23 CONS Base Pass Template.pdf
PDF 396 KB Posted
- Attached to
- Walk In Fridge & Freezer
- Solicitation number
- FA483025Q0006
About this file
This is a base access request template form used by the 23D Contracting Squadron at Moody Air Force Base, Georgia for requesting installation access passes for contractor personnel. The controlled unclassified information (CUI) form requires key details including the contract number, prime contractor name, duration of pass (not to exceed 1 year), and purpose of access.
The form includes fields for contractor personnel information including full name, date of birth (DOB), and organization/company. It specifically notes that DOB information is required for base access and Security Forces will request it at the Visitor's Center if not provided on the form. The template requires sponsor information including rank, name, duty title, email, and duty phone of the sponsoring official. The form is associated with a solicitation (FA483025Q0006) for a walk-in refrigerator and freezer replacement project at Moody AFB.
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Text version
CONTROLLED UNCLASSIFIED INFORMATION
DEPARTMENT OF THE AIR FORCE 23D CONTRACTING
SQUADRON (ACC) MOODY AIR FORCE BASE GEORGIA
Attack ∙ Rescue ∙ Prevail The information herein is For Official Use Only (FOUO) which must be protected under the Freedom of Information Act of 1996 and Privacy Act of 1974, as amended. Unauthorized disclosure or misuse of this PERSONAL INFORMATION may result in criminal and/or civil penalties
MEMORANDUM FOR 23 SFS/SFOXI
FROM: 23 CONS
SUBJECT: Request for Installation Access Personnel Pass
1. Request pass for the following person(s) to Moody AFB:
2. If you have any questions or concerns, please contact the undersigned:
Contract Number:
Prime Contractor:
Duration of Pass:
(NTE 1 Year)
Purpose:
Full Name Organization/CompanyDOB*
*Write N/A if contractor declined to provide information. Be advised that DOB information is required for base access.
Security Forces will ask for it at the Visitor's Center if not detailed in this form.
Sponsor Info: Rank, Name; Duty Title; Email; Duty Phone
| Date1_af_date: 11-Dec-2024 |
| Contract #: FA483025Q0006 |
| Contractor Name: ABCD |
| Duartion of Pass: 18 December 2024 - 18 December 2024 |
| Contract Purpose: 23 FSS Moody Field Club Site Visit |
| FullName1: John Doe Jr |
| FullName2: |
| FullName3: |
| FullName4: |
| FullName5: |
| SSNDOB1: 1 JULY 2000 |
| SSNDOB2: |
| SSNDOB3: |
| SSNDOB4: |
| SSNDOB5: |
| Org1: ABCD |
| Org2: |
| Org3: |
| Org4: |
| Org5: |
| SponsorInfo: SSgt June Alba, Contract Specialist, june.alba@us.af.mil, 257-2053 |
| Clear Form: |
File details come from the government source that posted it. Updated .