CLEARANCE VISITORS FORM revised 012423.pdf

PDF 135 KB Posted

Attached to
Operation and Maintenance of Water, Sewer and Waste Water Treatment Systems at Various Orange County Locations
Solicitation number
2137934
Issued by
Orange County, New York

About this file

This is a Visitor's Form for Building Clearance issued by the Orange County Sheriff's Office in Goshen, New York, designed to control access to Orange County facilities. The form requires visitors to provide personal identification information including name, address, date of birth, driver's license number, and contact details. Visitors must indicate which department they intend to visit—including Corrections, Food Service, Medical, Mental Health, Programs/Education, Department of Public Works, or other departments—and state the reason for their visit. The form specifies that submission must occur prior to facility entry and requires both the completed form and a copy of the visitor's driver's license for approval before access is granted.

This clearance mechanism applies to the Orange County Sheriff's facility located at 110 Wells Farm Road in Goshen, New York, and serves as a security control measure for the county's operations. Contact information for inquiries is provided through the Orange County Sheriff's Department via phone at 845-291-4033 or email at OCNYSheriff@OrangeCountyGov.com. The form contains no pricing information, contract terms, or service specifications, as it functions solely as an administrative access control document rather than a procurement instrument.

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Text version

110 Wells Farm Road • Goshen, NY 10924 • P: 845-291-4033 • E: OCNYSheriff@OrangeCountyGov.com

ORANGE COUNTY NEW YORK Sheriff Paul Arteta

VISITOR’S FORM FOR BUILDING CLEARANCE

NAME:_______________________________/__________________/_____________________________

(FIRST) (MIDDLE) (LAST)

ADDRESS:_______________________________________________________________________

EMAIL ADDRESS:________________________________________________________________

SEX: MALE__________ FEMALE__________ DATE OF BIRTH:_________________

DRIVER’S LICENSE NUMBER:__________________________________ STATE:__________

PHONE NUMBER:______________________________________________

DATE OF SUBMISSION: ________________________________

DATE OF VISIT: _______________________________________

DEPARTMENT TO BE VISITED: (CHECK ALL THAT APPLY)

CORRECTIONS________ FOOD SERVICE________ MEDICAL________

MENTAL HEALTH________ PROGRAMS/EDUCATION________ DPW________

OTHER________________________________________________________________________

(PLEASE PRINT DEPARTMENT OR EMPLOYEE TO BE VISITED IF NOT LISTED)

REASON FOR VISIT: ___________________________________________________________________

VISITOR MUST SUBMIT THIS FORM AND A COPY OF DRIVER’S LICENSE FOR APPROVAL PRIOR TO

ENTERING THE FACILITY

File details come from the government source that posted it. Updated .