Contractor Request Form 2025.pdf

206 KB Posted

Attached to
Refurbish Ultimate Warrior Statue Joint Base McGuire-Dix-Lakehurst
Solicitation number
FA448424Q0046
Issued by

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Written by GovTribe AI ·

This is a Contractor Request Form for accessing Joint Base McGuire-Dix-Lakehurst (JB MDL) specifically for contractors participating in a site visit for the Ultimate Warrior Statue refurbishment project. The form must be submitted by February 13, 2025 at 1:00 PM EST to gain access for the February 18, 2025 site visit.

The form requires detailed information including contractor personnel names, company names, full SSNs, dates of birth, and specifies access requirements from February 18-25, 2025. The location is identified as 5418 S Scott Plaza, Fort Dix, NJ, with a point of contact in building 2402 reachable at 609-754-5964. The form includes sponsor responsibilities such as advising guests of base entry procedures, health precautions, speed limits, cell phone use restrictions, and facility access limitations. The sponsor must acknowledge responsibility for guest conduct and serve as the point of contact for any police actions involving guests.

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Material Sub_UW Statue.xls XLS spreadsheet
SOW_Ultimate Warrior Statue Rev3.pdf PDF
Questions and Answers.pdf PDF
Solicitation Amendment FA448425Q00070001 SF 30.pdf PDF
SOW_Ultimate Weapon Statue REV1.docx DOCX document
A8 SFS Appendix CONTRACTOR APPENDIX.pdf PDF
A9 Medical Statement.pdf PDF
Solicitation - FA448425Q0007.pdf PDF
A7 JB MDL AT Awareness Guide for Contractors.pdf PDF
A6 JB MDL Antiterrorism Awareness for Contractors Trifold.pdf PDF

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DEPARTMENT OF THE AIR FORCE

87TH AIR BASE WING (AMC)

JOINT BASE MCGUIRE-LAKEHURST-DIX

MEMORANDUM FOR 87 SFS/WELCOME CENTER

FROM:

SUBJECT: Contractor Request Form

1. Request entry for the following individual(s) allowing access onto Joint Base MDL for the purpose of

If sponsorship privileges are needed type Yes or No: Not all personnel will be granted permissions. NCOIC or Welcome Center Supervisors can deny an individual if deemed they do not meet the proper criteria.

2. I work in building and can be reached at .

3. The visitor will be going to or state purpose for card/pass rights .

4. Dates Access required: Start Date End Date: .

NAME

(Last, First Middle

Initial)

COMPANY

NAME

FULL SSN Date of Birth Days of week access required

Time's access required

Sponsorship Privileges Yes or No

5. Please direct any questions regarding this matter to the member stated below.

Signature and DOD ID Number

First Mi Last, Rank, Service

Title, Organization

PRIVY ACT STATEMENT

AUTHORITY: 5 U.S.C. 301.10 U.S.C. 8012 and 8034, and EO 9397.

PRINCIPAL PURPOSE: To verify individual status and conduct any background checks to determine if access to Joint Base McGuire-Dix-Lakehurst(JB MDL) is warranted. ROUTINE USE: All information will be maintained in a central Security Forces database and may be disclosed to public affairs and security representatives to carry out official duties. Information will not be considered “Public Domain” and will be safeguarded by the end users.

DISCLOSURE: Information collected on this form and your signature are voluntary. If you have no objection to these procedures fill out the form and sign your name. Failure to provide the requested information or a signature may lead to denial of access and privileges at JB MDL.

example: 0900-2100

1625178068C Highlight

1625178068C Highlight

SPONSOR REQUIRED TO INITIAL BELOW ACKNOWLEDGING THEIR RESPONSIBILITIES

1. Sponsor will advise all guests of base entry procedures and limitations while on base to include required health precautions, speed limits, cell phone use, and use of base facilities.

2. Sponsor understands they are responsible for the conduct of all guests and will be held accountable for all actions of their guests.

