SOW Exhibit B - Contractor Information Shee.xlsx
XLSX spreadsheet 38 KB Posted
- Solicitation number
- 20161895
About this file
This is a Contractor Information Sheet template used by U.S. Customs and Border Protection (CBP) for managing short-term contractor and visitor access to CBP facilities. The form collects comprehensive personal and identification information for contractors and their personnel seeking entry to CBP locations, including full names, dates of birth, citizenship status, passport and visa details, driver's license information, Social Security numbers, and occupation. The sheet accommodates up to 84 individuals and requires designation of a CBP employee visitor escort and an on-site contractor point of contact with corresponding contact information.
Submission of the completed form is mandatory 72 hours prior to visitor arrival and must be directed to the Security Management Division via email at SMDSECURITYSERVICESBRANCH@cbp.dhs.gov or fax to 202-344-1860. All visitors must present U.S. Government-issued photo identification, check in and out at the Security Desk, and maintain constant escort by designated CBP employees throughout their time on CBP premises; one escort is required for every four visitors depending on vetting status, with some individuals requiring one-to-one escort. The form operates under the Privacy Act of 1974 and is used to conduct minimum security checks prior to granting limited authorized access to CBP facilities, with failure to provide required information resulting in denial of access.
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Text version
Short Term Contractors Template
| CBP Contractor Information Sheet | |
| Date Submitted: | From: |
| Contract Company Information | CBP Agency Information |
| Contract Company Name | CBP Location Address (Location, Building, Floor, Room #) |
Contract Company Address Visitor Escort Full Name (DHS/CBP Employee Only)
Contract Company POC (First & Last Name) Phone Number Email
On Site Contractor POC (First & Last Name) Phone Number Phone Office Mobile Office
| Date(s) and | |||||
| Time(s) of Visit | From Date | Time | To Date | Time |
| Purpose of Visit: | ||||||||||||||||||
| Provide all below information | ||||||||||||||||||
| # | Last Name(s) | First Name | Middle Name | DOB MM/DD/YYYY | U.S. Citizen (Y/N) | POB (City, State/ Country) | Occupation | Address | A Number | Exp Date | Visa Number | Exp Date | Passport Country | Passport # | Exp Date | Social Security Number | DL State Issued | Drivers |
License #
| 1 |
| 2 |
| 3 |
| 4 |
| 5 |
| 6 |
| 7 |
| 8 |
| 39 |
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| 84 |
| SUBMISSION: The Office of Professional Responsibility requires a mandatory submission of 72 hours prior to arrival of visitor(s) in order for any visitor to be considered for approval. Email request to SMDSECURITYSERVICESBRANCH@cbp.dhs.gov or fax to the Office of Professional Responsibility, ATTN: Security Management Division at 202-344-1860. |
NOTICE: All visitors must present a U.S. Government issued Photo Identification Card. All visitors must check in at the Security Desk upon arrival and check out at the desk upon departure. Visitor escorts are responsible for constant escort of visitors. The designated escort must accompany visitors at all times, to include returning visitors back to the front desk upon departure. Any visitors found in U.S. Customs and Border Protection space without an escort will be immediately reported to security and escortedout of CBP space. One escort must be provided for every four visitors (1-4), depending on Vetting status one escort may be required for evey person (1-1).
PRIVACY ACT NOTICE: This information is provided to PL 93-579 (Privacy Act of 1974). The purpose of this document is provide information necessary for a minimum security check prior tolimited authorized access to U.S. Customs and Border Protection facility. Failure to provide this information may result in denial of access.
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