Attachment_4._EAL_Request_-_Blank.doc
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- Attached to
- Buckley AFB/COANG - IDS ESS Conversion Federal contract opportunity
- Solicitation number
- W912LC-16-R-5007
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Attachment 4. EAL Request
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Text version
DEPARTMENT OF THE AIR FORCE
460TH SPACE WING (AFSPC)
MEMORANDUM FOR: 460SFS/S3IPP
DATE: 30 August 2016 SUBJECT: Access Roster for Unescorted Access to Buckley AFB
1. The below listed individual(s) requires access to the installation during the specified dates:
(NOTE: Request may not exceed 30 days) EFFECTIVE DATE: 7 Sept 2016 - 0700
EXPIRATION DATE: 7 Sept 2016 – 1500
SPONSORS/ POC NAME:
MSgt Noah Branscom
PHONE NUMBER: 847-9818
SSN: TBD
ORGANIZATION: 140MSG/MSC
COMPANY:
DESTINATION: Bldg 701 REASON FOR VISIT: Construction Site Visit
2. Fill in the blocks below with current information. All information must be included for each individual requiring access to the base. It is used to run Wants and Warrants Checks.
NAME:
Last, First MI
DOB
| DRIVERS LICENCE # or STATE I.D. # |
| STATE OF ISSUE |
| FULL SSN |
| CITIZENSHIP |
US
US
US
(*add rows above as necessary)
3. Visitors are required to have a valid form of picture identification. All individuals listed on an access roster who intend to drive on Buckley AFB are required to have a valid driver’s license, current vehicle registration and current vehicle insurance. Access rosters will only be accepted from the sponsoring agency. They can be hand carried to the VC or e-mailed to 460SFS.VC6TH@BUCKLEY.AF.MIL from a valid government email account. All requests must be submitted 72 hours in advance (weekends, holidays and Wing down days do not apply). Each list must contain all requested information and individuals must be listed in alphabetical order. Requests that do not contain all information for the sponsor or visitor will not be processed. Access rosters not in compliance with these instructions will be returned to the sponsoring agency. Please contact the 460SFS Visitor Center with any questions@ 720-847-9381.
AUTHENTICATED BY:
460 SECURITY FORCES SQUADRON
DATE:
Privacy Act
1974 as Amended applies - this communication contains personal information, which must be protected IAW DOD 5400.11R, AFI 33-332 and is “FOR OFFICIAL USE ONLY”
_822717659
File details come from the government source that posted it. Updated .