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
Issued by

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 FACILITIESSERMC access requests for:
1. U.S. Citizen1. SERMC Contracts
2. Foreign National with appropriate approval2. 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 facilityNote: 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:
2bDo not change (Default is SERMC)
3bEnter the name of the Agency
4bEnter the Contract Number. NOTE: This must be the PRIME CONTRACT. DO NOT USE PRIME CONTRACTOR ISSUED PO, etc.
5bSelect the type of contract from the pull-down menu.
6bSelect the ship or agency to be visited from the pull-down menu. VARIOUS SHIPS CAN BE LISTED HERE.
7bEnter the name of the FSO or Agency Point of Contact.
8bEnter the phone number (XXX-XXX-XXXX) for the point of contact listed in field 5b.
9bEnter 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 LLeave 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 INFORMATIONE-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 ContractSelect 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 NameSuffixFirst NameMiddle InitialEmployerUnique IdentifierU.S. CitizenDBIDS ISSUED (YES/NO)PurposeStart DateEnd Date

EXAMPLE

INDUSTRY/GOVERNMENT AGENCY INFORMATIONE-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 ContractAIT
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 NameSuffixFirst NameMiddle InitialEmployerUnique IdentifierU.S. CitizenDBIDS ISSUED (YES/NO)PurposeStart DateEnd Date
DoeSRJohnWShip Repair Company NamexxxxxNOYESWelding4/13/254/14/25

SERMC_Ships (DO NOT DELETE TAB)

Select ShipSuffix Field DataCitizenshipType of ContractYes
SERMCJRYESSelect from Pulldown Menu:
USS RAMAGE DDG-61SRNOSurface Combatant IDIQ MACNo
USS CARNEY DDG-64INon IDIQ Contract (C - Contract, Purchase Order)
USS THE SULLIVANS DDG-68IICIS IDIQ (Barge, Crane, Lagging, VLS, Staging, Preservation, Rigging)
USS DONALD COOK DDG-75IIIServices Contract
USS WINSTON S CHURCHILL DDG-81IVAIT
USS LASSEN DDG-82Other
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)

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