Shaw AFB Contractor Request Template (2023).docx
DOCX document 84 KB Posted
- Attached to
- K9 TURF REPLACEMENT/REPAIR
- Solicitation number
- FA480324Q0007
About this file
This document appears to be a template for requesting contractor access to Shaw Air Force Base. It outlines the required information to be provided, including the contractor's full legal name, date of birth, Social Security number, state driver's license number, and citizenship status. The sponsor, who is responsible for the contractor, must also provide their contact information and understand that they are responsible for ensuring the contractor's access pass is returned or deactivated when no longer required.
The related federal contract opportunity is for the replacement and repair of a 15,000 square foot K9 turf area at Shaw Air Force Base. The contract will require the provision of all necessary resources, such as tools, equipment, labor, and materials, for the installation of a new drainage system and turf. The solicitation number is FA480324Q0007, and the contracting agency is the Department of the Air Force Air Combat Command.
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Text version
DEPARTMENT OF THE AIR FORCE
20th FIGHTER WING (ACC)
SHAW AIR FORCE BASE SOUTH CAROLINA
DATE: XX/XX/XXXX
MEMORANDUM FOR 20 SFS/S-5V
(email to: TSgt Kolby Davis kolby.davis.1@us.af.mil, Ms. Jacqueline Hernandez-Sears jacqueline.hernandez-sears.1@us.af.mil or fax 803-895-5337 803-895-9085 or 803-895-9086)
FROM: (The person requesting background check be conducted)
SUBJECT: (i.e Contractor/Employee needing access to Shaw AFB)
WHO: (Company or Organization the Contractor/Employee will be working for)
WHAT FOR: (i.e Construction, New Hire, Job Interview, Meeting, New CAC or CAC Renewal, Work order etc.)
WHERE: (Location Contractor/Employee will be working at or needing access to)
If base wide give justification: (i.e Individual needs access to multiple buildings on base)
WHEN: (The exact day/dates and hours the individual will need access to the base (i.e. May 10, 2022, 0800-1700hrs or from May 10, 2022- May 10, 2023 Monday-Saturday, 0700-1900hrs)
SPONSOR: (The CAC holding individual responsible for the individual listed below and their organization)
CONTACT INFO: (i.e. Sponsor’s email and phone number W/extension)
The information below is protected under Privacy Act 1974 and will only be used to process Criminal Background History Checks to grant or deny access to Shaw AFB. It is further understood that anyone abusing approved privileges could, at a minimum, lose said privilege and possibly face criminal charges.
EXAMPLE
Full Legal Name (Last, First MI) Date Of Birth (Year/Mo/Day) Social Security Number
| ST-DL # |
| U.S. |
Citizen (Y/N)
********IF UNDER THE AGE OF 18, PLEASE COMPLETE A SEPARATE WORK REQUEST.*********
I UNDERSTAND THAT AS THE SPONSOR I AM RESPONSIBLE FOR THE PERSON(S) LISTED ON THIS FORM, AND FOR ENSURING THE ABOVE NAME INDIVIDUAL(S) TURNS IN THE DBIDS PASS OR RETRIEVE THE PASS ONCE THE INDIVIDUAL(S) ARE TERMINATED, QUIT, OR NO LONGER REQUIRES ACCESS. IF I AM NOT ABLE TO RETRIEVE THE PASS I WILL NOTIFY SECURITY FORCES TO HAVE THE INDIVIDUAL(S) PASS DEACTIVATED IN DBIDS.
This form must be sent by the sponsor from their government email and received at the email addresses/fax number listed above in the 20 SFS/S-5V section.
DATE: / /
FROM:
SUBJECT:
WHO:
WHAT FOR:
WHERE:
If base wide give justification:
WHEN:
SPONSOR:
CONTACT INFO:
The information below is protected under Privacy Act 1974 and will only be used to process Criminal Background History Checks to grant or deny access to Shaw AFB. It is further understood that anyone abusing approved privileges could, at a minimum, lose said privilege and possibly face criminal charges.
Full Legal Name (Last, First MI) Date Of Birth (Year/Mo/Day) Social Security Number
| ST-DL # |
| U.S. |
Citizen (Y/N)
I UNDERSTAND THAT AS THE SPONSOR I AM RESPONSIBLE FOR THE PERSON(S) LISTED ON THIS FORM, AND FOR ENSURING THE ABOVE NAME INDIVIDUAL(S) TURNS IN THE DBIDS PASS OR RETRIEVE THE PASS ONCE THE INDIVIDUAL(S) ARE TERMINATED, QUIT, OR NO LONGER REQUIRES ACCESS. IF I AM NOT ABLE TO RETRIEVE THE PASS, I WILL NOTIFY SECURITY FORCES TO HAVE THE INDIVIDUAL(S) PASS DEACTIVATED IN DBIDS.
This form must be sent by the sponsor from their government email and received at the email addresses/fax number listed above in the 20 SFS/S-5V section.
FOUO/CUI
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File details come from the government source that posted it. Updated .