Installation Access Request Form - Wing Form 13.xlsx

XLSX spreadsheet 132 KB Posted

Attached to
Repair Fencing and Cabling
Solicitation number
W50S97-21-B-0002
Issued by

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This document contains an installation access request form and information on a related federal contract opportunity for repairing fencing and cabling at a National Guard base in Tennessee. The installation access request form requires contractors to provide personal information such as name, date of birth, driver's license number, and social security number in order to receive a badge granting unescorted base access. It specifies the privacy act authority and routine uses for collecting this data. The federal contract opportunity is a solicitation issued by the Department of the Army National Guard to repair fencing and cabling basewide in accordance with the statement of work, construction plans, specifications, and building code requirements. The work location is the 118th Wing in Nashville, Tennessee.

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Sheet1 118th WING INSTALLATION ACCESS REQUEST

EMAIL THE COMPLETED, TYPED REQUEST TO THE VISITOR CONTROL SECTION (VCS) EMAIL BOX (USAF TN RSRC MGMT List 118 SFS Visitor Control Center) IN OUTLOOK. IF YOU HAVE ANY QUESTIONS PLEASE CALL SFS AT 660-8555. All personnel have given consent to run a background check in order to receive a DBIDs card or Visitor Pass, theSFS will and issue the DBIDS card or pass when contrator makes appointment with SFS personnel.

LAST NAME FIRST NAME MALE / FEMALE HEIGHT WEIGHT HAIR COLOR EYE COLOR DRIVERS LICENSE NUMBER STATE OF ISSUE SOCIAL SECURITY NUMBER DATE OF BIRTH (YYYYMMDD) NAME OF CONTRACTOR BUSINESS START DATE (YYYYMMDD) END DATE (YYYYMMDD) REQUEST TO DEVIATE FROM 0700-1530, M-F LOCATION(S) OF WORK SPONSORING UNIT SPONSOR NAME SPONSOR TELEPHONE NUMBER NOTES

In accordance with AFI 33-332, Air Force Privacy & Civil Liberties Program, 1.2.1 Privacy Act Notices
Authority - AFMAN 31-113, para 1.1.1.2
Purpose - The Privacy Act information is utilized to vet personnel by running background checks for visitors / contractors to obtain un-escorted access credentials to the installation.
Routine Uses - The information is shared with the Tennessee Bureau of Investigations NCIC system to provide background checks (vetting).
Disclosure - The information is voluntary enable to receive un-escorted access credentials to Berry Field and if the request for information is refused, the individual will be denied un-escorted access credentials to Berry Field and an escort will need to be provided by the sponsoring unit.

&28WING FORM 13, 11 APRIL 2019

Sheet2

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File details come from the government source that posted it. Updated .