N6274219R1304_Affidavit_BAL.pdf

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FY19 MCON PROJECT P-735 MACHINE GUN RANGE AT US NAVAL SUPPORT ACTIVITY ANDERSEN GUAM, JOINT REGION MARIANAS, GUAM
Solicitation number
N6274219R1304
Issued by

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This document contains a Base Access Listing Request (BAL) for personnel requiring access to Andersen Air Force Base to visit the site for solicitation N6274219R1304. The BAL provides names, dates of birth, and social security numbers for 25 individuals from unit/squadron 36 JQS requiring access to the base on Thursday July 18, 2019 from 0800 to 1300 hours to visit the site for the FY19 MCON Project P-735 Machine Gun Range at Naval Support Activity Andersen Guam, Joint Region Marianas, Guam. The solicitation number is N6274219R1304 and is issued by the Department of the Navy Naval Facilities Engineering Command for the FY19 MCON Project P-735 Machine Gun Range. No other details are provided in the BAL or solicitation description.

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N6274219R1304_Affidavit_BAL.pdf

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ANDERSEN AAFB ACCESS LISTING REQUEST

Base Access List (BAL)

Authority: AFI 31-113, Chapter 4 Identity Vetting and Fitness Determination Purpose: Installation Access Listing for personnel requesting access to Andersen AFB (AAFB).

SSN and DOB: Are used for further proofing and vetting of an individual requesting base access.

Routine Use(s): The Visitor Control Center/Base Access Office will use NAME, DOB and FULL SSN to perform fitness determination on all individuals listed in this document and issue an AF Form 75 / Visitor Pass.

Disclosure: Disclosure is voluntary. Failure to disclose all required information will result in that person not being allowed to enter Andersen AFB property.

TRACKING NUMBER

DATE

REQUESTOR: (Unit/ Squadron 36 JQS) SCHEDULED DATES (i.e. Feb14 – Jul 2015) - ACCESS (check all that apply)/TIME (i.e. 24/7) □ Su □ Mo □ Tu □ We □ Th □ Fr □ Sa TIME

PURPOSE:

***ACCESS TO ANDERSEN AFB RESTRICTED AREAS IS PROHIBITED***

BLOCK I. Personal Data

# Last Name First Name MI. Date of Birth (yyyymmdd)

FULL Social Security Number

The information herein is For Official Use Only (FOUO) which must be protected under Title 5, U.S.C. 552a - The Privacy Act of 1974, as amended. Unauthorized disclosure or misuse of this PERSONAL INFORMATION may result in criminal and/or civil penalties.

mailto:email@us.af.mil 1155849432A Typewritten Text

TRACKING NO:
BAL DATE:
REQUESTOR Unit Squadron 36 JQS:
SCHEDULED DATES ie Feb14 Jul 2015: 18 July 2019
fill_130: 18 July 2019
Su: Off
Mo: Off
Tu: Off
We: Off
Th: On
Fr: Off
Sa: Off
BAL TIME: 0800-1300
PURPOSE: Site Visit for RFP N6274219R1304, FY19 MCON PROJECT P-735 MACHINE GUN RANGE AT US NAVAL SUPPORT ACTIVITY ANDERSEN GUAM, JOINT REGION MARIANAS, GUAM
Last Name1:
First Name1:
MI1:
Date of Birth yyyymmdd1:
FULL Social Security Number1:
Last Name2:
First Name2:
MI2:
Date of Birth yyyymmdd2:
FULL Social Security Number2:
Last Name3:
First Name3:
MI3:
Date of Birth yyyymmdd3:
FULL Social Security Number3:
Last Name4:
First Name4:
MI4:
Date of Birth yyyymmdd4:
FULL Social Security Number4:
Last Name5:
First Name5:
MI5:
Date of Birth yyyymmdd5:
FULL Social Security Number5:
Last Name6:
First Name6:
MI6:
Date of Birth yyyymmdd6:
FULL Social Security Number6:
Last Name7:
First Name7:
MI7:
Date of Birth yyyymmdd7:
FULL Social Security Number7:
Last Name8:
First Name8:
MI8:
Date of Birth yyyymmdd8:
FULL Social Security Number8:
Last Name9:
First Name9:
MI9:
Date of Birth yyyymmdd9:
FULL Social Security Number9:
Last Name10:
First Name10:
MI10:
Date of Birth yyyymmdd10:
FULL Social Security Number10:
Last Name11:
First Name11:
MI11:
Date of Birth yyyymmdd11:
FULL Social Security Number11:
Last Name12:
First Name12:
MI12:
Date of Birth yyyymmdd12:
FULL Social Security Number12:
Last Name13:
First Name13:
MI13:
Date of Birth yyyymmdd13:
FULL Social Security Number13:
Last Name14:
First Name14:
MI14:
Date of Birth yyyymmdd14:
FULL Social Security Number14:
Last Name15:
First Name15:
MI15:
Date of Birth yyyymmdd15:
FULL Social Security Number15:
Last Name16:
First Name16:
MI16:
Date of Birth yyyymmdd16:
FULL Social Security Number16:
Last Name17:
First Name17:
MI17:
Date of Birth yyyymmdd17:
FULL Social Security Number17:
Last Name18:
First Name18:
MI18:
Date of Birth yyyymmdd18:
FULL Social Security Number18:
Last Name19:
First Name19:
MI19:
Date of Birth yyyymmdd19:
FULL Social Security Number19:
Last Name20:
First Name20:
MI20:
Date of Birth yyyymmdd20:
FULL Social Security Number20:
Last Name21:
First Name21:
MI21:
Date of Birth yyyymmdd21:
FULL Social Security Number21:
Last Name22:
First Name22:
MI22:
Date of Birth yyyymmdd22:
FULL Social Security Number22:
Last Name23:
First Name23:
MI23:
Date of Birth yyyymmdd23:
FULL Social Security Number23:
Last Name24:
First Name24:
MI24:
Date of Birth yyyymmdd24:
FULL Social Security Number24:
Last Name25:
First Name25:
MI25:
Date of Birth yyyymmdd25:
FULL Social Security Number25:
Text1: 2. Please contact (FIRST, LAST NAME) at (Duty Phone) or (email address) if you have any questions.

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