Base_Pass_Template.xlsx
XLSX spreadsheet 15 KB Posted
- Attached to
- Base Telecommunications Systems (BTS) Federal contract opportunity
- Solicitation number
- FA4861-14-R-C001
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Base Pass Template
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Sheet1
| CA Name: | ||||||||||
| CA Signature: | ||||||||||
| Phone #: | ||||||||||
| Company | Last Name | First Name | MI | Country of Citizenship | DOB | SSN | DL #/State | Locations | Valid Dates | Valid Days & Hrs |
| ABC Builders | Doe | John | A | US | 12/30/12 | XXX-XX-XXXX | 12345678 / TX | Nellis/Creech AFB | 10/7/14 | 7am-5pm |
JUSTIFICATION: Site Visit for the Base Telecommunications Systems. POC-SSgt Derek Urban
Note: Specify in detail the justification requesting the person(s) listed above having unescorted access. (i.e. requires access 3 times a week to service the vending machines on Nellis AFB)
I certify, in accordance with FAR 52.222-54 "Employment Eligibility Verification" that I have performed checks on all above listed employees through the E-Verify system.
Printed Name Signature
(PRIMARY CONTRACTOR NAME)
(PROJECT # and TITLE)
The individuals listed below have been thoroughly briefed on entry procedures and conconduct while on Nellis/Creech AFB.
Sheet2
Sheet3
File details come from the government source that posted it. Updated .