Base Access request Form.docx

OFFICIAL COMPANY LETTERHEAD

Date MEMORANDUM FOR: 96 SFS/S-5B through AAC/PKO

FROM: COMPANY’S NAME/ADDRESS

SUBJECT: Request for Pass

1. The following individuals request access to Eglin AFB to attend a site visit for the 7ths SFG Contract solicitation number W36QZT2163A09. The site visit will be held on Thursday August 23, 2012 from 0830-1100 hrs. The location will be building 4525.

2.. The individuals listed have been briefed that while on the installation they must comply with all local laws and policies. The failure to comply will result in loss of base access. Each individual understands that they must go to the Security Forces Pass and Registration office to receive their contractor identification pass. They further understand they must have a valid drivers license/Identification card, proof of current registration and insurance while driving on the installation.

3. When first arriving at the East Gate Pass and ID office, the following individuals will wait for a contracting escort.

4. I understand it is the contractor’s responsibility to collect the badges of terminated employees and to collect the badges at the conclusion of the work that was to be accomplished. Further, I understand that the contractor is responsible to turn the badges/passes in to the Security Forces Pass and registration office as soon as all work is complete.

Name of Individual Days/hrs of access SSN/Date of Birth /Drivers License #/State

MEMORANDUM FOR: 96SFS/S-5B

From: AAC/PKO The contracting office hereby verifies that the above contractor has an active contract and requires access to the base installations.

Authority: 10 U.S.C.8013, Secretary of the Air Force Purpose: Used by the Security Forces for issuing ID media. Some organizations may routinely keep copies of the above documentation in order to maintain control over persons authorized entry into certain areas. Accountability documents are used to insure proper control over the various forms utilized in these function Routine Use: In addition to those disclosures generally permitted under 5 U.S.C. 552(b) of the Privacy Act, these records or information contained therein may specifically be disclosed outside the DoD as a routine use pursuant to 5 U.S.C.552a(b)(3) as follows: