Atch_3_-_Base_Access_Request_Form.pdf

PDF 1 MB Posted Jun 15, 2017

Attached to: Renovate Hangar 70 Federal contract opportunity
Solicitation number: FA3016-17-R-0060
Issued by: Department of the Air Force Air Education and Training Command

About this file

From the source

Attachment 3 - Base Access Request Form

View the file

Other files for this federal contract opportunity

Other files attached to Renovate Hangar 70, newest first.
File	Type	Posted
Atch_1-_SOW_and__Specifications_-_20170509_Rev_2.pdf	PDF	Jul 10, 2017
FA3016-17-R-0060-0001_Signed.pdf	PDF	Jul 10, 2017
Atch_7-_Recovered_Material_Determination.pdf	PDF	Jun 15, 2017
FA3016-17-R-0060.pdf	PDF	Jun 15, 2017
Atch_4__Financial_Information_Questionnaire.docx	DOCX document	Jun 15, 2017
Atch_6_-_Government_Estimate_Breakdown-_Hanger_70_Basketball.pdf	PDF	Jun 15, 2017
Atch_1-_SOW_and__Specifications_-_20170509_Rev_1.pdf	PDF	Jun 15, 2017
Atch_8_-_TYMX160173_09_HAZMAT_Letter_Atch8.pdf	PDF	Jun 15, 2017
Atch_2_Wage_Determination_2_June.pdf	PDF	Jun 15, 2017
Atch_5_Contractor_Responsibility_Questionnaire.docx	DOCX document	Jun 15, 2017

On GovTribe

Work with this file on GovTribe

Download the original file
Contacts named in this file
Similar government files
Ask GovTribe AI about this file

Try for free Login

Text version

The file's text, extracted by GovTribe without its formatting.

Unescorted Access Request

I: Sponsor Information

2. Last Name, First Name MI1. Title 3. Duty Phone 4. Cell/Home Phone 5. DoD ID Number

6. Organization/Home Address 7. Email Address

II: Access Details

Contractor/Vendor

Personal Services

Visitor/Volunteer

Delivery/Pick-Up

Special Event

III: Visitor Center Use Only

From Date

To Date

From Time

To Time

Posted Date

(For EAL Use)Tracking Number

NCIC III

Received Date

SFMIS

ALERTS

TSDB

Digital/Wet Signature of Verifier

"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."

JBSA-FSH

JBSA-CB

JBSA-LAK

JBSA-RND

(Allow 30 minute lead time for entry)

Days of the Week

Vetted Date

ECP Posted Location (For EAL Use)

8. Category of Access 9. Location 10. Time Frame

13.

12. Contracted Company Sponsored or Special Event Name

Sunday

Monday

Tuesday

Wednesday

Thursday

Friday

Saturday

JBSA-SAMMC

11. Reason for Access (Specify)

(Ex: Pizza Delivery/Non Driver Status)

Attachment 3

Tracking Number

Sponsor

Last Name, First Name, MI DOB (DD/MMM/YY) ID Type ID Number State of Issue

"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."

IV: Guest Information

14. Enter information for all persons 18 years of age or older (in alphabetical order).

VCC Use Only

15. Sponsor's Digital or Wet Signature

To submit requests click on one of the location identifiers below

Long Term/EAL Short Term

"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."

V: Explanations

The following information has been provided to aid in the completion of the Unescorted Access Request.

Section I: Sponsor Information.

Block 1. Title The sponsors title (ie; Mr., Ms., Mrs., or associated rank of Military/GS employee).

Block 2. Last Name, First Name MI (Full name of sponsor, use format assigned).

Block 3. Duty Phone (Office number you can be reached at during business hours).

Block 4. Cell/Home Phone (Phone number you may be reached at during requested access times for your guests).

Block 5. DoD ID Number (Assigned number on your DoD ID Card-This is required to fully identify you in DBIDS).

Block 6. Organization/Home Address (If you are sponsoring for a government purpose use your organization. If it is for personal reasons use your home address).

Block 7. Email Address (email submissions will be sent encrypted utilizing a .mil email address).

Section II: Access Details.

Block 8. Category for Access (Check the category of your guest).

Block 9 Location (Check which location(s) in the JBSA area you are requesting your guests to have access to – Must be a valid need for entry to these locations. Contractor/Vendors must provide contract stating access locations are required).

Block 10. Time Frame

From Date (Start date of visit/contract, etc…)

To Date (End date of visit/contract, etc…)

From Time (Start time of visit or if continual access, start time each day)

To Time (End time of visit or if continual access, end time each day)

Days of Week (Days of week entry is required - If visiting select day(s) visit will take place, if continual access is required – actual days of work required to be present)

Block 11. Reason for Access (Specify reason for access (ie; Meeting, Tow Truck, Pop-A-Lock, Taxi, Wedding, Family visit, etc…).

Block 12. Identify the Visiting Company, Organization , or Name of Event).

Section III: Visitor Center Use Only.

Section IV: Guest Information.

Foreign visitors must be processed through the Foreign Disclosure Office. Contact the 502 ABW/FDO at (210) 466-3888.

For more than 20 visitors [Special Event] use continuation sheets).

Block 14. Fill in the blocks [alphabetical order] for all visitors 18 years of age or older.

Last Name, First Name MI (Full name of visitor, use format assigned).

DOB: Date of Birth (Use format assigned).

ID Type (Must be valid form of photo ID, DL – Drivers License, SID – State ID, VIC – Veteran Identification Card, PP –

Passport).

ID Number (The associated number assigned to the ID Type)

State of Issue (State where identification was issued)

If a tracking number is assigned, the sponsor will relay the number to their guest(s) for announcement at a visitor center. This will allow the Visitor Center Personnel to track completed paperwork for issuance of an access credential.

Block 15. Digital or Wet Signature (If capable a digital signature if preferred. If not possible, print, sign, and submit).

Sponsor

Tracking Number

Last Name, First Name, MI DOB (DD/MMM/YY) ID Type ID Number State of Issue

"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."

IV: Guest Information cont...

14. Enter information for all persons 18 years of age or older (in alphabetical order).

VCC Use Only

15. Requestor’s Digital or Wet Signature

1 Title:

2 Last Name First Name MI:

3 Duty Phone:

4 CellHome Phone:

5 DoD ID Number:

6 OrganizationHome Address:

7 Email Address:

ContractorVendor: Off

Personal Services: Off

DeliveryPickUp: Off

VisitorVolunteer: Off

Special Event: Off

JBSAFSH: Off

JBSASAMMC: Off

JBSACB: Off

JBSALAK: Off

JBSARND: Off

From Date:

From Time:

To Date:

To Time:

Sunday: Off

Monday: Off

Tuesday: Off

Wednesday: Off

Thursday: Off

Friday: Off

Saturday: Off

Reason for Access:

12 Contracted Company Sponsored or Special Event Name:

Tracking Number:

Received Date:

NCIC III: Off

ALERTS: Off

SFMIS: Off

TSDB: Off

Vetted Date:

EAL Posted Date:

ECP Posted Location:

Last Name First Name MI:

DOB DDMMMYY:

ID Type:

ID Number:

State of Issue:

undefined_2:

undefined_3:

undefined_4:

undefined_5:

undefined_6:

undefined_8:

undefined_9:

undefined_10:

undefined_11:

undefined_12:

undefined_13:

undefined_14:

undefined_15:

undefined_16:

undefined_17:

undefined_18:

undefined_20:

undefined_21:

undefined_22:

undefined_23:

undefined_25:

undefined_26:

undefined_27:

undefined_28:

undefined_29:

undefined_30:

undefined_32:

undefined_33:

undefined_34:

undefined_35:

undefined_36:

undefined_38:

undefined_39:

undefined_40:

undefined_41:

undefined_42:

undefined_44:

undefined_45:

undefined_46:

undefined_47:

undefined_48:

undefined_50:

undefined_51:

undefined_52:

undefined_53:

undefined_54:

undefined_56:

undefined_57:

undefined_58:

undefined_59:

undefined_60:

undefined_62:

undefined_63:

undefined_64:

undefined_65:

undefined_66:

undefined_68:

undefined_69:

undefined_70:

undefined_71:

undefined_72:

undefined_74:

undefined_75:

undefined_76:

undefined_77:

undefined_78:

undefined_80:

undefined_81:

undefined_82:

undefined_83:

undefined_84:

undefined_86:

undefined_87:

undefined_88:

undefined_89:

undefined_90:

undefined_92:

undefined_93:

undefined_94:

undefined_95:

undefined_96:

undefined_24:

