DBIDS_5500.pdf

DBIDS ACCESS REQUEST FORM (NAVSHIPYD PTSMH 5500)

SUBMISSION INFORMATION

1. Requester full name:

2. Title: Surveyor

3. Phone Number :

4. COMPANY NAME :

DBIDS INFORMATION

Is the company requesting access to the installation the primary Contractor Yes☐ No☐ If no, who do they subcontract for:

COMPANY REQUESTING ACCESS INFORMATION

Company Name (Corporate Legal name):

Company Address :

Company Phone Number(Corporate Office):

Company Local POC:

Email and Phone:

For access to: PORTSMOUTH NAVAL SHIPYARD Timeframe of Access Required: ☐ 0600-1800 ☐ 1400-2300 ☐ 24 Hours ☐ All Week ☐ M-F only ☐ Weekends Only

SPONSOR INFORMATION (MUST BE SHIPYARD PERSONNEL)

Sponsor Name: Jeannette Vincent Sponsor Organization: PWD Maine, ACQ Sponsor Title: Contract Specialist Sponsor Phone Number:207-438-4619 Sponsor Email Address: jeannette.vincent@navy.mil Contract or project number: N4008518D9509 Contract or Project ACCESS EXPIRATION Date: 09/12/19

Only ONE request for Company access should be submitted to;

PNSDBIDS@navy.mil (all requests for employees are on the 5512 and are carried by the employee to pass and ID once the company is approved) mailto:PNSDBIDS@navy.mil