Attachment J-7 NSFR Poland Base Escort Request.xlsx

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Attached to
Base Operations Support (BOS) Services at Naval Support Facility (NSF) Redzikowo, Poland
Solicitation number
N6247023R0010
Issued by

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This file contains a temporary visitor request form and instructions for Naval Support Facility (NSF) Redzikowo in Poland. The form collects personal information such as name, date of birth, passport or ID details, dates of visit, purpose of visit, and vehicle information. It requires contact information for the escort and their affiliation with the base. Escorts must be U.S. military, civilian, or contractor personnel performing in a supervisory role. Each escort is limited to four visitors for no more than seven days. Requests must be submitted 48 to 24 hours in advance by email to the base access email address provided.

The related federal contract opportunity is a solicitation from the Department of the Navy Naval Facilities Engineering Command for base operations support services at NSF Redzikowo. The solicitation seeks to provide base operations and life support services at the specified Navy base in Poland.

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Short Time Application

NSFR POLAND BASE ESCORT REQUEST

Notification of a temporary visit in the premises of the Base in Redzikowo of Polish citizens/Zgłoszenie tymczasowego pobytu na terenie bazy obywatela Polski.
No.Given NameSurnameDate of Birth
(dd.mm.yyyy)Organization / CompanyPassport or ID Number (as applicable)Origin of Passport or ID (Country)Estimated Arrival DateEstimated Departure DateHow Many Days (Max 7)Purpose of Visit/
Vehicle License PlateEscort (Name and Phone Number)
Lp.ImięNazwiskoUrodzonyFirmaNr dow osobistegoNarodowoścod dniado dniailość dni (do 7)Komentarzosoba odpowiedzialna za pobytPhone
ExampleJohnDoe11/11/77Afpha1234567USA
Sponsor - Organization / John Doe / (48) 512-825-595
_________________________________________________________
USG Sponsor Named Above Affirms:

Persons being escorted have legitimate need for short term access for temporary visit or delivery. Escort request is not an attempt to circumvent the permanent base access process

NSFR Visitor's Center (Access Control Facility - Bldg 4200)
Telephone: +48.59.714.4012 or 4010/ DSN: 324-771-4012 or 4010
DoD 5400.11-R
Routine Use: Information may be disclosed for any of the DoD "Blanket Routine Uses" published at http://privacy.defense.gov/blanket_uses.shtml. Contact your local Privacy Officer for further details.
Disclosures: Voluntary; however, failure to provide the information may result in our inability to grant access to our facilities.
INSTRUCTIONS FOR COMPLETING THIS REQUEST
INSTRUCTIONS FOR COMPLETING THIS REQUEST
1. Enter all requested information
2. Escort must be U.S. military, civilian or a contractor (Contractors may escort only when performing in a supervisory position)
3. The maximum visitors one person can escort is four (4)
4. Ensure the USG Sponsor's full name and contact phone number are provided
5. Submit the completed request to the following email address for processing:
nsf-redzikowo-base-access@us.navy.mil
6. Submit all requests at least 48 hours and no less than 24 hours in advance
7. The person submitting the request will be notified by email of approval and/or denial
Current as of: 05/17/2023

&"Times New Roman,Bold"&14&K002060CUI/PII/PRVCY

&KFF0000Created and Controlled by: NSF Redzikowo, Poland Category: PRVCY POC: NSFR Poland *Contains Privacy Information subject to the Privacy Act 1974 &"Times New Roman,Bold Italic"&14&K000000 &"Times New Roman,Bold"&K002060

CUI/PII/PRVCY

mailto:nsf-redzikowo-base-access@us.navy.mil

File details come from the government source that posted it. Updated .