Vetting_Access_Request_List_Blank.pdf

PDF 272 KB Posted May 3, 2018

Attached to: Bldg 859 DDC / HVAC Project Federal contract opportunity
Solicitation number: W912JB-18-B-5001
Issued by: Department of the Army Michigan Army National Guard

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Other files attached to Bldg 859 DDC / HVAC Project, newest first.
File	Type	Posted
Bid_Opening_859_DDC.pdf	PDF	Jun 20, 2018
Solicitation_Modification_01.pdf	PDF	Jun 11, 2018
W912JB-18-B-5001_Amendment_03.pdf	PDF	Jun 6, 2018
RFI_DOCUMENT_1_ANSWERS.pdf	PDF	May 24, 2018
W912JB-18-B-5001_Amendment_02.pdf	PDF	May 24, 2018
W912JB-18-B-5001_Amendment_01.pdf	PDF	May 22, 2018
859_DDC_Drawings_Reference.pdf	PDF	May 17, 2018
RFI'S_DOCUMENT_1.pdf	PDF	May 16, 2018
859_DDC_Drawings.pdf	PDF	May 15, 2018
Site_Visit_Minutes_859_DDC.pdf	PDF	May 15, 2018
Sign_In_Sheet.pdf	PDF	May 15, 2018
General_Specification__for_Building_859_(DDC).pdf	PDF	May 3, 2018
STATEMENT_OF_WORK_for_Building_859_(DDC).pdf	PDF	May 3, 2018
859_DDC___Brand_Name_Justification_CE_SIGNED_Redacted.pdf	PDF	May 3, 2018
W912JB-18-B-5001_SOLICITATION.pdf	PDF	May 3, 2018
Synopsis_859_DDC_Project.pdf	PDF	Apr 10, 2018

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LAST NAME FIRST NAME MIDDLE JR / SR DATE OF BIRTH

DRIVER'S LICENSE # OR

PERSONAL IDENTIFICATION

CARD #

STATE OF

ISSUE GENDER RACE

COUNTRY OF CITIZENSHIP /

PASSPORT NUMBER

(Foreign Visitors only)

"PRIVACY ACT STATEMENT: This electronic transmission may contain FOR OFFICIAL USE ONLY (FOUO) information that must be protected under the Privacy Act of 1974 (see AFI 33-332). NOTE: Due to the new update to DBIDS, either a social security card, tax ID number, or certificate of naturalization must be shown at the time of issue.

NAME MUST MATCH WHAT IS ON THE DRIVER'S LICENSE

START TIME: _______________ END TIME: ______________

SPONSOR SIGNATURE: SPONSOR AND PHONE NUMBER:

SELFRIDGE ANGB PRE-AUTHORIZATION ACCESS REQUEST LIST. (Please type or print clearly!)

COMPANY/EVENT: BEGIN DATE: DAYS (indicate): SUN MON TUE WED THU FRI SAT

LOCATION ON BASE/BLDG #: END DATE:

NOTE: Submit completed form to USAF.MI.127-WG.list.Pass-and-Id@mail.mil. Requests deadlines are as follows; for lists up to 30 names a MINIMUM of 3 business day notice, 31-75 names a MINIMUM of 5 business day notice and over 75 guests a MINIMUM OF 10 business day notice. These are suggested guidlines, not following these guidlines may delay processing of vetting requests.. All base access requests must be submitted via a .GOV or .MIL email account.

Previous Edition Obsolete March 2018

1. Authority: Air Force Manual 31-133, Installation Perimeter Access Control

2. Information provided will be entered into Michigan Law Enforcement Information Network, for vetting process.

3. Disclosure: Disclosure of this information is voluntary; however failure to provide the requested information will prevent further processing of this request.

1039496620N Highlight

1039496620N Typewritten Text

1039496620N Highlight

Sheet1

Blank Page

DESCRIPTION:

BEGIN DATE:

LOCATION:

END DATE:

START TIME:

END TIME:

SPONSOR AND PHONE NUMBERRow1:

SPONSOR AND PHONE NUMBERRow1_2:

SPONSOR AND PHONE NUMBERRow1_3:

SPONSOR AND PHONE NUMBERRow1_4:

SPONSOR AND PHONE NUMBERRow1_5:

SPONSOR SIGNATURERow1:

SPONSOR SIGNATURERow1_2:

SPONSOR SIGNATURERow1_3:

SPONSOR SIGNATURERow1_4:

SPONSOR SIGNATURERow1_5:

FIRST NAMERow1:

MIDDLERow1:

JR SRRow1:

DATE OF BIRTHRow1:

