DBIDS CARD- PAPER PASS REQUEST (Sponsor filled).xlsx

XLSX spreadsheet 40 KB Posted Feb 18, 2020

Attached to: USS EMORY S LAND (AS-39) Regular Overhaul/Dry Docking Federal contract opportunity
Solicitation number: N3220520R6501
Issued by: Department of the Navy Military Sealift Command

About this file

Written by GovTribe AI · Dec 28, 2023

This document contains a sample paper pass request form and instructions for obtaining base access at a Navy facility in Japan. The form collects personal information such as name, date of birth, citizenship, physical description, contact details, and employer information from individuals requesting a paper pass. It also documents the sponsoring organization within the Navy, dates and times of required access, and intended access areas around the base. A sample height and weight conversion chart is included as an appendix.

The related federal contract opportunity is a solicitation for the regular overhaul and drydocking of the USS Emory S. Land (AS-39). Interested contractors must submit a completed Form J-14 to receive the work item package and references for the solicitation. The soliciting agency is the Department of the Navy Military Sealift Command.

View the file

Other files for this federal contract opportunity

Other files attached to USS EMORY S LAND (AS-39) Regular Overhaul/Dry Docking, newest first.
File	Type	Posted
N3220520R6501-0007.docx	DOCX document	Mar 17, 2020
N3220520R6501-0006.docx	DOCX document	Mar 16, 2020
RFC_58-60.docx	DOCX document	Mar 16, 2020
N3220520R6501-0005.docx	DOCX document	Mar 12, 2020
RFC_48-57.docx	DOCX document	Mar 12, 2020
N3220520R6501-0004.docx	DOCX document	Mar 2, 2020
RFC_34_36-47.docx	DOCX document	Mar 2, 2020
N3220520R6501-0003.docx	DOCX document	Feb 24, 2020
RFC_26&30-35.docx	DOCX document	Feb 24, 2020
SECNAV5512-1.pdf	PDF	Feb 18, 2020
RFC_10&18-29.docx	DOCX document	Feb 18, 2020
N3220520R6501-0002.docx	DOCX document	Feb 18, 2020
J-10 Interport Differential - Amendment 1.docx	DOCX document	Feb 11, 2020
RFC_01-17.docx	DOCX document	Feb 11, 2020
N3220520R6501-0001.docx	DOCX document	Feb 11, 2020
J-3 Category B Items.xlsx	XLSX spreadsheet	Jan 28, 2020
J-11 Dry Dock Eval Form.docx	DOCX document	Jan 28, 2020
J-14 Technical Data Non-Disclosure.docx	DOCX document	Jan 28, 2020
J-12 Past Performance Data.docx	DOCX document	Jan 28, 2020
J-4 GFM List.pdf	PDF	Jan 28, 2020
J-9 Disclosure of Lobbying Activities SF-LLL.docx	DOCX document	Jan 28, 2020
N10420R6501 - J_A_Redacted.pdf	PDF	Jan 28, 2020
J-15 ROK POG Access Request-US.xlsx	XLSX spreadsheet	Jan 28, 2020
J-2 Category A Items.xlsx	XLSX spreadsheet	Jan 28, 2020
J-8 Request for Spec Clarification.docx	DOCX document	Jan 28, 2020
J-7 MSC Ship Repair Facility Survey.docx	DOCX document	Jan 28, 2020
J-13 Past Performance Questionnaire.docx	DOCX document	Jan 28, 2020
J-10 Interport Differential.docx	DOCX document	Jan 28, 2020
J-6 CDRLs.pdf	PDF	Jan 28, 2020
N3220520R6501.docx	DOCX document	Jan 28, 2020

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DBIDS CARD-PAPER PASS

APPOINTMENT DATE :	TIME:	DATE RECEIVED: BY:
DBIDS CARD / PAPER PASS
LAST (姓)	FIRST (名)		MIDDLE

DOB (生年月日):MM/DD/YYYY		GENDER (性別)					NATIONALITY (国籍)
		MALE / FEMALE (circle)					USA
DRIVER'S LICENSE NO.		ID TYPE :	PASSPORT				DBIDS NO.
		ID NO :
HAIR COLOR (髪の色)	EYE COLOR (目の色)			HT (身長/Ft.In.)				WT (体重/Pounds)
BLACK	BLACK			5' 10"				148
CURRENT ADDRESS / 現住所(英語及び漢字)
					/	N/A
PERMANENT ADDRESS FOR JAPANESE ONLY / 本籍地(日本人のみ)
N/A
PLACE OF BIRTH (出生地) :					/	N/A
🏣郵便番号/ZIP CODE	MOBILE OR HOME NO. (携帯電話/自宅)						EMAIL ADDRESS

