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
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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
| 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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