USAID Delivery Request Form.doc

FREIGHT DELIVERY REQUEST

TO :

RRBITC Loading Dock Manager

Federal Protective Service

FROM:

James Taylor, M/AS/FMD, Room B2.06D

Fax No.: 202-216-3378

FREIGHT DELIVERY COMPANY INFORMATION

Name of Freight Company making delivery Phone No.

Date of Arrival

Freight Co. Contact Person Fax No.

Estimated Time of Arrival

Driver’s Name Driver’s License No. & State

Date of Birth

Alternate Driver’s Name Driver’s License No. & State

Date of Birth

Vehicle Description (i.e., tractor trailer, etc) Type Make Tag No.

Length

Model State

Description of material being delivered

OFFICE/BUREAU REQUESTING DELIVERY

Office/Bureau Contact Person Phone No.

Fax No.

Deliveries to the Ronald Reagan Building, loading docks require 72 hour notice.

All deliveries are subject to an off-site security inspection by the Federal Protective Service, located at the FPS Mobile Scanning Facility, 12th and C Streets SW., Washington DC, prior to delivery to the RRB Loading Docks. All dock deliveries use the 14th Street South Entrance.

PRIVACY ACT STATEMENT

The following statement is required by the Privacy Act of 1974 (5 U.S.C. 522). Due to the events of September 11, 2001, security at the federal building housing USAID has been significantly increased. As such, it is necessary that Freight Companies planning to deliver goods and materials be aware of these additional security requirements. Failure to provide full information could result in the hampering of the delivery process. The information on this form is solely used for security purposes. No one other than the M/AS/FMD, ITC and FPS will have access to this form and information.

AID 519-1 (11/07)