Exhibit_E_ASG-KU_DES_Form_190-16.02_Enclosure_9.xlsx
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- Logistics Automation (LOGAUTIO) Services
- Solicitation number
- W52P1J-16-R-0050
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Exhibit E
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Sheet1
| ASG-KU VEHICLE REGISTRATION APPLICATION |
| SECTION I - VEHICLE INFORMATION |
| Type of Access: |
Vehicle Identification Number (17 Digit Number): Vehicle Classification:
License Plate Number: Body Type: Expiration of Vehicle Registration (DD-MMM-YY):
Manufacturer's Name: Color: Name of Rental / Leasing Company or Owner:
Model Name: Contract Expiration Date (For Fleet Vehicle): Name of Insurance Company:
Year of Vehicle: License Plate Issuing Country: Expiration of Insurance (DD-MMM-YY):
| SECTION II - VEHICLE OWNER / PRIMARY DRIVER / FLEET MANAGER INFORMATION | ||
| Last Name: | First, Middle Initial: | Date of Birth (DD-MMM-YY): |
Kuwait Civil ID Number/Passport Number: Company/Unit: Phone Number:
| SECTION III - COR / APPOINTED AUTHORITY (AA) INFORMATION AND RECOMMENDATION | ||
| AA Last Name: | AA First, Middle Initial: | AA Rank/Grade |
AA Unit/Organization: AA Work Number (DSN): AA Mobile Number:
AA Email Address: AA Signature and Date:
AA Recommended FPCON: AA Recommended Veh Exp Date (DD-MMM-YY): Remarks:
| SECTION IV - MOTOR VEHICLE OPERATOR ACKNOWLEDGMENT |
| Data Required by Privacy Act of 1974 (5 U.S. CODE 552a) |
| AUTHORITY: DoD Directive 5200.8 Security of DoD Installations and Resources, AR190-5 Motor Vehicle Traffic Supervision, CENTCOM OPORD 10-05 Antiterrorism and the ASG-KU Installation Access Policy. PRINCIPAL PURPOSE: To establish positive identification of vehicles authorized to access ASG-KU Installations. ASG-KU requires that all Non-Tactical Vehicles be registered and authorized prior to entry. MANDITORY DISCLOSURE REQUIREMENT: Failure to provide the required information, including passport number or Kuwait Civil Identification number will result in disapproval of this application. Disapproved applicants will be denied the privilege of Vehicle access onto ASG-KU Installations. |
| Acknowledgement of ASG-KU Installation Motor Vehicle Operator Responsibilities |
| As an ASG-KU Installation Motor Vehicle Operator, I acknowledge the following: |
1. I understand that upon entering, exiting or while on any ASG-KU Installation the Vehicle, including all contents, is subject to search at the discretion of the U.S. Government, its designate or the issuing agency.
2. While on post, I am responsible for displaying the Vehicle Placard so it is clearly visible.
3. I am responsible for cancelling the Vehicle Placard should I sell, exchange return or otherwise no longer have possession of the vehicle and return the Placard to Installation Access.
4. I understand that I must have a valid driver's license, valid registration and insurance and meet all requirements for entry onto ASG-KU Installations.
5. If my vehicle is stolen, I must immediately notify the PMO and Installation Access.
6. I acknowledge by my signature that I have read and understand the policy, requirements and responsibilities above.
(Print) Last, First, Middle Initial: Signature: Date (DD-MMM-YY):
| SECTION V - INSTALLATION ACCESS USE ONLY | ||
| Application Inspected By: | Signature and Date of Person Approving Application: | Expiration Date of Placard (DD-MMM-YY): |
Name of person Entering Data: Signature and Date of Person Entering Data: DBIDS Number of Primary Driver:
Verified Documents Enclosed: Remarks:
&9 Enclosure 9 - ASG-KU DES Form 190-16.02_Vehicle Application (17 Jul 2016)
Initials:
New Registration Renewal of Registration
GOV/TMP
Company Owned/Leased
POV
Charlie Delta Copy of vehicle registration Copy of Driver's License Copy of IA Card (front only) if applicable Copy of lease/rental agreement or separate copy of insurance
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File details come from the government source that posted it. Updated .