VCC Use Only:

undefined_7:

undefined_19:

undefined_31:

undefined_37:

undefined_43:

undefined_49:

undefined_55:

undefined_61:

undefined_67:

undefined_73:

undefined_79:

undefined_85:

undefined_91:

undefined_97:

undefined_98:

undefined_99:

undefined_100:

undefined_101:

undefined_102:

undefined_103:

undefined_104:

undefined_105:

undefined_106:

undefined_107:

undefined_108:

undefined_109:

undefined_110:

undefined_111:

undefined_112:

undefined_113:

undefined_114:

undefined_115:

Randolph:

Fort Sam Houston:

Last Name First Name MI-1:

DOB DDMMMYY-1:

ID Type-1:

ID Number-1:

State of Issue-1:

VCC Use Only-1:

undefined_2-1:

undefined_3-1:

undefined_4-1:

undefined_5-1:

undefined_6-1:

undefined_7-1:

undefined_8-1:

undefined_9-1:

undefined_10-1:

undefined_11-1:

undefined_12-1:

undefined_13-1:

undefined_14-1:

undefined_15-1:

undefined_16-1:

undefined_17-1:

undefined_18-1:

undefined_19-1:

undefined_20-1:

undefined_21-1:

undefined_22-1:

undefined_23-1:

undefined_24-1:

undefined_25-1:

undefined_26-1:

undefined_27-1:

undefined_28-1:

undefined_29-1:

undefined_30-1:

undefined_31-1:

undefined_32-1:

undefined_33-1:

undefined_34-1:

undefined_35-1:

undefined_36-1:

undefined_37-1:

undefined_38-1:

undefined_39-1:

undefined_40-1:

undefined_41-1:

undefined_42-1:

undefined_44-1:

undefined_45-1:

undefined_46-1:

undefined_47-1:

undefined_48-1:

undefined_49-1:

undefined_50-1:

undefined_51-1:

undefined_52-1:

undefined_53-1:

undefined_54-1:

undefined_55-1:

undefined_56-1:

undefined_57-1:

undefined_58-1:

undefined_59-1:

undefined_60-1:

undefined_61-1:

undefined_62-1:

undefined_63-1:

undefined_64-1:

undefined_65-1:

undefined_66-1:

undefined_67-1:

undefined_68-1:

undefined_69-1:

undefined_70-1:

undefined_71-1:

undefined_72-1:

undefined_73-1:

undefined_74-1:

undefined_75-1:

undefined_76-1:

undefined_77-1:

undefined_78-1:

undefined_79-1:

undefined_80-1:

undefined_81-1:

undefined_82-1:

undefined_83-1:

undefined_84-1:

undefined_85-1:

undefined_86-1:

undefined_87-1:

undefined_88-1:

undefined_89-1:

undefined_90-1:

undefined_91-1:

undefined_92-1:

undefined_93-1:

undefined_94-1:

undefined_95-1:

undefined_96-1:

undefined_97-1:

undefined_98-1:

undefined_99-1:

undefined_100-1:

undefined_101-1:

undefined_102-1:

undefined_103-1:

undefined_104-1:

undefined_105-1:

undefined_106-1:

undefined_107-1:

undefined_108-1:

undefined_109-1:

undefined_110-1:

undefined_111-1:

undefined_112-1:

undefined_113-1:

undefined_114-1:

undefined_115-1:

undefined_43-1:

JBSA-SAMMC:

JBSA-LKD1:

JBSA-LKD:

File details come from the government source that posted it. Updated Nov 14, 2017.