SVAttach1_PCD-F_190-5_Visitor_Notification_Form_2016.pdf

PCD VISITOR NOTIFICATION

PCD Form 190-5 (R) (E) March 2016

UNCLASSIFIED

Name of visitor(s):

1. 6.

2. 7.

3. 8.

4. 9.

5. 10.

Company / Organization: ( ) -

PCD Area to Visit:

Does visitor need to be escorted while on PCD (outside of Chemical Limited Area)? YES NO

Reason for Visit:

(If entering G-Block, PCAPP CLA, EDS CLA - explain area and specific purpose)

Date(s) of Visit: From: - - To: - - (mm - dd – year) (mm - dd – year)

Are any of the visitors foreign nationals?

(If YES, review and comply with Installation Access Control Plan, Visitor Access Section)

YES NO

This block is for Chemical Limited Area (CLA) access only!

Please issue a Visitor Chemical Badge for:

CLA Visitor Escorted Limited Only (Level 2) CLA Visitor Escorted Exclusion (Level 3)

“No escort” access must be approved through respective Surety Office prior to badge issuance.

CLA Visitor No Escort Limited Only (Level 2) CLA Visitor No Escort Exclusion (Level 3)

The POC for these visitors is: ( ) -

Printed Name of POC or CLA Approval Authority:

Signature of POC or CLA Approval Authority: ( ) -

SPECIAL NOTES:

• Point of Contact (POC) should notify visitors and contractors that they must have a valid driver’s license or photo ID (valid photo ID for passengers also), current vehicle registration and insurance or rental agreement and must also have a PCD POC prior to arriving at installation gate. If visitor is from a state non-compliant with the REAL ID Act of 2005, visitor must also have a secondary form of ID.

• Firearms and knives are not allowed on PCD without a special permit and can be secured in a location at the gate (if available) until they leave.

Cameras are allowed in certain areas only with prior approval and a Camera Pass from a PCD/PCAPP appointed OPSEC Officer.

• Submit this form (via fax or email) to your Point of Contact on PCD.

For INFORMATION, call the Identification & Registration Office at: (719)549-4529 g6edxmpb Typewritten Text Attachment 1 g6edxmpb Line g6edxmpb Line g6edxmpb Line g6edxmpb Line g6edxmpb Line g6edxmpb Line g6edxmpb Line g6edxmpb Typewritten Text Maximum of 3 per Offeror

PCD VISITOR NOTIFICATION

PCD Form 190-5 (R) (E) March 2016

UNCLASSIFIED

Instructions for Visitor Notification Form PCD 190-5:

NAME OF VISITOR(S): Use name on driver’s license up to ten names. Use another PCD 190-5 for additional names.

COMPANY/ORGANIZATION: Enter name of company/organization that the visitor(s) belong to in addition to a good contact number.

PCD AREA TO VISIT: Enter location of visitor(s) destination (PCD, PCAPP, EDS, Puebloplex, etc.) and check the appropriate block for requested escort requirements while on PCD (this does not include CLA). Point of Contact (POC) is responsible for escorting requirements if requested.

REASON FOR VISIT: Enter reason for visiting PCD. If requesting access to any limited/exclusion area on PCD, give a detailed explanation to include specific areas and purpose of visit.

DATES OF VISIT: Enter from and to dates for visit.

ARE ANY OF THE VISITORS FOREIGN NATIONALS: Check appropriate block and see Installation Access Control Plan, Visitor Access Section for further requirements.

YELLOW CLA ACCESS BLOCK: Read notes in red. Check appropriate block for requested limited/exclusion area of access.

THE POC FOR THESE VISITORS IS: Enter name of the POC on PCD to include a good contact number. This is the person that is requesting that a visitor has access to the Depot.

PRINTED NAME OF POC OR CLA APPROVAL AUTHORITY: Print name of POC to include a good contact number. If requesting CLA access, this must be a person listed on the Memorandum for Designation of Approval Authority for Visitor Requests for the Chemical Limited/Exclusion Areas.

SIGNATURE OF POC OR CLA APPROVAL AUTHORITY: Signature may be actual (scanned/faxed) or digital. If requesting CLA access, this block must be signed by a person listed on the Memorandum for Designation of Approval Authority for Visitor Requests for the Chemical Limited/Exclusion Areas.

See SPECIAL NOTES.

g6edxmpb Typewritten Text Do not fill out the CLA Access block.

g6edxmpb Typewritten Text A maximum of 3 including a UXO Tech II.

SPECIAL NOTES: