US Citizen Pre_Bid or Site Visit Form JUL 2021.pdf

190th ARW Forbes Field U.S. Citizen

Pre-Bid Meeting or Site Visit Request Form

This Request Form is for U.S. Citizens requesting approval to attend a pre-bid meeting or site visit at Forbes Field, Topeka KS. The form should be submitted to the Pre-Bid Meeting or Site Visit Point of Contact (POC) / Contracting Officer Representative (COR) at least Three (3) full business days prior to the proposed visit.

Pre-Bid Meeting/Site Visit POC: _____________________________________

Date the Request is Being Submitted (mm/dd/yyyy) ___________________

FULL LEGAL Name _______________________________________________________ (Last, First, Middle)

If you have only initials in your name, use them and state (IO). If you have no middle name, enter “NMN”. If you are a “Jr.,”Sr.,” “II,” etc., indicate your status (Do not list a Nickname) NOTE: Failure to provide FULL LEGAL name will delay approval

Date of Birth (mm/dd/yyyy) _______________

Last Four Digits of Social Security Number _________________

Project / Solicitaiton # to be visited:

Date of Proposed Visit (mm/dd/yyyy) ____________________________

In Case of Questions, Please Provide Phone Number: __________________________

Drivers License Number: State:

Height: Weight: Eye Color: Hair Color:

Company:

PRIVACY ACT STATEMENT

AUTHORITY: Information is solicited pursuant to E.O. 9379; The Privacy Act of 1974, 5 U.S.C 522a; DODD 8500.1 PRINCIPAL PURPOSE: To provide necessary information to determine if applicant meets installation access control requirements IAW HSPD12, DoD 5200.8, DTM 09-12, FIPS201, AND AFMAN 31-113. Use of SSN is necessary to make positive identification of an applicant. Records in the Defense Biometric Identification System (DBIDS) are maintained to support DoD physical security and information assurance programs and are used for identity verification purposes, to record personal property registered with the DoD, and for producing facility management reports. SSN, Driver’s License Number, or other acceptable identification will be used to distinguish individuals who request access to 190 ARW property.

ROUTINE USES: Used by the Air National Guard to accompany a request for a scheduled tour of the facility. MANDATORY OR VOLUNTARY DISCLOSURE AND EFFECT OF NOT PROVIDING INFORMATION: Providing the solicited information, including Social Security Number, is voluntary; however, failure to provide information may result in a denial of visitor access due to an inability to verify identification. The information provided to the 190th ARW will not be retained digitally or by hard copy after the scheduled visit.

Jul 2021 Version https://www.lrn.usace.army.mil/Business-With-Us/Contract-Security-Requirements/ mailto:tracy.w.dorrough.civ@mail.mil mailto:john.h.carter@usace.army.mil mailto:jason.j.klinger.civ@mail.mil