P-4b Navy DBIDS Contractor Visit Request (SERMC 5220_2 Rev 6_25) (Fillable).xlsx
XLSX spreadsheet 257 KB Posted
- Attached to
- USS WICHITA (LCS 13) Docking Selected Restricted Availability (DSRA) - Paint OEM and Technical Services
- Solicitation number
- N40027-26-R-0008
About this file
This is a Navy Contractor Visitor Access Request Form (SERMC 5220.2 Rev 6/25) used to request facility and vessel access for contractor personnel supporting Navy maintenance and repair work.
The form establishes minimum requirements for contractor visitor access to U.S. Navy ships and facilities, including U.S. citizenship or foreign national status with appropriate approval, verification of age (18 years or older), and confirmation that visitors have no prior restrictions on Navy vessel access. Requesters must complete agency information fields including the prime contract number, contract type, specific ship or facility to be visited, and the Facility Security Officer (FSO) or Agency Point of Contact (POC) details. For each visitor, the form requires completion of personal information fields including full legal name, employer, unique non-PII identifier from employer ID card, citizenship status, DBIDS issuance confirmation, purpose of visit, and start/end dates. Access requests must be submitted via email to sermc_mypt_security@us.navy.mil with separate emails for initial requests, deletions, additions, or changes; each email should contain only one access request and use a specific subject line format identifying the vessel/facility and date range. Visit requests are limited to the period of performance or one calendar year, whichever is shorter, and cannot be backdated. For classified access to restricted areas, a separate DISS Visit Request is required and must be submitted directly to the ship rather than SERMC. The form includes dropdown menus listing eligible vessels such as various DDG-class destroyers, LCS-class ships, and other Navy vessels, as well as contract type categories (IDIQ, Services Contract, Non-IDIQ Contract, and others).
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Instructions (READ FIRST)
CONTRACTOR VISITOR ACCESS REQUEST FORM
UPDATED: JULY 2021
| MINIMUM REQUIREMENTS FOR ACCESS TO U.S. SHIPS AND FACILITIES | SERMC access requests for: | ||
| 1. U.S. Citizen | 1. SERMC Contracts | ||
| 2. Foreign National with appropriate approval | 2. SERMC-Administered Contracts | ||
| 2. Must be 18 Y.O. | 3. Contracts directly supporting SERMC administered Avails/work efforts | ||
| 3. Verifiable requirement to access U.S. ship or facility | Note: Routine Administrative Access (those not associated with a SERMC monitored availability) or requests for access only to shipyards will not be processed. | ||
| INSTRUCTIONS FOR FIELDS 1B THRU 7B: | |||
| 2b | Do not change (Default is SERMC) | ||
| 3b | Enter the name of the Agency | ||
| 4b | Enter the Contract Number. NOTE: This must be the PRIME CONTRACT. DO NOT USE PRIME CONTRACTOR ISSUED PO, etc. | ||
| 5b | Select the type of contract from the pull-down menu. | ||
| 6b | Select the ship or agency to be visited from the pull-down menu. VARIOUS SHIPS CAN BE LISTED HERE. | ||
| 7b | Enter the name of the FSO or Agency Point of Contact. | ||
| 8b | Enter the phone number (XXX-XXX-XXXX) for the point of contact listed in field 5b. | ||
| 9b | Enter the e-mail address for the point of contact listed in field 5b. | ||
| INSTRUCTIONS FOR VISITOR INFORMATION FIELDS (starts from Line 10) FILL OUT ONLY THE BLUE FIELDS. DO NOT USE ANY PUNCTUATION BESIDES HYPHEN | |||
| Last Name (Column A) | Full, Legal Last Name of the Visitor | ||
| Suffix (Column B) | Legal Suffix (II, III, IV, JR, SR, etc.) | ||
| First Name (Column C) | Full, Legal First Name of the Visitor | ||
| Middle Name (Column D) | Must be either; 1) Full Middle Name 2) middle initial, 3) if no middle name, NMN | ||
| Employer (Column E) | Actual employer of the visitor. | ||
| Unique Identifier (Column F) | A unique, Non-PII, element that can identify the employee and issued on the Employeer issued Id Card CAN NOT BE SSN, DRIVERS LICENCE or ANY OTHER PII SENSITIVE ELEMENT | ||
| US CITIZEN (Column G) | Yes or No. (NOTE 1: For naturalized citizens, Select YES.) | ||
| DBIDS ISSUED (Column H) | Yes or No. (NOTE 2: For Naval Station Mayport DBIDS issued only, Select YES.) | ||
| Purpose (Column I) | The purpose of the visit. | ||
| Start Date (Column J) | Start Date of the Visit. NOTE: VISIT REQUEST START DATES CANNOT BE DATED PRIOR TO THE SUBMISSION OF THE REQUEST. Do not backdate visit requests. | ||
| End Date (Column K) | End Date of the Visit. | ||
| Column L | Leave Blank. Reserved for future use. | ||
| NOTE: VISIT REQUESTS WILL ONLY BE GRANTED FOR THE PERIOD OF PERFORMANCE OR ONE CALENDAR YEAR, WHICHEVER IS SHORTER. |
Notice to Industry Facility Security Officers/Security Managers/Agency POC:
By submitting visit requests, FSOs or Agency POC are acknowledging that the proper due diligence has been performed to verify each visitor:
1) meets all legal requirements to work onboard U.S. government facilities
2) is a US CITIZEN. If No, Company FSO or Agency POC validates/verifies that the individual listed is legally allowed to work in the United States and will not be accessing restricted areas.
3) over the age of 18.