DRIVERS LICENSE OR PERSONAL IDENTIFICATION CARD Row1:

STATE OF ISSUERow1:

GENDERRow1:

RACERow1:

COUNTRY OF CITIZENSHIP PASSPORT NUMBER Foreign Visitors onlyRow1:

FIRST NAMERow2:

MIDDLERow2:

JR SRRow2:

DATE OF BIRTHRow2:

DRIVERS LICENSE OR PERSONAL IDENTIFICATION CARD Row2:

STATE OF ISSUERow2:

GENDERRow2:

RACERow2:

COUNTRY OF CITIZENSHIP PASSPORT NUMBER Foreign Visitors onlyRow2:

FIRST NAMERow3:

MIDDLERow3:

JR SRRow3:

DATE OF BIRTHRow3:

DRIVERS LICENSE OR PERSONAL IDENTIFICATION CARD Row3:

STATE OF ISSUERow3:

GENDERRow3:

RACERow3:

COUNTRY OF CITIZENSHIP PASSPORT NUMBER Foreign Visitors onlyRow3:

FIRST NAMERow4:

MIDDLERow4:

JR SRRow4:

DATE OF BIRTHRow4:

DRIVERS LICENSE OR PERSONAL IDENTIFICATION CARD Row4:

STATE OF ISSUERow4:

GENDERRow4:

RACERow4:

COUNTRY OF CITIZENSHIP PASSPORT NUMBER Foreign Visitors onlyRow4:

FIRST NAMERow5:

MIDDLERow5:

JR SRRow5:

DATE OF BIRTHRow5:

DRIVERS LICENSE OR PERSONAL IDENTIFICATION CARD Row5:

STATE OF ISSUERow5:

GENDERRow5:

RACERow5:

COUNTRY OF CITIZENSHIP PASSPORT NUMBER Foreign Visitors onlyRow5:

FIRST NAMERow6:

MIDDLERow6:

JR SRRow6:

DATE OF BIRTHRow6:

DRIVERS LICENSE OR PERSONAL IDENTIFICATION CARD Row6:

STATE OF ISSUERow6:

GENDERRow6:

RACERow6:

COUNTRY OF CITIZENSHIP PASSPORT NUMBER Foreign Visitors onlyRow6:

FIRST NAMERow7:

MIDDLERow7:

JR SRRow7:

DATE OF BIRTHRow7:

DRIVERS LICENSE OR PERSONAL IDENTIFICATION CARD Row7:

STATE OF ISSUERow7:

GENDERRow7:

RACERow7:

COUNTRY OF CITIZENSHIP PASSPORT NUMBER Foreign Visitors onlyRow7:

FIRST NAMERow8:

MIDDLERow8:

JR SRRow8:

DATE OF BIRTHRow8:

DRIVERS LICENSE OR PERSONAL IDENTIFICATION CARD Row8:

STATE OF ISSUERow8:

GENDERRow8:

RACERow8:

COUNTRY OF CITIZENSHIP PASSPORT NUMBER Foreign Visitors onlyRow8:

FIRST NAMERow9:

MIDDLERow9:

JR SRRow9:

DATE OF BIRTHRow9:

DRIVERS LICENSE OR PERSONAL IDENTIFICATION CARD Row9:

STATE OF ISSUERow9:

GENDERRow9:

RACERow9:

COUNTRY OF CITIZENSHIP PASSPORT NUMBER Foreign Visitors onlyRow9:

FIRST NAMERow10:

MIDDLERow10:

JR SRRow10:

DATE OF BIRTHRow10:

DRIVERS LICENSE OR PERSONAL IDENTIFICATION CARD Row10:

STATE OF ISSUERow10:

GENDERRow10:

RACERow10:

COUNTRY OF CITIZENSHIP PASSPORT NUMBER Foreign Visitors onlyRow10:

FIRST NAMERow11:

MIDDLERow11:

JR SRRow11:

DATE OF BIRTHRow11:

DRIVERS LICENSE OR PERSONAL IDENTIFICATION CARD Row11:

STATE OF ISSUERow11:

GENDERRow11:

RACERow11:

COUNTRY OF CITIZENSHIP PASSPORT NUMBER Foreign Visitors onlyRow11:

FIRST NAMERow12:

MIDDLERow12:

JR SRRow12:

DATE OF BIRTHRow12:

DRIVERS LICENSE OR PERSONAL IDENTIFICATION CARD Row12:

STATE OF ISSUERow12:

GENDERRow12:

RACERow12:

COUNTRY OF CITIZENSHIP PASSPORT NUMBER Foreign Visitors onlyRow12:

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