Section L Appendix 1 - KSC Form 28-889 Visitor Badge Request.pdf
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- Attached to
- Modify Vehicle Assembly Building High Bay-3 Platforms for Block 1B Federal contract opportunity
- Solicitation number
- 80KSC021R0020
About this file
This document is a visitor badge request form for NASA's Kennedy Space Center. The form requests information for multiple visitors including full name, country of citizenship, social security number or passport information, date of birth, place of birth, company name and address. It also requires the dates of the visit and whether the visitor will be escorted. The form notes that the information collected is considered personally identifiable information and subject to federal privacy laws.
The related federal contract opportunity is a solicitation from NASA's Kennedy Space Center to modify vehicle assembly building high bay platforms. The contractor will fabricate and install new platforms weighing approximately 300,000 pounds each in the vehicle assembly building. Work will include constructing new floors, rooms, walls and ceilings. Additional ancillary work involves modifying and extending fire suppression, electrical, and gas systems. Installation will take place at heights ranging from 280 to 450 feet, requiring expertise in high altitude construction. The facility will remain operational, so construction must be completed during downtimes between launches.
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KSC Visitor Badge Request (Multiple)
NRRS 1620.105.A
Page of KSC FORM 28-889 NS (PI) 08/13 (1.1) PREVIOUS EDITIONS ARE OBSOLETE. Validate prior to use.
Fax No. 867-4854 Mail Code: KSC Badging Office Phone No. 867-7763 Through signature above I attest to the validity and purpose of this visit.
FULL NAME (Last, First, MI)
COUNTRY OF CITIZENSHIP
SSN/Passport/Naturalization # or Alien Reg. # (Green Card) COMPANY NAME and ADDRESS
DATE OF BIRTH
PLACE OF BIRTH
START DATE
END DATE
To Be Escorted Y/N WARNING. When filled in, this form contains Personally Identifiable Information (PII) that is subject to Federal law and regulation. PII may be used only as authorized, which includes securing it in accordance with NASA policy and procedural requirements. Penalties for misuse apply.
Report suspected misuse immediately to Security Operations Center at 877-NASA-SEC (627-2732).
05/05/14 05/05/14 05/05/14 05/05/14 05/05/14 05/05/14 05/05/14 05/05/14 05/05/14 9.0.0.2.20101008.1.734229 KSC Visitor Badge Request (Multiple) KSC FORM 28-889 Rev 08/13, Created 08/13 Version 1.1 08/13 KSC Forms KSC Visitor Badge Request (Multiple) 08/13 1.1
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