4) has not been previously restricted or denied eligibility for access to perform maintenance onboard US Navy vessels or at SERMC.
| ACCESS LIST SUBMISSION GUIDELINES |
| E-mail the request to: sermc_mypt_security@us.navy.mil. NOTE: ONLY ONE ACCESS REQUEST PER E-MAIL. ENSURE separate e-mails for: 1) Initial request 2) Deletions/Removals 3) Additions 4) Changes (i.e. contract or avail extensions) NOTE: For any submissions after the INITIAL, DO NOT CHANGE THE START DATE. |
| Subject Line and Contractor Visit Request must read/save as the same: <ship to be visited>/ <Prime Contractor> (Or state "Multiple Sub-contractors" for multiple subcontractors.)/ <dates of visit>. Industry Example: USS BOXER/AMEE BAY/1Jun25 - 9SEP25 or USS BOXER/Multiple Sub-Contractors/1JUN25 - 30JUN25 VARIOUS SHIPS OR MULTIPLE SHIPS/AMEE BAY/1Jun25 - 9SEP25 |
| NOTE: FOR 'Classified Access" to Restricted Areas: DISS Visit Request is required. ALL Classified Access Requests must be submitted to the ship (not SERMC) via the Defense Information System of Security (DISS). |
SERMC 5220/2 (Rev. 6/25)
DO NOT add any spaces/or press tab after you enter your information for Lines 2-9.
We wil be unable to approve your request until all corrections have been made.
Personnel Info
| AGENCY INFORMATION | E-mail the request to: sermc_mypt_security@us.navy.mil NOTE: ONLY ONE ACCESS REQUEST PER E-MAIL: 1) Initial request 2) Deletions/Removals 3) Additions 4) Changes (i.e. contract or Avail extensions) NOTE: Visit Requests cannot exceed a year. VISIT REQUESTS WILL ONLY BE GRANTED FOR THE PERIOD OF PERFORMANCE OR ONE YEAR, WHICHEVER IS SHORTER. (CANNOT SELF REQUEST ACCESS) | |||||||||
| Contract Support Region: | SERMC | |||||||||
| Contracting Prime: | ||||||||||
| Contract Number: | ||||||||||
| Type of Contract | Select from Pulldown Menu: | |||||||||
| Naval Vessel or SERMC: | Various or Multiple Ships Can Be Listed Here: | |||||||||
| Facility Security Officer (FSO)/Agency POC: | ||||||||||
| FSO/Agency POC Telephone Number: | ||||||||||
| FSO/Agency POC Email: | ||||||||||
| Last Name | Suffix | First Name | Middle Initial | Employer | Unique Identifier | U.S. Citizen | DBIDS ISSUED (YES/NO) | Purpose | Start Date | End Date |
EXAMPLE
| INDUSTRY/GOVERNMENT AGENCY INFORMATION | E-mail the request to: sermc_mypt_security@us.navy.mil NOTE: ONLY ONE ACCESS REQUEST PER E-MAIL: 1) Initial request 2) Deletions/Removals 3) Additions 4) Changes (i.e. contract or Avail extensions) NOTE: Visit Requests cannot exceed a year. VISIT REQUESTS WILL ONLY BE GRANTED FOR THE PERIOD OF PERFORMANCE OR ONE YEAR, WHICHEVER IS SHORTER. (CANNOT SELF REQUEST ACCESS) | |||||||||
| Contract Support Region: | SERMC | |||||||||
| Agency: | Ship Repair Company Name | |||||||||
| Contract Number: | N40027-25-F-0001; N40027-25-D-0001 | |||||||||
| Type of Contract | AIT | |||||||||
| SERMC or Ship: | USNS HUNTER NS 8102; USS NEVERSAIL FFG 50 | |||||||||
| Facility Security Officer (FSO)/Agency POC: | Jane Doe | |||||||||
| FSO/Agency POC Telephone Number: | 904-777-9999 | |||||||||
| FSO/Agency POC Email: | john.doe@companyname.com | |||||||||
| Last Name | Suffix | First Name | Middle Initial | Employer | Unique Identifier | U.S. Citizen | DBIDS ISSUED (YES/NO) | Purpose | Start Date | End Date |
| Doe | SR | John | W | Ship Repair Company Name | xxxxx | NO | YES | Welding | 4/13/25 | 4/14/25 |
SERMC_Ships (DO NOT DELETE TAB)
| Select Ship | Suffix Field Data | Citizenship | Type of Contract | Yes |
| SERMC | JR | YES | Select from Pulldown Menu: | |
| USS RAMAGE DDG-61 | SR | NO | Surface Combatant IDIQ MAC | No |
| USS CARNEY DDG-64 | I | Non IDIQ Contract (C - Contract, Purchase Order) | ||
| USS THE SULLIVANS DDG-68 | II | CIS IDIQ (Barge, Crane, Lagging, VLS, Staging, Preservation, Rigging) | ||
| USS DONALD COOK DDG-75 | III | Services Contract | ||
| USS WINSTON S CHURCHILL DDG-81 | IV | AIT | ||
| USS LASSEN DDG-82 | Other | |||
| USS MASON DDG-87 | ||||
| USS FARRAGUT DDG-99 | ||||
| USS JASON DUNHAM DDG-109 | ||||
| USS THOMAS HUDNER DDG-116 | ||||
| USS DELBERT D BLACK DDG-119 | ||||
| USS JOHN BASILONE DDG-122 | ||||
| MV VINDICATOR | ||||
| NECC PATROL CRAFT | ||||
| OTHER (VISIT SHIP) |
File details come from the government source that posted it. Updated .