C-3_Clearance_Report_Form-SF117.doc
Standard Form DOC document 43 KB Posted
- Attached to
- Vehicle Sliding Gate Project and Perimeter Security Upgrade-United States Mint San Francisco-
- Solicitation number
- TM-HQ-17-P-0192
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Who attaches SF 117
| Agency | Files |
|---|---|
| Department of the Treasury United States Mint | 1 |
Other files
| File | Type | Posted |
|---|---|---|
| Pedestrian_Alert_System.pdf | ||
| Sliding_Gate_and_Perimeter_Upgrade_-SOW.pdf | ||
| US_MINT_SAN_FRANCISCO_GATE.PDF |
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Text version
UNITED STATES MINT POLICE
Clearance Information and Request Form file_0.jpg
PLEASE PRINT CLEARLY
U.S. Citizen YES
NO
Passport No. (If Applicable)
LAST NAME:
FIRST MI
Sex Race Date of Birth
Place of Birth
SSN:
Residence Address
Street Number:
Street Name:
Town/City:
State:
Zip Code:
Contractor / Company Name:
Street Number:
Street Name:
Town/City:
State: _ Zip Code:
Telephone / Fax
Identification Information
Driver License Number:
State Issued By: Expiration Date:
Arrival Date:
Estimated Arrival Time:
Purpose of Visit
Name of Employee Requesting Clearance
Copies of Documents needed: Driver license, Passport, Alien Registration Card, Certificate of Naturalization
To Return Form by Email: xxxxxx@usmint.treas.gov (Form must be protected/encrypted)
NCIC REFERENCE NUMBER:
FBI REFERENCE NUMBER:
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