Attch_12_-_Base_Pass_Request_Form.docx

DEPARTMENT OF THE AIR FORCE

502D AIR BASE WING

JOINT BASE SAN ANTONIO

FA3089-16-R-0035 Attachment 12

FROM: 502 CONS/JBKCA

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.)

FA3016-16-R-0035

ATTACHMENT 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.

Home Address

Registration Office Use Only

Requesting Authority/Authorizing Official

NCIC

COPS/SFMIS

Signature

FBI TWL

OFF INIT

SUP INIT

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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