Security Info Sheet (SIS v. 4).pdf
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- Solicitation number
- W91237-SN-0002
About this file
This is a Security Information Sheet (version 4) required for visitors to U.S. Army Corps of Engineers properties. The form requires detailed personal information including full name, date of birth, SSN, place of birth, citizenship status, contact information, and contractor/supervisor details including prime contract or task order numbers. For non-U.S. persons, additional documentation is required including passport, U.S. residency proof, and work visa, along with start/end dates and justification.
The form must be submitted to the Huntington District Security Office, specifically to Stephen R. Curry (PERSEC), Travis L. Berry (Antiterrorism), and William M. Tomblin (Physical Security). The document states that all blocks must be completed or the submittal will be rejected. This version is dated September 23, 2024, with previous editions noted as obsolete. The form is specifically referenced in relation to an Industry Day event for Fiber Reinforced Polymer contractors at the Robert C. Byrd Locks and Dam facility.
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Other files
| File | Type | Posted |
|---|---|---|
| FRP Industry Day Security Info Sheet (SIS v. 4).pdf |
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Text version
SECURITY INFORMATION SHEET version 4
Full Name (Last, First, Middle)
Date of Birth (MM/DD/YYYY)
Full SSN
City and State of Birth
Country of Birth
US Citizen (check one) Yes ___ or No ___
Email Address
Phone Numbers Primary
Secondary
Prime Contractor Name (Supervisor if you work for Prime)
Prime Contractor E-mail (Supervisor if you work for Prime)
Prime Contractor Phone Number (Supervisor if you work for Prime)
Prime Contract Number _______________________________________________________, or Task Order Number
Corps of Engineers COR or ACO
All blocks must be filled out or submittal will be rejected.
* See page 2 for additional documents required.
Send to Huntington District Security Office
Stephen R. Curry, PERSEC stephen.r.curry@usace.army.mil
Travis L. Berry, Antiterrorism travis.l.berry@usace.army.mil
William M. Tomblin, Physical Security william.m.tomblin@usace.army.mil
23 Sept 2024 Previous Editions Obsolete
H1CTXESH
Highlight
Non- U.S. Persons
Blank Page
| Full SSN: |
| City and State of Birth: |
| Country of Birth: |
| Email Address: |
| Primary: |
| Secondary: |
| Prime Contract Number: |
| Task Order Number: |
| Corps of Engineers COR or ACO: |
| Full Name: |
| Date of Birth: |
| Citizenship: Yes |
| Prime contractor or supervisor's name: |
| Prime Contractor or Supervisor's Email (if you work for Prime): |
| Prime Contractor Phone Number (Supervisor if you work for Prime): |
| List Box1: [] |
| Check Box4: Off |
| Check Box5: Off |
| Check Box6: Off |
| Passport Data Page: Passport Attached |
| Proof of US Permanent Residency: U.S. Residency Proof Attached |
| Work Visa: Work VISA attached |
| Start: |
| End: |
| Justification: |
| Start Date Label: Start Date |
| End Date Label: End Date |
| Justification Label: Justification |
File details come from the government source that posted it. Updated .