BPM007689 ATT 1 19B Form.pdf
PDF 171 KB Posted
- Solicitation number
- BPM007689
- Issued by
- Gila County, Arizona
About this file
This file contains a Camp Navajo Limited Area Access Request Form (SOP 19B) issued by the Arizona Army National Guard in conjunction with an Invitation for Bid (IFB NG-25-003) for roof removal and installation at Buildings 239 and 241 at Camp Navajo in Bellemont, Arizona. The form is required for all bidders seeking to attend a non-mandatory pre-bid conference and site visit scheduled for September 2, 2026, at 10:00 AM Arizona Time at Camp Navajo, 1 Hughes Avenue, Building 16, Bellemont, Arizona 86015. Bidders must complete and submit the access request form to Douglas Taylor at douglas.taylor@azdema.gov prior to the site walk to gain entrance to the facility. Additionally, all attendees must sign in through the provided Google Docs link by August 27, 2026, at 5:00 PM Arizona Time. Upon arrival at the base gate, bidders must inform security personnel that they are present for the pre-construction meeting and job walk for re-roofing projects at GSA Buildings 239 and 241, and must present valid identification.
The access request form requires applicants to provide personal information including name, date of birth, contact information, company affiliation, and purpose of access, with access dates not to exceed one year. The form requests documentation of security clearances (Secret or above), DD Form 369 completion, and a signed Non-Disclosure Agreement (NDA). Camp Navajo security personnel will conduct records checks and determine whether escorts are required for facility access. On-site DEMA personnel will review the Camp Navajo-Specific Contract Provisions (BPM007689 ATT 2 1141) at the start of the site walk to ensure all bidders understand applicable requirements.
View the file
Other files
On GovTribe
Work with this file
- Download the original file
- Contacts named in this file
- Similar government files
- Ask GovTribe AI about this file
Text version
P.O. Box 16123, Bellemont, Arizona 86015-6123
CAMP NAVAJO
REQUEST FOR LIMITED AREA ACCESS
Date of Request: (YYYY-MM-DD)
Company/Organization: Name/Title/Contact Info for Company Manager/Supervisor:
Person needing authorization: Name of Applicant (Last, First MI):
Date of Birth: (YYYY-MM-DD): Contact Phone Number:
Purpose/Activity Requiring Access:
Start Date: (YYYY-MM-DD) End Date: (YYYY-MM-DD) Dates Access Requested:
(May not exceed one (1) year)
SOP NUMBER 19B
ANNEX B
AZIA-GC-DIO-SM
Documentation Attached:
Secret or Above Clearance DD Form 369 (Mar 2007) Other:
Camp Navajo Contact: Camp Navajo Division/ Department:
Approved Escort (AE)No Escort Required (NER)Escort Required (ER)Type of Access Requested:
(Check one only)
Camp Navajo Contact Person (Must be a Camp Navajo Employee):
Camp Navajo Contact Signature: By signing, you are requesting access as requested above for legitimate/approved purposes.
CAMP NAVAJO SECURITY USE ONLY
Date/Time Recd: ____________________
Review by: _________________________
Security office records check by: ________
Manager/Supervisor Signature: I certify the person needing authorization has not and does not display character traits that raise significant doubts as to their honesty or stability.
DD 369 Required?
Date/Time DD 369 Submtd: ____________
Approved Not Approved Apprvd w/ Mod
Modifications:
Signed By
Date/Time Requestee's Supervisor Notified
Date/Time DD 369 Results Rcd.: _________
REVISION DATE: 2014-06-26
Government Photo ID that will be provided at Entry:
(Driver's License, Passport, etc - Include number, state and expiriation date)
Name:
Title:
Phone 1: Phone 2:
email:
Co. Name
Address
City State Zip
Country
Social Security Number or DOD ID:
DISCLOSURE: The providing of a Social Security Number is voluntary, however, your application for access may not be able to be processed without that information.
Lvl of Clearance: _________
Adj. Date: ______________
NDA Signed: Yes No
NoYesUS Access:
P.O. Box 16123, Bellemont, Arizona 86015-6123
CAMP NAVAJO
REQUEST FOR LIMITED AREA ACCESS
Company/Organization:
Name/Title/Contact Info for Company Manager/Supervisor:
Person needing authorization:
Purpose/Activity Requiring Access:
Dates Access Requested:
(May not exceed one (1) year)
SOP NUMBER 19B
ANNEX B
AZIA-GC-DIO-SM
Documentation Attached:
Camp Navajo Contact:
Type of Access Requested:
(Check one only)
CAMP NAVAJO SECURITY USE ONLY
Date/Time Recd: ____________________ Review by: _________________________ Security office records check by: ________ Date/Time DD 369 Submtd: ____________ Modifications:
Signed By Date/Time Requestee's Supervisor Notified Date/Time DD 369 Results Rcd.: _________
REVISION DATE: 2014-06-26
DISCLOSURE: The providing of a Social Security Number is voluntary, however, your application for access may not be able to be processed without that information.
Lvl of Clearance: _________ Adj. Date: ______________ NDA Signed:
US Access:
Arizona Army National Guard Maj Bruce Farley Normal cleo Microsoft Office Word
8/29/2007 10:46:00 AM
8/31/2007 12:14:00 PM
8/31/2007 12:21:00 PM
Camp Navajo 1188864
8/31/2007 12:14:00 PM
| DateTimeField1: |
| TextField2: |
| TextField3: |
| CheckBox1: 0 |
| CheckBox1: 0 |
| CheckBox2: 0 |
| TextField4: |
| TextField5: |
| CheckBox3: 0 |
| CheckBox3: 0 |
| CheckBox3: 0 |
| SignatureField1: |
| PrintButton1: |
| SignatureField2: |
| CheckBox4: 0 |
| : |
| TextField6: |
| Name: |
| Address: |
| Country: |
| email: |
| City: |
| State: |
| ZipCode: |
| CheckBox5: 0 |
| CheckBox5: 0 |
| CheckBox6: 0 |
| CheckBox6: 0 |
File details come from the government source that posted it. Updated .