Security Forces Site Visit Entry Form.pdf

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Attached to
Construct Security Forces Facility Federal contract opportunity
Solicitation number
W50S8W21R0002
Issued by
Department of the Army National Guard

About this file

This document contains a security forces site visit entry form and related federal contract opportunity notice. The site visit entry form requires submission by May 19th for a site visit on May 25th to the Wyoming Air National Guard base regarding solicitation number W50S8W21R0002 for the construction of a new security forces facility. The form collects names, dates of birth, driver's license numbers and issuing states for up to twelve individuals requiring escorted base access. The related contract opportunity is for the construction of the security forces facility, with requests for information due by June 1st and answers to be posted by June 4th. A site visit will be conducted on May 25th, and the completed entry form must be emailed by May 19th for visitor access. The Department of the Army National Guard is the contracting agency.

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Text version

ENTRY AUTHORITY LIST (EAL)

PRIVACY ACT STATEMENT: 1. AUTHORITY: USC Title 10, 8013 2. PURPOSE: Used to collect information needed for entry control to the 153d Airlift Wing.

3. ROUTINE USES: This information will not be disclosed outside the Department of Defense. 4. DISCLOSURE: Voluntary. However, failure to provide information results in the denial of entry to the 153d Airlift Wing.

The following individuals will be on the installation for the listed function/business and dates stated. All individuals listed will be escorted at all times by the Point of Contact for this EAL. This EAL is used for business/functions not associated with contracts.

DESCRIPTION OF BUSINESS/FUNCTION: LOCATION OF BUSINESS/FUNCTION INCLUSIVE DATES:

POINT OF CONTACT: (Last, First, MI) PHONE #: UNIT: DATE SUBMITTED:

#1. NAME: (Last, First, MI) DATE OF BIRTH: DRIVER LICENSE #: STATE OF ISSUE:

#2. NAME: (Last, First, MI) DATE OF BIRTH: DRIVER LICENSE #: STATE OF ISSUE:

#3. NAME: (Last, First, MI) DATE OF BIRTH: DRIVER LICENSE #: STATE OF ISSUE:

#4. NAME: (Last, First, MI) DATE OF BIRTH: DRIVER LICENSE #: STATE OF ISSUE:

#5. NAME: (Last, First, MI) DATE OF BIRTH: DRIVER LICENSE #: STATE OF ISSUE:

#6. NAME: (Last, First, MI) DATE OF BIRTH: DRIVER LICENSE #: STATE OF ISSUE:

#7. NAME: (Last, First, MI) DATE OF BIRTH: DRIVER LICENSE #: STATE OF ISSUE:

#8. NAME: (Last, First, MI) DATE OF BIRTH: DRIVER LICENSE #: STATE OF ISSUE:

#9. NAME: (Last, First, MI) DATE OF BIRTH: DRIVER LICENSE #: STATE OF ISSUE:

#10. NAME: (Last, First, MI) DATE OF BIRTH: DRIVER LICENSE #: STATE OF ISSUE:

#11. NAME: (Last, First, MI) DATE OF BIRTH: DRIVER LICENSE #: STATE OF ISSUE:

#12. NAME: (Last, First, MI) DATE OF BIRTH: DRIVER LICENSE #: STATE OF ISSUE:

AUTHENTICATED BY SFS: (LAST, FIRST, MI) AUTHENTICATED BY SFS: (SIGNATURE) DATE:

153AW FORM 12, 20200701 PREVIOUS EDITIONS OBSOLETE

Security Forces Site Visit Bldg 16 Lecture Hall 5/25/2021

Santos, Desiree M 307-772-6887 153 MSG

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