G1529.pdf
PDF 801 KB Posted
- Attached to
- Kawakami Ammunition Depot
- Solicitation number
- W912HV23B0013
About this file
This document contains a one time/multiple access roster form and information about an upcoming federal contract opportunity. The roster form collects visitor information for access to U.S. Army installations in Japan, including name, passport details, and sponsorship. It is the responsibility of the individual sponsor to provide accurate information for security screening.
The federal contract opportunity is a presolicitation notice for repair work at the Kawakami Ammunition Depot facilities in Japan. The U.S. Army Corps of Engineers Engineering District Japan plans to issue a solicitation in June for repairs to bring various ammunition storage facilities up to requirements. The work includes repairs to numerous structures at the Kawakami Ammunition Depot.
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Other files
| File | Type | Posted |
|---|---|---|
| G1529-1.pdf | ||
| Form1529 sample 2022-01-28.pdf | ||
| Kawakami Site Visit Package 1 Facility Breakdown.pdf |
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Text version
PageONE TIME/MULTIPLE ACCESS ROSTER
ESRV2.90PREVIOUS EDITIONS ARE OBSOLETE.USAGJ FORM 1529, DEC 2020
1. INSTRUCTION
DATE OF REQUEST
of Pages
A "One Time/Multiple Access Roster" is valid for a single group visit for a specific date and time. It is the sole responsibility of the individual sponsor to include all information listed. Processing time can be reduced if each sponsor will take the time to legibly list the required information in both English and Kanji. This roster must be submitted to the Pass office at Camp Zama, SHA or SGD or HB four (4) working days might no be processed in time.
Any request that is submitted or the same day will not be processed. Sponsor must sign guest in at the gate.
The sponsor's signature services as an acknowledgment the sponsor is aware of his/her individual responsibilities as the sponsor and to exercise total control over his/her non-SOFA guests in accordance with the provisions contained in USAGJ Regulation 190-13.
a.
b.
a. TYPED NAME (Last, First MI)
e. DESTINATION/INSTALLATION
h. MULTIPLE ACCESS
EFFECTIVE DATE
f. PURPOSE
i. MULTIPLE ACCESS
EXPIRATION DATE
k. SPONSOR'S SIGNATURE
g. TYPE OF REQUEST
d. TELEPHONE NO.b. RANK c. DUTY TELEPHONE NO.
a. VISIT DAY
NATIONALITY NAME (Last, First MI) ADDRESS VEHICLE
PLATE NO.
GATE NO.
d. TOTAL (VEHICLE)c. TOTAL (PERSONNEL)
FROM
b. VISIT TIME
TO
ONE TIME MULTIPLE
2. SPONSOR INFORMATION & ACCESS DESCRIPTION
3. VISITORS INFORMATION
e. AREA(S) TO BE AUTHORIZED
ZAMA SGD SHA YND APC PIER6 TORII
PASSPORT NO.
TEL
DRIVER'S LICENSE NO.
j. SPONSOR'S ORGANIZATION
SEX DATE OF BIRTH EYE COLOR HAIR COLOR HEIGHT WEIGHT
NATIONALITY NAME (Last, First MI) ADDRESS VEHICLE
PLATE NO.
PASSPORT NO.
TEL
DRIVER'S LICENSE NO.
SEX DATE OF BIRTH EYE COLOR HAIR COLOR HEIGHT WEIGHT
NATIONALITY NAME (Last, First MI) ADDRESS VEHICLE
PLATE NO.
PASSPORT NO.
TEL
DRIVER'S LICENSE NO.
SEX DATE OF BIRTH EYE COLOR HAIR COLOR HEIGHT WEIGHT
NATIONALITY NAME (Last, First MI) ADDRESS VEHICLE
PLATE NO.
PASSPORT NO.
TEL
DRIVER'S LICENSE NO.
SEX DATE OF BIRTH EYE COLOR HAIR COLOR HEIGHT WEIGHT
GATE NO.
GATE NO.
GATE NO.
AUTHORITY:
PRINCIPAL PURPOSE:
ROUTINE USES:
DISCLOSURE:
DATA REQUIRED BY THE PRIVACY ACT OF 1974
Title 10 U.S.C., Code, Section 3013.
To provide information to officials of the Army responsible for monitoring/controlling visitor's status.
Information is used to record and assign authorized pass numbers to allow authorized visitors onto U.S. Army installations.
