Shaw AFB Contractor Request Template (2024) (WORK PURPOSES).pdf
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- Attached to
- FA480325Q0064 - Repair Interior B1601 (Amended)
- Solicitation number
- FA480325Q0064
About this file
This document is a Base Access Request Form from the 20th Fighter Wing at Shaw Air Force Base in South Carolina, dated 09/12/2025. The form requests base access for contractors to conduct a site visit and measurement at Building 1601 on September 12, 2025, at 1300 hours. The sponsor is 2nd Lt. Johnathan Youngblood, who can be contacted at johnathan.youngblood.2@us.af.mil or 803-895-9808.
The form includes a table for vendors to provide personal information for background checks, including full legal name, date of birth, social security number, state driver's license number, and citizenship status. The sponsor acknowledges responsibility for ensuring proper handling of base access passes and compliance with base security protocols. The document is marked as Controlled Unclassified Information (CUI) and emphasizes the protection of personal information under the Privacy Act of 1974.
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Text version
DEPARTMENT OF THE AIR FORCE
20th FIGHTER WING (ACC)
SHAW AIR FORCE BASE SOUTH CAROLINA
CUI
Victory By Valor
DATE: 09/12/2025
FROM: 20th CONS
SUBJECT: Contractors need base access to measure for Building1601
WHO: Interested Vendors
WHAT FOR: Site Visit at Building 1601
WHERE: Building 1601
If base wide give justification:
WHEN: 12 Sep 25 at 1300
SPONSOR NAME: Johnathan Youngblood, 2nd Lt
DOD EDPI:
CONTACT INFO: johnathan.youngblood.2@us.af.mil 803-895-9808
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.
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.
Full Legal Name (Last, First MI)
Date Of Birth (Year/Mo/Day)
Social Security Number
ST-DL #
(REAL ID Y/N)
U.S.
Citizen (Y/N) mailto:johnathan.youngblood.2@us.af.mil
File details come from the government source that posted it. Updated .