SiteVisitForm11062013.doc

HOLLOMAN AFB

VISIT ACCESS REQUEST

(VAR-2)

For contracts NOT awarded/administered by the 49th Contracting Squadron and that DO NOT require access to classified or sensitive unclassified information or unescorted entry to AF controlled/restricted areas on Holloman AFB (HAFB).

MEMORANDUM FOR 49 CES/CENMP)

49 SFS/S5AV (49 SFS Pass and Registration)

IN TURN

FROM: (COMPANY NAME)

SUBJECT: Contractor Visit Access Request (VAR)

References:

a. Contract Number: GS-00P-13-BSC-0937 Contract Title: Holloman Utilities Privatization

b. Contract Start Date: 19 Nov 2013 Contract End Date: 19 Nov 2013

c. Contracting Office: GSA

d. Contracting Official/Phone/ email: Linda Collins/ 202-708-9881/ lindal.collins@gsa.gov

e. HAFB Point of Contact:

Name: _Mr. Robert Soto

Telephone #_575-572-6627

E-mail address _Robert.Soto@holloman.af.mil________ NOTE: This form should be emailed to Robert Soto and Linda Collins at least five business days prior to the Conference and Site Visit.

Request that a visitor pass be issued to the contractor(s) listed below. All employees will be briefed on and shall comply with HAFB security requirements. All employees have signed the government provided consent form authorizing the U.S. Government (United States Air Force) to conduct a background check to confirm their eligibility to gain access to HAFB, NM.

(SFS USE ONLY)

/PERM. RESIDENT/ US PASSPORT #

(IF APPLICABLE)

PREVIOUS

TRACKING #

PRIVACY ACT STATEMENT

Authority: 10 U.S.C. 101 and E.O. 9397

Principal Purpose: For granting access to a military (Federal) installation.

Routine Use: Record access approval; use of SSN, DOB, POB &Citizenship is necessary to make positive identification of the individual and records.

Disclosure is Voluntary: Failure to provide the information could result in approval being denied.

HOLLOMAN AFB

VISIT ACCESS REQUEST

(VAR-2) cont.

Contractors denied unescorted entry as a result of their background check may ONLY be approved for escorted entry by the 49 SFS/CC. ONLY the site manager, foreman, superintendent (designated by asterisk on a VAR), or a contractor with a valid DoD Common Access Card (CAC) may escort employees approved for escorted entry. Contractor escort authority is limited to ONLY those employees approved for escorted entry. EXCEPTION: The site manager, foreman, superintendent, or a contractor with a valid DoD CAC may escort non-routine pickups and deliveries. Pickup/delivery drivers will provide a bill of lading at the time of pass issuance; passes will not exceed six (6) hours. Routine pickups and deliveries require the contractor add the driver(s) to a VAR to undergo the appropriate background check. All VARS must be typed and hand delivered to the Welcome Center.

Contractors shall report to the 49 SFS Welcome Center (bldg 1) with photo identification issued by a federal/state activity. Employees requesting to operate a company or privately owned vehicle on the installation shall provide a valid driver’s license, current vehicle registration, and proof of current vehicle insurance or car rental agreement.

All Foreign Nationals requesting access to HAFB (for official and unofficial visits) must provide three (3) valid forms of ID consisting of: A state issued drivers license/ID card, Social Security card, Resident alien card, Employment Authorization Document, or Passport/Birth certificate.

CONTRACTOR VISIT INFORMATION:

* Visitor passes will NOT exceed contract performance period or 1 year, whichever is less.

Period of visit: 19 Nov 2013 to 19 Nov 2013 Reason for visit: Attend Pre-proposal Conference and Site Visit Visit location: 49 CES Conference Room Upon completion of visit/and/or contractual requirements, all government issued credentials/passes shall be immediately returned to the 49 SFS Welcome Center Office.

Please direct any questions to me at (XXX) XXX-XXXX.

I certify the attached employee information is true and correct.

Signature of Company Official (Required) Date _______ (Required)

Typed/Printed Name

Job Title/Company Name

I have reviewed and approved this visit access request.

Signature of Sponsoring Unit CC/(Required) Date _______ (Required) Or Unit Security Manager/Company Manager Typed/Printed Name

Unit or Agency

PAGE

ALL VARS MUST BE TYPED Current version: 21 Oct11