Attachment_VIII_-_Form_100-E_Short_Term_Up_Range_Access.xlsx
XLSX spreadsheet 44 KB Posted
- Attached to
- UpRange Security Services Federal contract opportunity
- Solicitation number
- W911SG-16-R-0001
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Attachment VIII - Form 100-E Short Term Up-Range Access
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Approve
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ESL FORM 100
UNESCORTED UPRANGE TRAVEL REQUEST FORM THIS FORM, WHEN APPROVED, MUST BE IN VISITOR'S POSSESSION WHEN TRAVELLING UPRANGE!
Sec 2. ESCORTED YES OR NO Sec 3. LAST NAME Sec 4. FIRST NAME Sec 5. CAC Card Yes or No Sec 6. Individuals Organization Sec 7. CELL PHONE OF VISITOR Sec 8. Gate Access Required Sec 9. START DATE Sec 10. END DATE
Sec 11. In the box below please provide the purpose of the visit, the proposed route of travel, and the primary times of the access. This access requirement must be for official business and must be verified by the Sponsoring Official
Sec 12. Sponsor's Data STEP 13.
| Name of Sponsor / Requesting Official: | Individuals have/will receive the White Sands UXO and NO photography briefings and the verifying paperwork is/will be on file with our organization. |
| Sponsor's Organizatio: | |
| Sponsor's Phone Number: | |
| Date of Request: | |
| Yes or No |
| PHYSICAL SECURITY APPROVAL: |
| Short Term Up Range Access Form 100, Current as of 19 March 2015 |
FOR BUSSES
| All busses must be listed: | |||||||||
| WSMR PASS # | Bus Make | Bus Model | Bus Year | Bus Color | Company Name | License Plate # | Licensed in State | Insurance Carrier | Policy # |
FOR POVs and Rentals
| USE OF THIS FORM IS INTENDED FOR VEHICLES THAT ARE NOT MILITARY OR GSA VEHICLES WITH GOVERNMENT PLATES OR POVs BEARING THE DD FORM 2220 STICKER SET | ||||||||||||||
| Column A will be completed by WSMR. | ||||||||||||||
| Column J, K, and L Name of initial operator. | ||||||||||||||
| Column O, unit/organization vehicle operated by. | ||||||||||||||
| PASS # (WSMR Will Complete) | VEHICLE MAKE | Vehicle Model | Vehicle Color | TAG # | TAG State | TAG Expiration | Rental Co Name (if POV so state) | Contract # (if POV N/A) | First Name | MI | Last Name | DL # | DL State Abbr. | PEO-I/BMC/OTC/ 2-1/Other |
BUS DRIVERS
| All bus drivers must be listed so passes can be prepared after background checks are accomplished. | ||||||
| WSMR PASS # | LAST NAME | FIRST NAME | DL # | DL State | COMPANY NAME | TWIC Card # |
File details come from the government source that posted it. Updated .