US Citizen Security Form.pdf
PDF 227 KB Posted
- Attached to
- Watts Bar Lock - Armor Wall Painting Federal contract opportunity
- Solicitation number
- W912P521B0020
About this file
This document contains a site visit request form and a pre-solicitation notice for a federal construction contract.
The site visit request form requires prospective visitors to provide their full legal name, date of birth, last four digits of their social security number, driver's license information, the Nashville District Corps of Engineers field location to be visited, date of the proposed visit, and a contact phone number. It must be submitted to the designated site visit point of contact at least five business days before the proposed visit. The form is used to verify identification and conduct background checks to determine eligibility for access to U.S. Army Corps of Engineers facilities.
The pre-solicitation notice indicates that the U.S. Army Corps of Engineers Nashville District intends to issue a firm fixed price construction contract for painting the wall armor at Watts Bar Lock in Decatur, Tennessee. The estimated value of the project is between $500,000 and $1,000,000. A site visit is tentatively scheduled for August 17, 2021 at 10:30am Eastern Time. Interested vendors are encouraged to submit the site visit request form promptly to avoid missing the submission deadline. Questions regarding the project must be emailed to the specified contracting specialist.
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| File | Type | Posted |
|---|---|---|
| Foreign National Security Form.pdf |
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Text version
01/23/2019
Nashville District Corps of Engineers
U.S. Citizen
Site Visit Request Form
This Request Form is for U.S. Citizens requesting approval to attend a meeting or site visit at one of the
Nashville District (LRN) Corps of Engineers field locations. The form should be submitted to the
Nashville District Meeting or Site Visit Point of Contact (POC) to be forwarded to the LRN Security
Management Office (LRN-SM) at least Five (5) full business days prior to the proposed visit.
LRN Meeting/Site Visit POC: _____________________________________
Nashville District (LRN) Contact Person)
Date the Request is Being Submitted to LRN (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 ____________
Driver’s License Number and State ________________________
LRN Field Location (Project Site) to be visited: _______________________
Date of Proposed Visit (mm/dd/yyyy) ____________________________
In Case of Questions, Please Provide Phone Number: __________________________
IMPORTANT: Submit form directly to Site Visit POC (contracting representative or Corps POC). DO
NOT submit the form directly to the Security Office Unless Directed. For questions regarding the site visit contact the Site Visit POC.
Only confirmed/approved visitors will be permitted on the tour. No substitutions or additions are allowed.
Visitors may not carry packages, backpacks, or other containers during the tour.
Photographs and video recording of the interior of the Power Plant is strictly prohibited.
No high-heel, open toe shoes, including clogs and Crocs or bare feet will be allowed on a tour.
NOTE: Any increase in threat conditions may result in an approved tour being cancelled with little notice. We regret any inconvenience this may cause.
For questions regarding completing the form, contact one of the individuals listed below:
Tracy Dorrough, Personnel Security Specialist, 615-736-7397 (Primary Security POC)
John Carter, Security Specialist, 615-736-7397
Jay Klinger, District Security Chief, 615-736-2185
PRIVACY ACT STATEMENT
AUTHORITY: Information is solicited pursuant to Title 10, U.S. Code, Section 3013 and E.O. 9397.
PRINCIPAL PURPOSE: To provide information necessary for preparation of a scheduled tour of the facility, verify positive identification of visitor(s), and conduct background checks for determinations of the eligibility of individuals for access to U.S.
Army Corps of Engineers facilities.
ROUTINE USES: Used by the U.S. Army Corps of Engineers to accompany a request for a scheduled tour of the facility.
MANDATORY OR VOLUNTARY DISCLOSURE AND EFFECT OF NOT PROVIDING INFORMATION: Providing the solicited information, including Social Security Number, is voluntary; however, failure to provide information may result in a denial of visitor access due to an inability to verify identification. The information provided to the U.S. Army Corps of
Engineers will not be retained digitally or by hard copy after the scheduled visit.
mailto:tracy.w.dorrough@usace.army.mil mailto:john.j.carter@usace.army.mil mailto:jason.j.klinger@usace.army.mil
| Drivers License Number and State: |
| Contracting Representative or Corps POC: |
| Date of Request: |
| LEGAL Name: |
| Birthday mm/dd/yyyy: |
| Last Four #s of SSN: |
| Project Site your visiting (e: |
| g: |
| Barkley Dam): |
| Date of arrival mm/dd/yyyy: |
| Contact number if we have questions: |
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