3. Sponsor is the point of contact for any police actions concerning their guests.

4. Sponsor acknowledges that anyone named on the attached form that has disqualifying factors on a criminal check or has been barred from a military installation will be denied entry. The sponsor will be notified of the results of these checks.

SPONSORS INITIALS:

MEMORANDUM FOR 87 SFS/S5W
FROM:
FIRST MI LAST, RANK, SERV
1 Request entry for the following individual allowed access onto Joint Base MDL for the purpose of: Site visit for statue.
2 I work in building: 2402
and can be reached at: 609-754-5964
NAME Last First Middle InitialRow1:
COMPANY NAMERow1:
FULL SSNRow1:
Date of BirthRow1:
Days of week access requiredRow1:
Hours of day access requiredRow1:
Sponsorship Privileges Yes or NoRow1:
NAME Last First Middle InitialRow2:
COMPANY NAMERow2:
FULL SSNRow2:
Date of BirthRow2:
Days of week access requiredRow2:
Hours of day access requiredRow2:
Sponsorship Privileges Yes or NoRow2:
NAME Last First Middle InitialRow3:
COMPANY NAMERow3:
FULL SSNRow3:
Date of BirthRow3:
Days of week access requiredRow3:
Hours of day access requiredRow3:
Sponsorship Privileges Yes or NoRow3:
NAME Last First Middle InitialRow4:
COMPANY NAMERow4:
FULL SSNRow4:
Date of BirthRow4:
Days of week access requiredRow4:
Hours of day access requiredRow4:
Sponsorship Privileges Yes or NoRow4:
NAME Last First Middle InitialRow5:
COMPANY NAMERow5:
FULL SSNRow5:
Date of BirthRow5:
Days of week access requiredRow5:
Hours of day access requiredRow5:
Sponsorship Privileges Yes or NoRow5:
NAME Last First Middle InitialRow6:
COMPANY NAMERow6:
FULL SSNRow6:
Date of BirthRow6:
Days of week access requiredRow6:
Hours of day access requiredRow6:
Sponsorship Privileges Yes or NoRow6:
NAME Last First Middle InitialRow7:
COMPANY NAMERow7:
FULL SSNRow7:
Date of BirthRow7:
Days of week access requiredRow7:
Hours of day access requiredRow7:
Sponsorship Privileges Yes or NoRow7:
NAME Last First Middle InitialRow8:
COMPANY NAMERow8:
FULL SSNRow8:
Date of BirthRow8:
Days of week access requiredRow8:
Hours of day access requiredRow8:
Sponsorship Privileges Yes or NoRow8:
NAME Last First Middle InitialRow9:
COMPANY NAMERow9:
FULL SSNRow9:
Date of BirthRow9:
Days of week access requiredRow9:
Hours of day access requiredRow9:
Sponsorship Privileges Yes or NoRow9:
NAME Last First Middle InitialRow10:
COMPANY NAMERow10:
FULL SSNRow10:
Date of BirthRow10:
Days of week access requiredRow10:
Hours of day access requiredRow10:
Sponsorship Privileges Yes or NoRow10:
NAME Last First Middle InitialRow11:
COMPANY NAMERow11:
FULL SSNRow11:
Date of BirthRow11:
Days of week access requiredRow11:
Hours of day access requiredRow11:
Sponsorship Privileges Yes or NoRow11:
NAME Last First Middle InitialRow12:
COMPANY NAMERow12:
FULL SSNRow12:
Date of BirthRow12:
Days of week access requiredRow12:
Hours of day access requiredRow12:
Sponsorship Privileges Yes or NoRow12:
NAME Last First Middle InitialRow13:
COMPANY NAMERow13:
FULL SSNRow13:
Date of BirthRow13:
Days of week access requiredRow13:
Hours of day access requiredRow13:
Sponsorship Privileges Yes or NoRow13:
FIRST MI LAST RANK SERV:
Title Organization:
Text1: 87 CONS/PKA
Text2: 5418 S Scott Plaza, Fort Dix, NJ 08640
Text4:
Start Date_af_date: 18-Feb-2025
End Date_af_date: 2/18/25

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