Atch_8_Base_Pass_Req_Form.pdf

RFP FA3016-16-R-0039 Atch 8

DEPARTMENT OF THE AIR FORCE

502D AIR BASE WING

JOINT BASE SAN ANTONIO

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 Antonio Matos/Gail Gabrysh/ Jon Sanders

COPS/SFMIS

Signature

FBI TWL

Title Chief, CENMP-RND

OFF INIT

Duty Phone 210-652-5749/2394

SUP INIT

Email 29TUantonio.matos@us.af.milU29T / 29TUjon.sanders.2@us.af.milU29T

All requests must be submitted in person or via encrypted .mil email to 29TU902SFS.VRC@US.AF.MILU29T 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."

mailto:antonio.matos@us.af.mil mailto:jon.sanders.2@us.af.mil mailto:902SFS.VRC@US.AF.MIL

FOR OFFICIAL USE ONLY

FOR OFFICIAL USE ONLY

Contract/Service Number

RFP FA3016-16-R-0039 Atch 8

Full Name DOB Home Address Make Model Year Plate# State Color Number State

Application for Installation Access Credential (Spreadsheet)

Personal Information

Total Number of ApplicantsAttachment 1 to Application for Installation Access Request (AIAC-1)

[start date of base pass] [end date of base pass]

Company/Organization

[company name and address]

Vehicle Information Driver's License

Employment Start Date Employment End Date