W911SA24Q3112 Attachment 7 (FMF451 Installation Access Check Request).pdf

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Custodial Services at Facility MI051 in Augusta, MI
Solicitation number
W911SA-24-Q-3112
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This document is a Fort McCoy Installation Access NCIC-III Check Request form. It is used to determine the suitability of individuals requesting access to Fort McCoy. The form collects personal information such as the individual's name, driver's license details, work access hours, and work area/visit location. It also requires the sponsor's information, including their name, organization, phone number, and email address. The purpose for access and any applicable contract number and expiration date must be provided. The form is submitted to the Directorate of Emergency Services for review and approval or denial of access.

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Other files

File Type Posted
W911SA24Q3112 Solicitation.pdf PDF
W911SA24Q3112 Attachment 1 (Price Schedule) CUI.xlsx XLSX spreadsheet
W911SA24Q3112 Attachment 5 (Rest Room Cleaning Sheet).docx DOCX document
W911SA24Q3112 Attachment 8 (FMF452 Installation Access Pass Request).pdf PDF
W911SA24Q3112 Attachment 3 (Drawing MI051).pdf PDF
W911SA24Q3112 Attachment 4 (Room Chart Task Frequency).xlsx XLSX spreadsheet
W911SA24Q3112 Attachment 2 (AT-OPSEC).pdf PDF
W911SA24Q3112 Attachment 6 (Service Ticket Template).docx DOCX document

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Fort McCoy Form 451 December 2021 FOUO Fort McCoy Form May 2021 Obsolete Page of AEM6.2 v11 Fort McCoy Installation Access NCIC-III Check Request Prescribing Regulation: Army Regulation 190-13, Proponent Directorate of Emergency Services

PRIVACY ACT STATEMENT AUTHORITY: The Privacy Act of 1974, Title 5 USC 552a. PRINCIPLE PURPOSE(S): To determine suitability of individual(s) requesting access to Fort McCoy. This information will be used to generate state and federal criminal history records checks. ROUTINE USE(S): Personal information may be disclosed to appropriate military and civilian emergency and investigation agencies to assist in determining suitability for access to Fort McCoy. DISCLOSURE: Voluntary; however failure to provide information will result in a refusal to grant access to Fort McCoy.

Legal Name as Appears on Driver's License or State ID. Example: John Edward Doe M 29-Apr-64 F123-4567-8912-54

WI

25-Jan-15 24-Jan-16

MON-FRI 0700-1700

Bldg 100 Commissary/TCI DES PS Use Only Last Name First Name Middle Name or NMN if none

SEX (M/F)

DOB

Drivers License Number Drivers License State Begin Date End Date Work Access Hours Work Area/ Visit Location Company Name Clear/Denied/NMI (DES PS use only) Remarks Block (At a minimum include: purpose for access; contract number and expiration date) ** Note: If access is for contract purpose, Sponsor will be the COR. In all cases, Sponsor must be affiliated with Fort McCoy.

When complete submit to: usarmy.mccoy.id-readiness.mbx.des-physical-security-iacs-form@army.mil Legal Name as Appears on Driver's License or State ID. Example: John Edward Doe M 29-Apr-64 F123-4567-8912-54

WI

25-Jan-15 24-Jan-16

MON-FRI 0700-1700 HOURS

Bldg 100 Commissary/TCI DES PS Use Only Last Name First Name Middle Name or NMN if none

SEX (M/F)

DOB

Drivers License Number Drivers License State Begin Date End Date Work Access Hours Work Area/ Visit Location Company Name Clear/Denied/NMI (DES PS use only) 11.0.0.20130303.1.892433.887364 Trudy L. Ward 20170612

DHR-ASD

Fort McCoy Installation Access NCIC-III Check Request Trudy L. Ward Fort McCoy Form 451

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