Att. X) DBIDS ACCESS REQUEST FORM.docx

DBIDS ACCESS REQUEST FORM (NAVSHIPYD PTSMH 5500)

SUBMISSION INFORMATION

1. Access Requested For (Full Name):

2. Title:

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:

(IF REQUEST IS FOR MORE THAN ONE PERSON PLEASE ATTACH EMPLOYEE LIST)

COMPANY REQUESTING ACCESS INFORMATION

Company Name (Corporate Legal name):

Company Address :

Company Phone Number (Corporate Office):

Company Local POC:

Email and Phone:

Are Any Personnel Foreign Nationals?

Yes ☐ No ☒ (If Yes provide separate list of Names)

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: Lauren Lyons

Sponsor Organization: NAVFAC

Sponsor Title: Project Manager

Sponsor Phone Number: 207-438-4605

Sponsor Email Address: Lauren.a.lyons.civ@us.navy.mil

Contract or project number: N6247026R0012 Multiple Award Construction Contract (MACC) for Design-Build (DB) and Design-Bid-Build (DBB) New Construction, Renovation, Alteration, and Repair for Large General, Industrial, and Waterfront Construction Projects PRE PROPOSAL SITE VISIT

Contract or Project ACCESS EXPIRATION Date: NO DATE / PRE AWARD

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) Revision 12/16/19 image1.jpeg