASEECITYINST 5512.1B and DCMS denial criteria, you will be contacted and the visitor request will be denied pending a follow up request. If you have any further questions please feel free to contact the CGPD. |
mailto:d05-smb-baseecityvisitors@uscg.milmailto:Renee.E.Gasper@uscg.mil image1.emf image2.emf image3.emf image4.emf image5.emf
File details come from the government source that posted it. Updated .