Attachment (b) DBIDS Card - Paper Pass Request.xlsx

XLSX spreadsheet 78 KB Posted Nov 27, 2019

Attached to: HOODS & DUCTS Federal contract opportunity
Solicitation number: N4008420R6300
Issued by: Department of the Navy Naval Facilities Engineering Command

View the file

Other files for this federal contract opportunity

Other files attached to HOODS & DUCTS, newest first.
File	Type	Posted
Attachment (d) Provision 52.204-24.pdf	PDF	Nov 27, 2019
Attachment (2) ELIN.xlsx	XLSX spreadsheet	Nov 27, 2019
Attachment (c) SECNAV5512-1.pdf	PDF	Nov 27, 2019
Attachment (e) PPQ Form.doc	DOC document	Nov 27, 2019
Attachment (a) Pre-Proposal Inquiry Fom.doc	DOC document	Nov 27, 2019

On GovTribe

Work with this file on GovTribe

Download the original file
Contacts named in this file
Similar government files
Ask GovTribe AI about this file

Try for free Login

Text version

The file's text, extracted by GovTribe without its formatting.

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)
DRIVER'S LICENSE NO.		ID TYPE :		DBIDS NO.
		ID NO :
HAIR COLOR (髪の色)	EYE COLOR (目の色)		HT (身長/Ft.In.)		WT (体重/Pounds)

CURRENT ADDRESS / 現住所(英語及び漢字)
	/
PERMANENT ADDRESS FOR JAPANESE ONLY / 本籍地(日本人のみ)

PLACE OF BIRTH (出生地) :		/
🏣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)

08:00

16:00

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) :

N4008420R6300

CONTRACT TITLE (契約名称):

DUCT, GREASE AND FIRE SUPPRESSION SYSTEM MAINTENANCE

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)

NAVFACFE, PWD, FEAD, ACQ

Keiko Ujiie

SPONSOR'S E-MAIL :

keiko.ujiie1.ja@fe.navy.mil

SPONSOR'S SIGNATURE

SPONSOR'S PHONE NO :

0956-50-2502

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

TVP

		NUMBER OF PASS HOLDER		2	(	2	)			NUMBER OF PASS HOLDER		2	(	2	)
PURPOSE	Engine Maintenance		NUMBER OF TVP	1	(	1	)	PURPOSE	Engine Maintenance		NUMBER OF TVP	1	(	1	)

APPLICATION FOR VEHICLE ACCESS PASS	APPLICATION FOR VEHICLE ACCESS PASS
DATE	DATE	31-Dec-1899
TO: Security Office, Fleet Activities, Sasebo	TO: Security Office, Fleet Activities, Sasebo

It is requested that a Vehicle Access Pass be issued to the following				`		It is requested that a Vehicle Access Pass be issued to the following
person/company:						person/company:
PERSON/COMPANY	(Sub Contr of	0			)	PERSON/COMPANY
0						0
MAIN CONTRACTOR ADDRESS & TELEPHONE NUMBER						MAIN CONTRACTOR ADDRESS & TELEPHONE NUMBER
1456 Ainoura-cho, Sasebo City						1456 Ainoura-cho, Sasebo City
0						0
PERIOD			CONTRACT NUMBER			PERIOD		CONTRACT NUMBER
			0			31-Dec-1899		0
SIGNATURE OF DEPARTMENT HEAD (SPONSOR)						SIGNATURE OF DEPARTMENT HEAD (SPONSOR)
0						0
0						0
TO BE PREPARED BY APPLICANT						TO BE PREPARED BY APPLICANT
DATE						DATE	31-Dec-1899

LICENSE PLATE NO.		MAKE & YEAR		LICENSE PLATE NO.		MAKE & YEAR
				0		0
TYPE OF VEHICLE	SERIAL NUMBER		COLOR OF VEHICLE	TYPE OF VEHICLE	SERIAL NUMBER		COLOR OF VEHICLE
				0	0		0
DRIVER'S NAME			PASS NUMBER	DRIVER'S NAME			PASS NUMBER
0	0			0	0		0
SUBCONTRACTOR ADDRESS & TELEPHONE NUMBER				SUBCONTRACTOR ADDRESS & TELEPHONE NUMBER
0				0
0				0
DESTINATION				DESTINATION
				0
SIGNATURE				元請会社代表者又は工事責任者署名

0			0
TO BE PREPARED BY REGISTRATION SECTION		TO BE PREPARED BY REGISTRATION SECTION
DATE		DATE
EXPIRATION DATE OF INSPECTION	EXPIRATION DATE OF INSURANCE (JCI)	EXPIRATION DATE OF INSPECTION		EXPIRATION DATE OF INSURANCE (JCI)

