Combat Arms Site Visit Entry Form.pdf

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Attached to
Construct Combat Arms Facility
Solicitation number
W50S8W-21-R-0004
Issued by

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This document contains a site visit entry form and related federal contract opportunity announcement. The site visit entry form is for a planned visit on August 2, 2021 to the 153rd Airlift Wing Combat Arms Emergency Management Facility site in Cheyenne, Wyoming. It requires attendees to submit their names, dates of birth, driver's license numbers and issuing states by July 29 to the point of contact.

The related federal contract opportunity is to construct a new Combat Arms Emergency Management Facility at the Wyoming Air National Guard. It solicits requests for information by August 10, 2021 and will post answers by August 12, 2021. A mandatory site visit is scheduled for August 2, 2021 at 10:00 am and the attached security form must be completed for base access. The opportunity is identified as solicitation number W50S8W-21-R-0004 and is issued by the Department of the Army National Guard.

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ENTRY AUTHORITY LIST (EAL)

PRIVACY ACT STATEMENT: 1. AUTHORITY: USC Title 10, 8013 2. PURPOSE: Used to collect information needed for entry control to the 153d Airlift Wing.

3. ROUTINE USES: This information will not be disclosed outside the Department of Defense. 4. DISCLOSURE: Voluntary. However, failure to provide information results in the denial of entry to the 153d Airlift Wing.

The following individuals will be on the installation for the listed function/business and dates stated. All individuals listed will be escorted at all times by the Point of Contact for this EAL. This EAL is used for business/functions not associated with contracts.

DESCRIPTION OF BUSINESS/FUNCTION: LOCATION OF BUSINESS/FUNCTION INCLUSIVE DATES:

POINT OF CONTACT: (Last, First, MI) PHONE #: UNIT: DATE SUBMITTED:

#1. NAME: (Last, First, MI) DATE OF BIRTH: DRIVER LICENSE #: STATE OF ISSUE:

#2. NAME: (Last, First, MI) DATE OF BIRTH: DRIVER LICENSE #: STATE OF ISSUE:

#3. NAME: (Last, First, MI) DATE OF BIRTH: DRIVER LICENSE #: STATE OF ISSUE:

#4. NAME: (Last, First, MI) DATE OF BIRTH: DRIVER LICENSE #: STATE OF ISSUE:

#5. NAME: (Last, First, MI) DATE OF BIRTH: DRIVER LICENSE #: STATE OF ISSUE:

#6. NAME: (Last, First, MI) DATE OF BIRTH: DRIVER LICENSE #: STATE OF ISSUE:

#7. NAME: (Last, First, MI) DATE OF BIRTH: DRIVER LICENSE #: STATE OF ISSUE:

#8. NAME: (Last, First, MI) DATE OF BIRTH: DRIVER LICENSE #: STATE OF ISSUE:

#9. NAME: (Last, First, MI) DATE OF BIRTH: DRIVER LICENSE #: STATE OF ISSUE:

#10. NAME: (Last, First, MI) DATE OF BIRTH: DRIVER LICENSE #: STATE OF ISSUE:

#11. NAME: (Last, First, MI) DATE OF BIRTH: DRIVER LICENSE #: STATE OF ISSUE:

#12. NAME: (Last, First, MI) DATE OF BIRTH: DRIVER LICENSE #: STATE OF ISSUE:

AUTHENTICATED BY SFS: (LAST, FIRST, MI) AUTHENTICATED BY SFS: (SIGNATURE) DATE:

153AW FORM 12, 20200701 PREVIOUS EDITIONS OBSOLETE

Combat Arms Emergency Management Site Visit Bldg 16 Lecture Hall 8/2/2021

Santos, Desiree M 307-772-6887 153 MSG

1241970570N Cross-Out

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