SFS Form 12 - Template1.xls
XLS spreadsheet 58 KB Posted
- Attached to
- 115 FW Construct Alert GOV Parking Shelter
- Solicitation number
- W50S9F26BA011
- Issued by
-
Department of the Army National Guard
About this file
This is a Truax Field Pre-Authorization Request Form (SFS Form 12) used for personnel access control at Truax Field in Madison, Wisconsin. The form is a template designed to collect and validate personal identification information for contractor and vendor personnel requiring base access. Each form accommodates up to 35 individuals per page and requires the following data: full name (matching driver's license), date of birth, gender, driver's license number and state of issue, and previous state of residence. The form includes fields for company information (company name, point of contact, address, phone, and email), project details (project location, prime contractor, start and end dates), and project point of contact information. Each entry must be validated and authenticated by authorized security personnel with corresponding dates. The form is associated with the 115th Fighter Wing's Construct Alert Government Owned Vehicles (GOV) Parking Shelter project, a construction requirement for two aerospace control alert mission shelters with a budget range of $1,250,000 to $1,750,000. This is a 100% Total Small Business Set-Aside under NAICS Code 236220 (Commercial and Institutional Building Construction). The form itself is a standard access control template rather than substantive contract documentation, serving as an administrative tool for security clearance and base access authorization for personnel supporting the solicitation W50S9FG-26-B-A011.
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Sheet1
| TRUAX FIELD PRE-AUTHORIZATION REQUEST FORM | |||||||
| Company Name: | Project Location: | Truax Field, Madison, WI 53704 | |||||
| Company POC: | Project Prime: | TBD | |||||
| Company Address: | Start Date: | 8/20/26 | |||||
| End Date: | 8/20/26 | ||||||
| Company POC PH#: | Project POC: | Lt Col Dave Mattila | |||||
| Company POC Email: | Project POC Phone #: | 608-245-4788 | |||||
| NAME MUST MATCH WHAT IS ON YOUR DRIVER'S LICENSE | |||||||
| NAME: LAST | FIRST | MI | DOB | M/F | DRIVER'S LICENSE #/STATE | PREVIOUS STATE RESIDED | |
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| NAME MUST MATCH WHAT IS ON YOUR DRIVER'S LICENSE | |||||||
| Validated by: | Authenticated by: | ||||||
| Date: | Date: | ||||||
| 115 SFS Form 12 (30JUL19) | |||||||
| Company Name: | Project Location: | ||||||
| Company POC: | Project Prime: | ||||||
| Company Address: | Start Date: | ||||||
| End Date: | |||||||
| Company POC PH#: | Project POC: | ||||||
| Company POC Email: | Project POC Phone #: | ||||||
| NAME MUST MATCH WHAT IS ON YOUR DRIVER'S LICENSE | |||||||
| NAME: LAST | FIRST | MI | DOB | M/F | DRIVER'S LICENSE #/STATE | PREVIOUS STATE RESIDED | |
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| NAME MUST MATCH WHAT IS ON YOUR DRIVER'S LICENSE | |||||||
| Validated by: | Authenticated by: | ||||||
| Date: | Date: | ||||||
| 115 SFS Form 12 (30JUL19) | |||||||
| TRUAX FIELD PRE-AUTHORIZATION REQUEST FORM | |||||||
| Company Name: | Project Location: | ||||||
| Company POC: | Project Prime: | ||||||
| Company Address: | Start Date: | ||||||
| End Date: | |||||||
| Company POC PH#: | Project POC: | ||||||
| Company POC Email: | Project POC Phone #: | ||||||
| NAME MUST MATCH WHAT IS ON YOUR DRIVER'S LICENSE | |||||||
| NAME: LAST | FIRST | MI | DOB | M/F | DRIVER'S LICENSE #/STATE | PREVIOUS STATE RESIDED | |
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| NAME MUST MATCH WHAT IS ON YOUR DRIVER'S LICENSE | |||||||
| Validated by: | Authenticated by: | ||||||
| Date: | Date: | ||||||
| 115 SFS Form 12 (30JUL19) | |||||||
| TRUAX FIELD PRE-AUTHORIZATION REQUEST FORM | |||||||
| Company Name: | Project Location: | ||||||
| Company POC: | Project Prime: | ||||||
| Company Address: | Start Date: | ||||||
| End Date: | |||||||
| Company POC PH#: | Project POC: | ||||||
| Company POC Email: | Project POC Phone #: | ||||||
| NAME MUST MATCH WHAT IS ON YOUR DRIVER'S LICENSE | |||||||
| NAME: LAST | FIRST | MI | DOB | M/F | DRIVER'S LICENSE #/STATE | PREVIOUS STATE RESIDED | |
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| NAME MUST MATCH WHAT IS ON YOUR DRIVER'S LICENSE | |||||||
| Validated by: | Authenticated by: | ||||||
| Date: | Date: | ||||||
| 115 SFS Form 12 (30JUL19) | |||||||
| TRUAX FIELD PRE-AUTHORIZATION REQUEST FORM | |||||||
| Company Name: | Project Location: | ||||||
| Company POC: | Project Prime: | ||||||
| Company Address: | Start Date: | ||||||
| End Date: | |||||||
| Company POC PH#: | Project POC: | ||||||
| Company POC Email: | Project POC Phone #: | ||||||
| NAME MUST MATCH WHAT IS ON YOUR DRIVER'S LICENSE | |||||||
| NAME: LAST | FIRST | MI | DOB | M/F | DRIVER'S LICENSE #/STATE | PREVIOUS STATE RESIDED | |
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| NAME MUST MATCH WHAT IS ON YOUR DRIVER'S LICENSE | |||||||
| Validated by: | Authenticated by: | ||||||
| Date: | Date: | ||||||
| 115 SFS Form 12 (30JUL19) |
&C&P of &N&R
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