Site_Visit_Request_Form.pdf

Nashville District Corps of Engineers

U.S. Citizen

Pre-Bid Meeting and/or Site Visit Request Form

This Request Form is for U.S. Citizens requesting approval to attend a pre-bid meeting and/or site visit at or in Nashville District (LRN) restricted/controlled areas (such as a Power Plant or Navigation Lock) or which will include discussion anything other than public domain information. The form must be sent to the LRN Point of Contact (POC) at least five (5) days prior to the proposed visit. If submitting the document in less than five days, the Offeror/Bidder may not receive approval for meeting and/or site visit. The LRN POC will notify the individual(s) if the request is approved or denied.

LRN Pre-Bid Meeting and/or Site Visit POC: __________________________________

Date the Request is Being Submitted to LRN-POC (mm/dd/yyyy) _________________

FULL LEGAL Name ______________________________________________________ (Last, First, Middle)

If you have only initials in your name, use them and state (IO). If you have no middle name, enter “NMN”. If you are a “Jr.,”Sr.,” “II,” etc., indicate your status (Do not list a Nickname) NOTE: Failure to provide FULL LEGAL name will delay approval

Date of Birth (mm/dd/yyyy) _______________

Last Four Digits of Social Security Number _________________

LRN Field Location (Project Site) to be Visited:

Date of Proposed Visit (mm/dd/yyyy) ____________________________

In Case of Questions, Please Provide Phone Number: __________________________

Nashville District Corps of Engineers Security Office Contact Information:

Tracy Dorrough, Security Technician, 615-736-7397 Jay Klinger, Security Specialist, 615-736-2185 Connie Hardeman, Security Manager, 615-736-5567 Contact any of the individuals listed above for more information and/or clarification.

Mailing Address: USAED, Nashville 110 9th Ave S, Room A-405

ATTN: CELRN-SM

Nashville, TN 37203

CELRN-SM Fax Number: 615-736-7145

PRIVACY ACT STATEMENT

Information is solicited in accordance with Title 10, US Code Section 552 and is used to provide information necessary in preparation for a pre-bid meeting and/or site visit and to verify positive identification of visitor. Solicited information is voluntary; however, failure to provide information may result in denied visitor access. The information provided to the Nashville District will not be retained digitally or by hard copy after the scheduled meeting/site visit.

AUG 2015 Version