Amendment 0001 - Bidder Walkthrough Attachment.pdf

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IMDR-ES FORM 2, JAN 20 PREVIOUS EDITION IS OBSOLETE

APPLICATION FOR SPONSORSHIP

PRIVACY ACT STATEMENT: The information you provide is covered by the Privacy Act of 1974, Title 5, U.S.C. 552a.

AUTHORITY: 10 U.S.C. 3013, Secretary of the Army; Army Regulation 190-13, The Army Physical Security Program and E.O. 9397 (SSN).

PRINCIPAL PURPOSE(S): To record personal data and vehicle information to ensure positive identification of personnel authorized access to the installation/restricted areas; to conduct criminal background checks through local and national law enforcement databases; to maintain accountability for issuance and disposition of access passes.

ROUTINE USES: The DoD Blanket Routine Use set forth at the beginning of the Army's compilation of systems of records notices may apply to this system.

DISCLOSURE: Voluntary. However, failure to provide the requested information will result in denial of access to the installation.

Request sponsorship for the following individuals:

Last Name

First Name

Middle Initial

Date of Birth

ID Type

ID Number

ID State *See Reverse*

Vehicle

Justification:

DATE OF REQUESTED ACCESS (MM/DD/YYYY) TIME OF REQUESTED ACCESS

FROM TO FROM TO

DAYS REQUESTED ACCESS MONDAY TUESDAY WEDNESDAY THURSDAY FRIDAY SATURDAY SUNDAY

SPONSOR’S INFORMATION:

LAST NAME: FIRST NAME: MI:

RANK/GRADE: ORGANIZATION: TELE:

ADDRESS: EMAIL:

I acknowledge as a Sponsor that the name(d) individuals have official business to conduct on Fort Drum

(Sponsor’s Signature) Date

The above individuals are approved / disapproved for issuance of Friends of the North Country Local Access Badge.

Approving Official Printed Name Approving Official Signature

SECTION BELOW IS FOR USE BY INSTALLATION ACCESS CONTROL OFFICE

NCIC-III DATE: CLEARED / FAILED (circle one) CONTROL #

NCIC-III Officer Printed Name NCIC-III Officer Signature

IMDR-ES FORM 2, JAN 2016 PREVIOUS EDITION IS OBSOLETE

APPLICATION FOR SPONSORSHIP INSTRUCTIONS

USE: The information contained in the application will serve as input data to conduct a NCIC-III background check as required by AR 190-13. If you do not type the information on this form insure that your writing is neat and legible to avoid any mistakes, confusion, or delays when conducting checks and preparing passes.It is essential that all users of this form provide the required information according to the instructions below:

Last Name: self-explanatory.

First Name: self-explanatory.

Middle Initial: self-explanatory.

Date of Birth: DDMMMYYYY (example: 05 Feb )

ID Type: Driver’s License; Passport; School ID; etc.

ID Number: may be letters and numbers depending on identification.

ID State:

+ Federal officials may continue to accept Enhanced Driver’s Licenses from these states.

Vehicle Color: Red, Blue, Black, White, etc.

Vehicle Plate: The alphanumeric license plate displayed on the vehicle.

State: The state that issued the plate displayed on the vehicle.

Relationship: The connection between the individual being sponsored and the sponsor (mother, father, son, daughter, friend, contractor, etc.)

Justification: Explain the reason (bonafide need) why the individual(s) need access to Fort Drum.

Dates of Requested Access: DDMMMYYYY (example: 05 Feb ) for From and To.

Times of Requested Access: 24 hour clock (1300; 2315; etc.) for From and To.

Days Requested Access: Check the box for each applicable day of the week.

Sponsor’s Information: self-explanatory.

Sponsor’s Signature and date: self-explanatory. Electronic signature preferred.

The completed form can be emailed to:

usarmy.drum.imcom.mbx.des-acp@ .mil (Preferred method)

Delivered to ,