JA Carpet Replacement Base Pass.pdf

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Attached to
JA Carpet Replacement
Solicitation number
FA483025Q0067
Issued by

About this file

This document is a memorandum from the 23d Contracting Squadron requesting installation access for a site visit related to a carpet installation project at Building 105 on Moody Air Force Base. The request is associated with Request for Quote (RFQ) FA483025Q0067 for the 23 WG/JA office carpet replacement. The memorandum includes a table for recording visitor details such as full name, last 6 digits of SSN/DOB, organization, and access expiration date, with a maximum validity of one year. The document is marked as Controlled Unclassified Information (CUI) and must be protected under the Freedom of Information Act and Privacy Act, with potential disciplinary consequences for unauthorized disclosure.

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Text version

CUI

DEPARTMENT OF THE AIR FORCE

23D SECURITY FORCES SQUADRON (ACC)

MOODY AIR FORCE BASE GEORGIA

MEMORANDUM FOR 23 SFS

FROM: 23d Contracting Squadron

SUBJECT: Request for Installation Access

1. I am requesting a pass for the following people to Moody AFB for the purpose of Site- Vist for a Carpet Installation Project at BLDG 105 (RFQ:FA483025Q0067).

Full Name: as they appear on their valid state ID.

Last 6 of

SSN/DOB

Organization/Company /School Name:

Expiration Date:

(not to exceed 1yr)

2. Brief synopsis of the situation: Request pass for the following person(s) to Moody AFB for SITE VISIT: 23WG/JA - BLDG 105

Aden J. Luna ,Amn ,USAF Contracting Specialist

Attack · Rescue · Prevail The information here is Controlled Unclassified Information (CUI) 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 disciplinary action, criminal and/or civil penalties.

1636106905A Cross-Out

Full Name as they appear on their valid state IDRow1:
Last 6 of SSNDOBRow1:
OrganizationCompany School NameRow1:
Expiration Date not to exceed 1yrRow1:
Full Name as they appear on their valid state IDRow2:
Last 6 of SSNDOBRow2:
OrganizationCompany School NameRow2:
Expiration Date not to exceed 1yrRow2:
Full Name as they appear on their valid state IDRow3:
Last 6 of SSNDOBRow3:
OrganizationCompany School NameRow3:
Expiration Date not to exceed 1yrRow3:
Full Name as they appear on their valid state IDRow4:
Last 6 of SSNDOBRow4:
OrganizationCompany School NameRow4:
Expiration Date not to exceed 1yrRow4:
Full Name as they appear on their valid state IDRow5:
Last 6 of SSNDOBRow5:
OrganizationCompany School NameRow5:
Expiration Date not to exceed 1yrRow5:
Full Name as they appear on their valid state IDRow6:
Last 6 of SSNDOBRow6:
OrganizationCompany School NameRow6:
Expiration Date not to exceed 1yrRow6:

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