N6274219R1310_ONE-DAY_PASS.DOC

REQUEST FOR BASE ACCESS

FOR OFFICIAL USE ONLY

Privacy Act Statement: Pursuant to 5 U.S.C. section 552 and SECNAVINST 5720.42F, this information being requested is on a voluntary basis; however, failure to provide the personal information requested is grounds to deny you entry onto Naval Base Guam property, in accordance with DODINST 2000.16.

DATE OF REQUEST: ___________________

Access requested for: CONTRACTOR/VENDOR/SERVICE PROVIDER __X__YES_______NO One-Day Passes Only:_X______________________NCAC Credential________________

COMPANY NAME _____________________________________________________

MAILING ADDRESS:

DESCRIPTION OF WORK TO BE PERFORMED: One time pre-proposal site visit for RFP N62742-19-R-1310, Unaccompanied Enlisted Housing, Naval Base Guam, Joint Region Marianas, Guam AREA(S) OF ACCESS (i.e.: Main Base, NCTS, USNH, etc.)

Main Base, Naval Base Guam

AUTHORIZED DATE

19 March 2019

DEFAULT ACCESS TIME: 0500-1800, Monday to Saturday JUSTIFICATION is required for access other than the DEFAULT TIME above:

DURATION/EXPIRATION DATE:

1 day pass for 3/19/19

EMPLOYEE(S) LAST NAME, FIRST NAME:

SSN:

DOB:

(Note: Full SSN is needed to properly identify persons requesting access. Failure to provide this information may prevent Naval Base Guam from processing your request)

Authorized Sponsor/GOVT AGENCY POC (NAME AND TITLE): Kevin Perez, Contract Specialist, NAVFAC MAR

POC TELEPHONE NUMBER: 671-333-2581

POC EMAIL ADDRESS: Eddie.Pelkey@fe.navy.mil

A STANDARD ADVANCE NOTICE OF ONE WEEK IS REQUIRED, ALTHOUGH BONIFIED EMERGENCIES WILL BE CONSIDERED ON A CASE, BY CASE BASIS. Requests for weekend, non-standard duty hours and access to restricted areas (i.e. the naval magazine or supply) require special consideration and longer processing times. Please take this into consideration when making your requests.