Exhibit_02(a)__Form_139_ABWNC.pdf

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FMSS CONSOLIDATED ARMED GUARD SERVICES
Solicitation number
TIRMS-17-R-00003
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EXHIBIT 02a - FORM 139

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PHYSICAL SECURITY AND EMERGENCY PREPAREDNESS

MONTHLY GUARD REGISTER

YEAR

DATE

(a)

PRINT NAME

(Last-First-Initial)

(b)

SIGNATURE IN

NAME OF POST

(d)

POST #

(e)

SIGNATURE OUT

(f)

SEE

FOOTNOTE

TIME of

ARRIVAL

(g)

TIME of

DEPARTURE

(h)

MONTH

* IRS PSEP COR and Contract Administration personnel, when conducting an inspection or investigation, must place an "X" in this column in RED INK

Revised for IRS internal usage March 2012

CAUTION: False entries on this document will be cause for removal from all government contracts

RECORD OF TIME OF ARRIVAL AND DEPARTURE

CONTRACT GUARDING DUTY REGISTER

SITE/ BUILDING ADDRESS

FORM 139 1

F139

SITE/ BUILDING ADDRESS:
YEAR:
MONTH:
(DATE (a), <Row 1>):
(PRINT NAME (Last-First-Initial) (b), <Row 1>):
(SIGNATURE IN ©, <Row 1>):
(NAME OF POST (d), <Row 1>):
(POST # (e), <Row 1>):
(SIGNATURE OUT (f), <Row 1>):
(SEE FOOTNOTE *, <Row 1>):
(TIME of ARRIVAL (g), <Row 1>):
(TIME of DEPARTURE (h), <Row 1>):
(DATE (a), <Row 2>):
(PRINT NAME (Last-First-Initial) (b), <Row 2>):
(SIGNATURE IN ©, <Row 2>):
(NAME OF POST (d), <Row 2>):
(POST # (e), <Row 2>):
(SIGNATURE OUT (f), <Row 2>):
(SEE FOOTNOTE *, <Row 2>):
(TIME of ARRIVAL (g), <Row 2>):
(TIME of DEPARTURE (h), <Row 2>):
(DATE (a), <Row 3>):
(PRINT NAME (Last-First-Initial) (b), <Row 3>):
(SIGNATURE IN ©, <Row 3>):
(NAME OF POST (d), <Row 3>):
(POST # (e), <Row 3>):
(SIGNATURE OUT (f), <Row 3>):
(SEE FOOTNOTE *, <Row 3>):
(TIME of ARRIVAL (g), <Row 3>):
(TIME of DEPARTURE (h), <Row 3>):
(DATE (a), <Row 4>):
(PRINT NAME (Last-First-Initial) (b), <Row 4>):
(SIGNATURE IN ©, <Row 4>):
(NAME OF POST (d), <Row 4>):
(POST # (e), <Row 4>):
(SIGNATURE OUT (f), <Row 4>):
(SEE FOOTNOTE *, <Row 4>):
(TIME of ARRIVAL (g), <Row 4>):
(TIME of DEPARTURE (h), <Row 4>):
(DATE (a), <Row 5>):
(PRINT NAME (Last-First-Initial) (b), <Row 5>):
(SIGNATURE IN ©, <Row 5>):
(NAME OF POST (d), <Row 5>):
(POST # (e), <Row 5>):
(SIGNATURE OUT (f), <Row 5>):
(SEE FOOTNOTE *, <Row 5>):
(TIME of ARRIVAL (g), <Row 5>):
(TIME of DEPARTURE (h), <Row 5>):
(DATE (a), <Row 6>):
(PRINT NAME (Last-First-Initial) (b), <Row 6>):
(SIGNATURE IN ©, <Row 6>):
(NAME OF POST (d), <Row 6>):
(POST # (e), <Row 6>):
(SIGNATURE OUT (f), <Row 6>):
(SEE FOOTNOTE *, <Row 6>):
(TIME of ARRIVAL (g), <Row 6>):
(TIME of DEPARTURE (h), <Row 6>):
(DATE (a), <Row 7>):
(PRINT NAME (Last-First-Initial) (b), <Row 7>):
(SIGNATURE IN ©, <Row 7>):
(NAME OF POST (d), <Row 7>):
(POST # (e), <Row 7>):
(SIGNATURE OUT (f), <Row 7>):
(SEE FOOTNOTE *, <Row 7>):
(TIME of ARRIVAL (g), <Row 7>):
(TIME of DEPARTURE (h), <Row 7>):
(DATE (a), <Row 8>):
(PRINT NAME (Last-First-Initial) (b), <Row 8>):
(SIGNATURE IN ©, <Row 8>):
(NAME OF POST (d), <Row 8>):
(POST # (e), <Row 8>):
(SIGNATURE OUT (f), <Row 8>):
(SEE FOOTNOTE *, <Row 8>):
(TIME of ARRIVAL (g), <Row 8>):
(TIME of DEPARTURE (h), <Row 8>):
(DATE (a), <Row 9>):
(PRINT NAME (Last-First-Initial) (b), <Row 9>):
(SIGNATURE IN ©, <Row 9>):
(NAME OF POST (d), <Row 9>):
(POST # (e), <Row 9>):
(SIGNATURE OUT (f), <Row 9>):
(SEE FOOTNOTE *, <Row 9>):
(TIME of ARRIVAL (g), <Row 9>):
(TIME of DEPARTURE (h), <Row 9>):
(DATE (a), <Row 10>):
(PRINT NAME (Last-First-Initial) (b), <Row 10>):
(SIGNATURE IN ©, <Row 10>):
(NAME OF POST (d), <Row 10>):
(POST # (e), <Row 10>):
(SIGNATURE OUT (f), <Row 10>):
(SEE FOOTNOTE *, <Row 10>):
(TIME of ARRIVAL (g), <Row 10>):
(TIME of DEPARTURE (h), <Row 10>):
(DATE (a), <Row 11>):
(PRINT NAME (Last-First-Initial) (b), <Row 11>):
(SIGNATURE IN ©, <Row 11>):
(NAME OF POST (d), <Row 11>):
(POST # (e), <Row 11>):
(SIGNATURE OUT (f), <Row 11>):
(SEE FOOTNOTE *, <Row 11>):
(TIME of ARRIVAL (g), <Row 11>):
(TIME of DEPARTURE (h), <Row 11>):
(DATE (a), <Row 12>):
(PRINT NAME (Last-First-Initial) (b), <Row 12>):
(SIGNATURE IN ©, <Row 12>):
(NAME OF POST (d), <Row 12>):
(POST # (e), <Row 12>):
(SIGNATURE OUT (f), <Row 12>):
(SEE FOOTNOTE *, <Row 12>):
(TIME of ARRIVAL (g), <Row 12>):
(TIME of DEPARTURE (h), <Row 12>):
(DATE (a), <Row 13>):
(PRINT NAME (Last-First-Initial) (b), <Row 13>):
(SIGNATURE IN ©, <Row 13>):
(NAME OF POST (d), <Row 13>):
(POST # (e), <Row 13>):
(SIGNATURE OUT (f), <Row 13>):
(SEE FOOTNOTE *, <Row 13>):
(TIME of ARRIVAL (g), <Row 13>):
(TIME of DEPARTURE (h), <Row 13>):
Revised for IRS internal usage March 2012:
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