EXHIBIT_D-JB2_0-180_and_SECNAV.pdf

Justification:

(Specific reasons justifying access to JBPHH, ability to sponsor, to have unescorted access, access above FPCON Bravo or for specific days/times, etc)

SUMMARY SHEET FOR VISITOR PASS REQUESTS TO ACCESS

JOINT BASE PEARL HARBOR-HICKAM PROPERTIES

Sunday Monday Tuesday Wednesday Thursday Friday SaturdayPass Days:

Daily Start Time:

1. All information must be typed; Last Name, First Name, MI, to match individual submitted SECNAV 5512-1

2. The only information that can be written is date and signatures, digital signatures are accepted and highly encouraged.

3. All names below must have an accompanying SECNAV 5512 in order to conduct proper background check. Names without a submitted SECNAV 5512 will not be processed.

4. This letter must be received by Pass and ID 14 business days prior to required access date (times may vary). Personnel must pick up their badges within 30 days after notified ready for issuance. Applications will be discarded after 30 days and a new one must be submitted.

5. Place of performance/location visiting must be properly annotated. NCTAMS, West Loch, JBPHH Main Base, etc., may be used if justification block below documents the need for base wide access.

6. Visitor Pass expiration date must be entered. Depending on request, expiration date WILL NOT exceed one year.

7. Incomplete forms or forms with errors will be returned for correction; they will not be processed.

8. Approved requests will be e-mailed to the requester's and/or sponsor's e-mail address unless otherwise specified on the form.

Issue Location:

(DBIDS select Nimitz):

From:

(Unit/Organization)

Pass Type:

Pass Expiration Date:

(1 year or less):

Area or Address:

Date

Last Requester:

May be sponsor, usually site manager/contractor Signature

PhoneMIFirst

Email

Grade

Date

Last Sponsor:

Government employee working with contractor Signature

PhoneMIFirst

Email

Grade

Last Command:

Required for all passes exceeding 30 days Signature Date

PhoneMIFirst

Email

Grade

Last Housing:

Required ONLY for house guests over 30 days Signature Date

PhoneMIFirst

Email

Grade

Daily End Time:

JBPHH/JB2 Form 0-180 (1 April 2018) https://cnic.navy.mil/regions/cnrh/installations/jb_pearl_harbor_hickam/om/pass-and_id.html

Visitor Listing:

(All names below must have an accompanying SECNAV 5512 filled out in order to conduct proper background checks)

PID MI First Name Last Name PID MI First Name Last Name

Pass Start Date:

Requesting one day access to attend pre-proposal and site visit for Solicitation W912J619R5000 Addition to LOCRF B3408

Please CC Requestor/Sponsor on Approval/Denial Email

Nimitz (Main Office)154 CES-HIANG Short Term 1-30 Days

JBPHH - Main Base

Buis (808) 789-0102MGlenda glenda.buis.1@us.af.mil Ms.

Pagala (808)789-0101Douglas douglas.pagala@us.af.mil

E7

Placencia (808) 789-0100Emilio emilio.placencia@us.af.mil O3

PRIVACY ACT STATEMENT

AUTHORITY: Section 3101, Title 44, US Code, 5 USC 552A PRINCIPAL PURPOSES: The purpose of requesting personal information is to assist security personnel in developing records to document contractor employee suitability for access to Joint Base Pearl Harbor-Hickam, Hawaii to work under Navy, Air Force, or local contracts. The social security number and date and place of birth are necessary to identify persons, maintaining records, and for criminal history/background checks.

ROUTINE USES: This information may be used to determine suitability of persons desiring access to Joint Base Pearl Harbor-Hickam as well as for other lawful purposes including law enforcement and litigation.

DISCLOSURE IS VOLUNTARY: Disclosure of requested information is voluntary. However, failure to provide information will result in access privileges being refused or withdrawn. The Privacy Act Statement will apply throughout the duration of the contract while serving in the capacity of prime contractor or subcontractor/supplier/employee.

Visitor Listing (continued)

First:Last:Grade:Date received:

Pass and ID use Only

PID MI First Name Last Name PID MI First Name Last Name