US_Citizen_Pre-Bid_or_Site_Visit_Form_JUL_2014.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 one of the Nashville District (LRN) Corps of Engineers field locations and must be sent to the LRN Security Management Office (LRN-SM) at least five (5) days prior to the proposed visit. The form can be submitted by email, fax or regular mail (see contact information below).

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

Date the Request is Being Submitted to LRN-SM (mm/dd/yyyy) ___________________

FULL LEGAL Name _______________________________________________________

(Last, Middle, First) 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 email: tracy.dorrough@usace.army.mil Jay Klinger, Security Specialist, 615-736-2185 email: jason.j.klinger@usace.army.mil Connie Hardeman, Security Manager, 615-736-5567 email: connie.f.hardeman@usace.army.mil Contact any of the individuals listed above for more information and/or clarification.

Mailing Address: USAED, Nashville

ATTN: CELRN-SM

PO Box 1070 Nashville, TN 37202-1070

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 scheduled tour and/or briefing 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 tour date.