Voluntary. Failure to disclose the required information will result in authorized pass numbers not being issued; therefore, causing the applicants to have to meet and escort on and off the installation their visitors.
V2.90
FMO
USAGJ FORM 1529
Mitsue-Miller, Yukiyo
ONE TIME/MULTIPLE ACCESS ROSTER
09 DEC 2020
DEC 2020
Page
ONE TIME/MULTIPLE ACCESS ROSTER
ESR
V2.90
PREVIOUS EDITIONS ARE OBSOLETE.
USAGJ FORM 1529, DEC 2020
1. INSTRUCTION
DATE OF REQUEST
of Pages A "One Time/Multiple Access Roster" is valid for a single group visit for a specific date and time. It is the sole responsibility of the individual sponsor to include all information listed. Processing time can be reduced if each sponsor will take the time to legibly list the required information in both English and Kanji. This roster must be submitted to the Pass office at Camp Zama, SHA or SGD or HB four (4) working days might no be processed in time.
Any request that is submitted or the same day will not be processed. Sponsor must sign guest in at the gate.
The sponsor's signature services as an acknowledgment the sponsor is aware of his/her individual responsibilities as the sponsor and to exercise total control over his/her non-SOFA guests in accordance with the provisions contained in USAGJ Regulation 190-13.
a.
b.
a. TYPED NAME (Last, First MI)
e. DESTINATION/INSTALLATION
h. MULTIPLE ACCESS EFFECTIVE DATE
f. PURPOSE
i. MULTIPLE ACCESS EXPIRATION DATE
k. SPONSOR'S SIGNATURE
g. TYPE OF REQUEST
d. TELEPHONE NO.
b. RANK
c. DUTY TELEPHONE NO.
a. VISIT DAY
NATIONALITY
NAME (Last, First MI)
ADDRESS
VEHICLE PLATE NO.
GATE NO.
d. TOTAL (VEHICLE)
c. TOTAL (PERSONNEL)
FROM
b. VISIT TIME
TO
2. SPONSOR INFORMATION & ACCESS DESCRIPTION
3. VISITORS INFORMATION
e. AREA(S) TO BE AUTHORIZED
PASSPORT NO.
TEL
DRIVER'S LICENSE NO.
j. SPONSOR'S ORGANIZATION
SEX
DATE OF BIRTH
EYE COLOR
HAIR COLOR
HEIGHT
WEIGHT
NATIONALITY
NAME (Last, First MI)
ADDRESS
VEHICLE PLATE NO.
PASSPORT NO.
TEL
DRIVER'S LICENSE NO.
SEX
DATE OF BIRTH
EYE COLOR
HAIR COLOR
HEIGHT
WEIGHT
NATIONALITY
NAME (Last, First MI)
ADDRESS
VEHICLE PLATE NO.
PASSPORT NO.
TEL
DRIVER'S LICENSE NO.
SEX
DATE OF BIRTH
EYE COLOR
HAIR COLOR
HEIGHT
WEIGHT
NATIONALITY
NAME (Last, First MI)
ADDRESS
VEHICLE PLATE NO.
PASSPORT NO.
TEL
DRIVER'S LICENSE NO.
SEX
DATE OF BIRTH
EYE COLOR
HAIR COLOR
HEIGHT
WEIGHT
GATE NO.
GATE NO.
GATE NO.
AUTHORITY: PRINCIPAL PURPOSE: ROUTINE USES: DISCLOSURE:
DATA REQUIRED BY THE PRIVACY ACT OF 1974
Title 10 U.S.C., Code, Section 3013. To provide information to officials of the Army responsible for monitoring/controlling visitor's status. Information is used to record and assign authorized pass numbers to allow authorized visitors onto U.S. Army installations. Voluntary. Failure to disclose the required information will result in authorized pass numbers not being issued; therefore, causing the applicants to have to meet and escort on and off the installation their visitors.
| NumericField1: |
| DateField1: |
| TextField1: |
| TextField2: |
| CheckBox1: 0 |
| CheckBox1: 0 |
| NumericField2: |
| TimeField1: |
| SignatureField1: |
| CheckBox-Zama: 0 |
| CheckBox-SGD: 0 |
| CheckBox-SHA: 0 |
| CheckBox-YND: 0 |
| CheckBox-APC: 0 |
| CheckBox-PIER6: 0 |
| CheckBox-TORII: 0 |
File details come from the government source that posted it. Updated .