DECAL/TEMPORARY VISTOR PASS NUMBER DECAL/TEMPORARY VISTOR PASS NUMBER

FILE COPY

SAMPLE FOR TVP

		NUMBER OF PASS HOLDER		6	(	45	)	PUROSE		NUMBER OF PASS HOLDER			6	(	45	)
										（人パスの保持数）
PURPOSE	資材搬入		NUMBER OF TVP	2	(	15	)	（使用目的）	資材搬入			NUMBER OF TVP	2	(	15	)
											（車両パスの保持数）

APPLICATION FOR VEHICLE ACCESS PASS					APPLICATION FOR VEHICLE ACCESS PASS
DATE	31-Oct-2014				DATE（申請日）	31-Oct-2014
TO: Security Office, Fleet Activities, Sasebo					TO: Security Office, Fleet Activities, Sasebo				長崎重工の契約全体でパス所有者が４５名。
									そのうち米軍塗装工業が６名いる。
It is requested that a Vehicle Access Pass be issued to the following				`	It is requested that a Vehicle Access Pass be issued to the following
person/company:					person/company:				長崎工業の契約全体車両パスが６台あり
PERSON/COMPANY		(SUB CONTRACTOR OF NAGASAKI HEAVY IND.)			PERSON/COMPANY（申請会社名）			(SUB CONTRACTOR OF NAGASAKI HEAVY IND.)	そのうち米軍塗装工業の車両パスが
BEIGUN TOSO KOGYO					BEIGUN TOSO KOGYO				２台目である。
MAIN CONTRACTOR ADDRESS & TELEPHONE NUMBER					MAIN CONTRACTOR ADDRESS & TELEPHONE NUMBER
12-41, AOSAKI-CHI, SASEBO					（元請会社住所及び電話番号）		12-41, AOSAKI-CHI, SASEBO
0956-24-9999					0956-24-9999
PERIOD			CONTRACT NUMBER		PERIOD（契約期限）			CONTRACT NUMBER（契約番号）
31-Oct-15			N12335-12-A-0001		31-Oct-2015			N12335-12-A-0001
SIGNATURE OF DEPARTMENT HEAD (SPONSOR)					SIGNATURE OF DEPARTMENT HEAD (SPONSOR)（米軍側工事担当者署名）

	T. SASEBO, PWD SASEBO			T. SASEBO, PWD SASEBO
TO BE PREPARED BY APPLICANT			TO BE PREPARED BY APPLICANT
DATE		31-Oct-14	DATE（申請日）		31-Oct-2014

LICENSE PLATE NO.		MAKE & YEAR		LICENSE PLATE NO.（車両ナンバー）		MAKE & YEAR（メーカ・年式）
SASEBO 555 TO 1234		TOYOTA 2010		SASEBO 555 TO 1234		TOYOTA 2010
TYPE OF VEHICLE	SERIAL NUMBER		COLOR OF VEHICLE	TYPE OF VEHICLE（形状）	SERIAL NUMBER（車体番号）		COLOR OF VEHICLE（色）
VAN	ABC10-1234567		WHITE	VAN	ABC10-1234567		WHITE
DRIVER'S NAME			PASS NUMBER	DRIVER'S NAME（運転者名）			PASS NUMBER（パス番号）
GEIGUN, TARO			900123	GEIGUN, TARO			900123
SUBCONTRACTOR ADDRESS & TELEPHONE NUMBER				SUBCONTRACTOR ADDRESS & TELEPHONE NUMBER（申請会社住所及び電話番号）
234-2 KUROSAKI-CHO, NASAGAKI CITY, NAGASAKI PREF.				234-2 KUROSAKI-CHO, NASAGAKI CITY, NAGASAKI PREF.
095-823-3323				095-823-3323
DESTINATION				DESTINATION（行き先）
MAIN BASE / AKASAKI / YOKOSE				MAIN BASE / AKASAKI / YOKOSE
SIGNATURE				SIGNATURE（元請会社代表者又は工事責任者署名）

	S. NAGASAKI			S. NAGASAKI
TO BE PREPARED BY REGISTRATION SECTION			TO BE PREPARED BY REGISTRATION SECTION
DATE			DATE
EXPIRATION DATE OF INSPECTION		EXPIRATION DATE OF INSURANCE (JCI)	EXPIRATION DATE OF INSPECTION		EXPIRATION DATE OF INSURANCE (JCI)

DECAL/TEMPORARY VISTOR PASS NUMBER DECAL/TEMPORARY VISTOR PASS NUMBER

( )内は工事全体の数。左側は今回の申請会社の数申請用の項目に入力すると、自動的にCopy用の項目に同時入力されます。切り取って申請用（サインの入った原本）を提出する。署名者の名前、部署を記入して署名をもらう

ORIGINAL

File details come from the government source that posted it. Updated Nov 27, 2019.