AAFB_Foreign_National_Access_Request_Form.pdf
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- Solicitation number
- N4019220R1800
About this file
This document contains a foreign national access request form and details of a related federal contract opportunity for environmental services. The foreign national access request form requires information such as visitor names, dates of visit, identification types, and addresses to process requests for access to Andersen Air Force Base in Guam. The related federal contract opportunity is a 100% small business set-aside solicitation issued by the Naval Facilities Engineering Command for hazardous waste, hazardous material, and spill response services in Joint Region Marianas. The single-award IDIQ contract has a maximum value of $20 million over a five-year base period and four option years. Services include operation of storage facilities, waste collection and disposal, sampling, and spill response. The pre-proposal conference is scheduled for November 8, 2019, and the solicitation is available on FBO.com as of October 25, 2019.
AAFB Foreign National Access Request Form
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DEPARTMENT OF THE AIR FORCE
HEADQUARTERS 36TH WING (PACAF)
ANDERSEN AIR FORCE BASE GUAM
Foreign National Access Request Form Contractor Request
APPROVED BY: ___________________________ TRACKING NUMBER: _______________________ FVR NUMBER: _________________
PROJECT COORDINATOR CONTRACTING OFFICER
First Name
Last Name:
Contact Phone Number:
Email Address:
Organization:
Visitor’s intended location on Andersen:
Visitor 1 Visitor 2 Visitor 3 Visitor 4 First Name:
Last Name:
Date of Birth:
DD / MMM / YYYY
DD / MMM / YYYY
DD / MMM / YYYY
DD / MMM / YYYY
Country of Citizenship:
Identification Type
[] Passport [] I-94 [] U.S. Visa [] Other:___________
[] Passport [] I-94 [] U.S. Visa [] Other:___________
[] Passport [] I-94 [] U.S. Visa [] Other:___________
[] Passport [] I-94 [] U.S. Visa [] Other:___________
Occupation:
Place of Employment:
Relationship to Escort:
How long is your stay on Andersen AFB?
From:________/________/________
DD MMM YYYY
To:________/_________/_________
DD MMM YYYY
From:________/________/________
DD MMM YYYY
To:________/_________/_________
DD MMM YYYY
From:________/________/________
DD MMM YYYY
To:________/_________/_________
DD MMM YYYY
From:________/________/________
DD MMM YYYY
To:________/_________/_________
DD MMM YYYY
Purpose of visit to Andersen?
Address while on Guam:
Street
_________________________,, Guam _______ City Zip
Street
_________________________,, Guam _______ City Zip
Street
_________________________,, Guam _______ City Zip
Street
_________________________,, Guam _______ City Zip
PRIVACY ACT STATEMENT: AUTHORITY: Title 5 USC Section 301, Departmental Regulation Principle Purpose: To record personal information and determine access to the installation ROUTINE PURPOSE: To request and record the issuance of a Visitor Pass when the use of another form is not authorized or specified. Failure to provide any information requested may result in non-issuance of the Visitor Pass. Disclosure of information is voluntary acceptance of these terms constitutes approval for a background check to be conducted as part of the request approval process. The information is necessary for validation of identity and determination of entry eligibility on to Andersen Air Force Base. Failure to provide this information may result in non-issuance determination by the issuing authority.
Date Approved: _________________
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