N0018919DQXXX_Visitor_Access_Form.docx
DOCX document 29 KB Posted
- Solicitation number
- N0018919DQXXX
About this file
This document contains an installation access request form for Naval Support Activity Mechanicsburg and a related special notice for a federal contract opportunity. The installation access request form collects personnel information such as name, date of birth, citizenship status, driver's license information, dates of requested access, and government sponsor details for visitors requiring access to Building 14 on the installation. It notes that photo identification is required and includes privacy act statements. The related special notice indicates the installation access request form has been modified and the new form should be used if a firm requires installation access. No other contract opportunity details are provided.
N0018919DQXXX_Visitor_Access_Form.docx
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Other files
| File | Type | Posted |
|---|---|---|
| N0018919DQXXX_NSA_MECH_SPONSOR_vetting_request_worksheet.xlsx | XLSX spreadsheet | |
| N0018919DQXXX_PWS_NAVSUP_BSC_8A_Requirement.pdf | ||
| N0018919DQXXX_BSC_Industry_Day_Flyer.pdf |
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Text version
NAVAL SUPPORT ACTIVITY MECHANICSBURG PERSONNEL INFORMATION FOR VISITOR ACCESS
INSTRUCTIONS: Fill out form completely (Print/Type – MUST BE LEGIBLE) Submit by email to: Visitor Control Center NSA_MECH_VIS_MSG@navy.mil
ALL REQUESTS SHOULD BE SUBMITTED AT LEAST 5 WORKING DAYS PRIOR TO VISIT
COMPANY NAME / ADDRESS
BUILDING TO BE VISITED: Building 14 Special Events Forum
LAST NAME
FIRST NAME,
MIDDLE INITIAL
DATE OF BIRTH
(MM/DD/YYYY)
IS THIS PERSON
A U. S. CITIZEN?
IF NO, PLEASE PROVIDE PLACE OF BIRTH
1) DRIVERS LICENSE NUMBER
AND
2) STATE of ISSUENCE
DATE(S) OF REQUESTED ACCESS (MM/DD/YYYY) to (MM/DD/YYYY)
| 05/03/2019 |
| 05/03/2019 |
| 05/03/2019 |
| GOV’T SPONSOR’S NAME (PRINTED) |
| COMMAND/CODE |
| PHONE |
| DATE |
| Mark Stumpo |
| NAVSUP FLC Norfolk/Code 215 |
| (717) 605-6459 |
| 05/3/2019 |
NOTE: ALL PERSONS ENTERING NSA MECHANICSBURG MUST HAVE PHOTO IDENTIFICATION IN THEIR POSSESSION.
Data subject to protection under the provisions of the Privacy Act of 1974 – FOR OFFICIAL USE ONLY.
Information contained within this document or its attachments may contain personnel information, disclosure of which is generally prohibited by the Privacy Act (5 U.S.C. 552a). Protected information included in this document or its attachments are in accordance with section (b)1 of the Act which permits disclosure to individuals within the Department of Defense (DoD) with an official need to know. Release of such protected information outside of the DoD is prohibited. If you have received this communication in error, please notify Dennis Rich immediately by email, dennis.rich@navy.mil or call X3351 and delete the original message.
Privacy Sensitive - Any Misuse or Unauthorized Disclosure May Result in Both, Civil and Criminal Penalties.
VISITOR ACCESS (05-14)
File details come from the government source that posted it. Updated .