COMPANY NAME (申請者の所属会社) WORK PHONE NO. (勤務先の電話)

TIME (入門時間) FROM ~ TO						DAYS OF WEEK (入門曜日)		DATE OF ENTRY ( 申請期間)
0700	~	1800				S / M / T / W / T / F / S (circle)			~
MAIN CONTRACTOR (元請会社):
PHONE NO (電話番号) :								CONTRACT PERIOD (契約期間)
CONTRACT NO (契約番号) :				N32205-20- etc					~
CONTRACT TITLE (契約名称):					USNS etc.
ACCESS AREA (行先)
1. MAIN BASE 2. M/B HOUSING 3. HARIO HOUSING 4. FIDDLER'S GREEN 5. M/B PIERS
6. AKASAKI 7. IORIZAKI 8. YOKOSE 9. MAEBATA ORD 10. HARIOSHIMA ORD (circle)
SPONSORING ORGANIZATION (スポンサー部署)							SPONSOR'S NAME (TYPE)
U.S. NAVY'S MILITARY SEALIFT COMMAND YOKOHAMA							ANTHONY LEOFSKY, P.E.
SPONSOR'S E-MAIL :			Anthony.Leofsky@fe.navy.mil				SPONSOR'S SIGNATURE
SPONSOR'S PHONE NO :			080-2185-1564
PRIVACY ACT STATEMENT
Collection of this is authorized by the Privacy Act, U.S.C. Section 552(a). The information will be used to process Base Pass.
The information on this form may be disclosed to the third parties in accordance with the provision of 5 U.S.C. Section 552(b).
Completion of this form is voluntary; however, failure to provide the information requested may preclude the processing of Base Pass
PASS COORDINATOR (パスコ－ディネ－タ－)							PASS & ID OFFICE
NAME & PHONE NO :
DATE RETURNED : BY							CONFIRMED BY :
TRANSMITTAL / FILE NO :							DATE TRANSFERRED :

200-2, 20190306

SAMPLE FOR DBIDS CARD-PAPER PAS

APPOINTMENT DATE :

TIME:

DATE RECEIVED: BY:

DBIDS CARD / PAPER PASS

佐世保

400

ち

9876

LAST (姓)

FIRST (名)

MIDDLE

① BEIGUN 米軍

TARO 太郎

DOB (生年月日):MM/DD/YYYY

GENDER (性別)

NATIONALITY (国籍)

② 10/27/1979

MALE / FEMALE (circle)

JAPAN

DRIVER'S LICENSE NO.

ID TYPE :

④PASS PORT

DBIDS NO.

③92045674XXXX

ID NO :

④ KR23321243

⑤

①

日本名がある場合は、横に記入

HAIR COLOR (髪の色)

EYE COLOR (目の色)

HT (身長/Ft.In.)

WT (体重/Pounds)

②

日付は月 / 日 / 西暦で記入

BLACK

BROWN

⑥5'10"

152

③

運転免許証の番号を記入

CURRENT ADDRESS / 現住所(英語及び漢字)

④

運転免許証が無い場合、証明書の種類と番号を記入

XXXX HIRASE-CHO, SASEBO-CITY / 佐世保市平瀬町xxxx

⑤

所持しているパスがあれば記入

PERMANENT ADDRESS FOR JAPANESE ONLY / 本籍地(日本人のみ)

⑥

フィート、インチで記入（別表参照）

XX-XX AKASAKI-CHO, SASEBO-CITY / 佐世保市赤崎町xx-xx

⑦

長崎県以外の場合は都道府県から記入

PLACE OF BIRTH (出生地) :

⑦ / URESHINO-CITY, SAGA PREF. / 佐賀県嬉野市

⑧

必項なので、無い場合、フリーメール等で良いので作成する。

🏣郵便番号/ZIP CODE

MOBILE OR HOME NO. (携帯電話/自宅)

EMAIL ADDRESS

857-1234

090-1234-xxxx / 0956-23-xxxx

⑧beigun.t@jjj.jp

COMPANY NAME (申請者の所属会社)

WORK PHONE NO. (勤務先の電話)

ABC COMPANY

0956-50-xxxx

TIME (入門時間) FROM ~ TO

DAYS OF WEEK (入門曜日)

DATE OF ENTRY ( 申請期間)

0800

1645

S / M / T / W / T / F / S (circle)

1/31/19

1/31/20

MAIN CONTRACTOR (元請会社):

SASEBO KENSETSU

PHONE NO (電話番号) :

0956-XX-XXXX

CONTRACT PERIOD (契約期間)

CONTRACT NO (契約番号) :

N012345-14-XXXX

1/31/19

10/31/21

CONTRACT TITLE (契約名称):

BEIGUN CO.

ACCESS AREA (行先)

1. MAIN BASE 2. M/B HOUSING 3. HARIO HOUSING 4. FIDDLER'S GREEN 5. M/B PIERS

6. AKASAKI 7. IORIZAKI 8. YOKOSE 9. MAEBATA ORD 10. HARIOSHIMA ORD (circle)

SPONSORING ORGANIZATION (スポンサー部署)

SPONSOR'S NAME (TYPE)

JED SASEBO RESIDENT OFFICE

JAMES J. JOHNSON, LT, USN

SPONSOR'S E-MAIL :

johnson.j@jjj.jp

SPONSOR'S SIGNATURE

SPONSOR'S PHONE NO :

0956-50-XXXX

PRIVACY ACT STATEMENT

Collection of this is authorized by the Privacy Act, U.S.C. Section 552(a). The information will be used to process Base Pass.

The information on this form may be disclosed to the third parties in accordance with the provision of 5 U.S.C. Section 552(b).

Completion of this form is voluntary; however, failure to provide the information requested may preclude the processing of Base Pass

PASS COORDINATOR (パスコ－ディネ－タ－)

PASS & ID OFFICE

NAME & PHONE NO :

DATE RETURNED : BY

CONFIRMED BY :

TRANSMITTAL / FILE NO :

DATE TRANSFERRED :

200-2, 20190306

・PAPER PASSの申請で車両乗入が必要な場合

・DBIDS CARD所有者で３０日以内の車両パスが

必要な場合に記入する。

申請の種類に応じて、DBIDS CARDか

PAPER PASS のどちらかに〇をつける。

SAMPLE

HEIGHT.WEIGHT CONVERSION CHARTS

Appendix A Height and Weight Conversion Charts
Weight-Conversion Chart:		Height-Conversion Chart
(2.2045 pounds = 1 kg)		(.39370 inches = 1 cm)
Weight in kilograms	Converted to pounds	Height in centimeters	Height in feet	Height in inches
			and inches
35	77	122	4 feet 0 inches	48
37	82	124	4 feet 1 inches	49
39	86	127	4 feet 2 inches	50
41	90	130	4 feet 3 inches	51
43	95	132	4 feet 4 inches	52
45	99	135	4 feet 5 inches	53
47	104	137	4 feet 6 inches	54
49	108	140	4 feet 7 inches	55
51	112	142	4 feet 8 inches	56
53	117	145	4 feet 9 inches	57
55	121	147	4 feet 10 inches	58
57	126	150	4 feet 11 inches	59
59	130	152	5 feet 0 inches	60
61	134	155	5 feet 1 inches	61
63	139	157	5 feet 2 inches	62
65	143	160	5 feet 3 inches	63
67	148	163	5 feet 4 inches	64
69	152	165	5 feet 5 inches	65
71	157	168	5 feet 6 inches	66
73	161	170	5 feet 7 inches	67
75	165	173	5 feet 8 inches	68
77	170	175	5 feet 9 inches	69
79	174	178	5 feet 10 inches	70
81	179	180	5 feet 11 inches	71
83	183	183	6 feet 0 inches	72
85	187	185	6 feet 1 inches	73
87	192	188	6 feet 2 inches	74
89	196	191	6 feet 3 inches	75
91	201	193	6 feet 4 inches	76
93	205	196	6 feet 5 inches	77
95	209	198	6 feet 6 inches	78
97	214	201	6 feet 7 inches	79
99	218	203	6 feet 8 inches	80
101	223	206	6 feet 9 inches	81
103	227	208	6 feet 10 inches	82
105	231	211	6 feet 11 inches	83
107	236
109	240
111	245
113	249
115	254
117	258
119	262
121	267
123	271
125	276
127	280
129	284
131	289
133	293
135	298
137	302

File details come from the government source that posted it. Updated Feb 18, 2020.