RFP_Atch_8_Base_Pass_Req_Form.docx

DOCX document 118 KB Posted

Attached to
Install Variable Frequency Drive, Bldg 496 Federal contract opportunity
Solicitation number
FA3016-16-R-0032
Issued by
Department of the Air Force Air Education and Training Command

About this file

Atch 8a Base Pass Request Form

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Text version

DEPARTMENT OF THE AIR FORCE

502D AIR BASE WING

JOINT BASE SAN ANTONIO

RFP FA3016-16-R-0032 Atch 8

MEMORANDUM FOR 502D SECURITY FORCES SQUADRON DATE:

802D SECURITY FORCES SQUADRON
902D SECURITY FORCES SQUADRON

FROM: 502 CES/CENMP

SUBJECT: Application for Contractor/Vendor Installation Access Credential (AIAC)

1. The following company/organization is providing either vendor’s service or holds a contract with our organization. The individual is required to enter Joint Base San Antonio: Randolph AFB in an official capacity on a regular basis. Request the issuance of an access credential. (If JBSA-Wide access is required, the memo must explicitly state so.)

Company/Organization
Contract/Service Number
Required Times/Days of Week
Required Dates
Contractor, Inc
RFP FA3016-16-R-0032
06:00 – 18:00 / Monday -Friday
XX-DEC-14

Full Address of Company/Organization

2. The below listed individual understands that this is an identification credential, not a sponsoring credential and that it will not allow entry into any facilities other than the installation gates. Use of this credential is strictly for business purposes only. Individual also agrees to adhere to all vehicle regulations and guidelines set forth by AFI 31-204, Air Force Motor Vehicle Traffic Supervision, and those set by the installation commander.

3. Upon termination contract expatriation, employee termination, or expiration of the access credential, the holder agrees to return it to the host contractor, sponsor, or building 1032 Visitor Center, adjacent to the Main Gate.

Name of Credential Holder
Date of Birth
XXXXXX
XXXXXXX

Home Address

Vehicle Make
Vehicle Model
Year
Color
XXXXXXX
XXXXXXX
XXXXXXX
XXXXXXX
Plate #
State
DL Number
State
XXXXXXX
XXXXXXX
XXXXXXX
XXXXXXX

Registration Office Use Only

Requesting Authority/Authorizing Official

NCIC

Printed Name
Judi Tepperman/Antonio Matos/Bryan Harvey

COPS/SFMIS

Signature

FBI TWL

Title
Chief, CENMP-RND

OFF INIT

Duty Phone
210-652-5749/2394

SUP INIT

Email
judith.tepperman@us.af.mil /

antonio.matos@us.af.mil / bryan.harvey@us.af.mil

All requests must be submitted in person or via encrypted .mil email to 902SFS.VRC@US.AF.MIL NLT 5 working days prior to the start date."FOUO, This document contains information exempt from mandatory disclosure under the FOIA. Title 5 U.S.C. 552 (b) (6) applies. This document also contains personal information that is protected by the Privacy Act of 1974 and must be safeguarded from unauthorized disclosure."

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