A07_JBCC_Base_Access.pdf

PDF 105 KB Posted Sep 10, 2018

Attached to: Furnish and Install Variable Frequency Drives Federal contract opportunity
Solicitation number: W912SV18Q6019
Issued by: Department of the Army Massachusetts Army National Guard

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A07_Provisions_&_Clauses.pdf	PDF	Sep 10, 2018

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JBCC EVENT/PROJECT ROSTER Office use only

Event/Project Name: Sent to BDOC:

Destination: Approved:

Start & End Dates: Sponsor called:

Sponsor

Name/Phone: Daily Roster?:

Company/POC/Phone: Date:

COMPLETE ALL BLOCKS RETURN TO ACCESS CONTROL/PASS & ID, 3-5 WORKING DAYS PRIOR TO ARRIVAL FOR BACKGROUNDS

MUST BE TYPED & SENT ELECTRONICALLY TO ACCESS CONTROL/PASS & ID FOR TRACKING PURPOSES

LEGAL Last Name LEGAL First Name MI Driver's License # State

Citizen? DOB I-Gate

ALL PARTIES AGREE TO NCIC BACKGROUND CHECKS?

NCIC APPROVAL: CJIS REP SIGNATURE: rev: 03/01/17

Originating Agency Contact Information:

Comments:

EventProject Name: WWTP VFD Project-W912SV-18-Q-6019

Destination: BUILDING 3255 Waste Water Treatment Plant

Start End Dates: 13 September 2018 (one day pass only)

Sponsor NamePhone: MSgt Kirk Wetherbee / 508-968-4977

CompanyPOCPhone:

Last NameRow1:

LEGAL First NameRow1:

MIRow1:

Drivers License Row1:

StateRow1:

USA CitizenRow1:

DOBRow1:

IGateRow1:

Last NameRow2:

LEGAL First NameRow2:

MIRow2:

Drivers License Row2:

StateRow2:

USA CitizenRow2:

DOBRow2:

IGateRow2:

Last NameRow3:

LEGAL First NameRow3:

MIRow3:

Drivers License Row3:

StateRow3:

USA CitizenRow3:

DOBRow3:

IGateRow3:

Last NameRow4:

LEGAL First NameRow4:

MIRow4:

Drivers License Row4:

StateRow4:

USA CitizenRow4:

DOBRow4:

IGateRow4:

Last NameRow5:

LEGAL First NameRow5:

MIRow5:

Drivers License Row5:

StateRow5:

USA CitizenRow5:

DOBRow5:

IGateRow5:

Last NameRow6:

LEGAL First NameRow6:

MIRow6:

Drivers License Row6:

StateRow6:

USA CitizenRow6:

DOBRow6:

IGateRow6:

Last NameRow7:

LEGAL First NameRow7:

MIRow7:

Drivers License Row7:

StateRow7:

USA CitizenRow7:

DOBRow7:

IGateRow7:

Last NameRow8:

LEGAL First NameRow8:

MIRow8:

Drivers License Row8:

StateRow8:

USA CitizenRow8:

DOBRow8:

IGateRow8:

Last NameRow9:

LEGAL First NameRow9:

MIRow9:

Drivers License Row9:

StateRow9:

USA CitizenRow9:

DOBRow9:

IGateRow9:

Text3:

Text4:

Text5:

Text6:

Text7:

Originating Agency Contact Information:

Check Box3: Yes

NCIC Approval: [Yes]

Comments:

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