AccessPass_CGJMTC_04-04-2018.pdf

CONTRACTOR ‐ Special Work Conditions

GATE ACCESS PASS – DK SECURITY DPTMS

Camp Grayling Access Roster STANDARD FORM (CG JMTC Rev 1.0)

SUBJECT: Access Roster, Camp Grayling Joint Maneuver Training Center (CG JMTC)

MEMORANDUM FOR: DPTMS, Building 545, Brigade Road, Camp Grayling, Michigan 49012-9205

1. The purpose of this memorandum is to request escort privileges for the individuals listed below. Once identified by proper identification the individuals will be assigned to designated work areas as determined by the military escort identified below. The individuals are the responsibility of the escort and they must comply with post policy procedures in an effort to protect the force and eliminate risk and vulnerability for all hazards.

2. These individuals are working for: _ (Your Company’s Name) ____ on (Contract: Title & Location) _________________________________________________with a scheduled completion date of: __Day-MONTH-YR___________. The purpose for their entry is: ______________________________________________________________________ Use the space below to provide the names of assigned individuals. Provide a copy to DK Security upon entry into the post, and send to AT/FP Officer assigned to Camp Grayling DPTMS, Building 545.

Name Last, First DOB Operator

License No.

COMPANY START DATE ACCESS

EXPIRES

Last, First mm/dd/yyyy S‐123‐555‐222 Inspect‐It‐All 04/16/2018 04/30/2018

Last, First mm/dd/yyyy S‐321‐222‐222 Inspect‐It‐All 04/16/2018 04/30/2018

Last, First mm/dd/yyyy N‐123‐333‐222 Inspect‐It‐All 04/16/2018 04/30/2018

Last, First mm/dd/yyyy B‐123‐444‐222 Inspect‐It‐All 04/16/2018 04/30/2018

Last, First mm/dd/yyyy S‐123‐555‐222 Inspect‐It‐All 04/16/2018 04/30/2018

Last, First mm/dd/yyyy S‐321‐222‐222 Inspect‐It‐All 04/16/2018 04/30/2018

Last, First mm/dd/yyyy N‐123‐333‐222 Inspect‐It‐All 04/16/2018 04/30/2018

Last, First mm/dd/yyyy B‐123‐444‐222 Inspect‐It‐All 04/16/2018 04/30/2018

Office Symbol Date

YOUR COMPANY NAME

Street Address

City, State, Zip Code

Camp Grayling Access Roster STANDARD FORM (CG JMTC Rev 1.0)

Last, First mm/dd/yyyy S‐123‐555‐222 Inspect‐It‐All 04/16/2018 04/30/2018

Last, First mm/dd/yyyy S‐321‐222‐222 Inspect‐It‐All 04/16/2018 04/30/2018

Last, First mm/dd/yyyy S‐321‐222‐222 Inspect‐It‐All 04/16/2018 04/30/2018

Last, First mm/dd/yyyy N‐123‐333‐222 Inspect‐It‐All 04/16/2018 04/30/2018

Last, First mm/dd/yyyy B‐123‐444‐222 Inspect‐It‐All 04/16/2018 04/30/2018

Last, First mm/dd/yyyy S‐123‐555‐222 Inspect‐It‐All 04/16/2018 04/30/2018

Last, First mm/dd/yyyy S‐321‐222‐222 Inspect‐It‐All 04/16/2018 04/30/2018

Last, First mm/dd/yyyy N‐123‐333‐222 Inspect‐It‐All 04/16/2018 04/30/2018

Last, First mm/dd/yyyy B‐123‐444‐222 Inspect‐It‐All 04/16/2018 04/30/2018

Last, First mm/dd/yyyy S‐123‐555‐222 Inspect‐It‐All 04/16/2018 04/30/2018

Last, First mm/dd/yyyy S‐321‐222‐222 Inspect‐It‐All 04/16/2018 04/30/2018

Last, First mm/dd/yyyy N‐123‐333‐222 Inspect‐It‐All 04/16/2018 04/30/2018

Last, First mm/dd/yyyy B‐123‐444‐222 Inspect‐It‐All 04/16/2018 04/30/2018

Last, First mm/dd/yyyy S‐123‐555‐222 Inspect‐It‐All 04/16/2018 04/30/2018

Last, First mm/dd/yyyy S‐321‐222‐222 Inspect‐It‐All 04/16/2018 04/30/2018

Last, First mm/dd/yyyy N‐123‐333‐222 Inspect‐It‐All 04/16/2018 04/30/2018

Last, First mm/dd/yyyy S‐123‐555‐222 Inspect‐It‐All 04/16/2018 04/30/2018

Last, First mm/dd/yyyy S‐321‐222‐222 Inspect‐It‐All 04/16/2018 04/30/2018

Last, First mm/dd/yyyy N‐123‐333‐222 Inspect‐It‐All 04/16/2018 04/30/2018

Last, First mm/dd/yyyy B‐123‐444‐222 Inspect‐It‐All 04/16/2018 04/30/2018

Last, First mm/dd/yyyy S‐123‐555‐222 Inspect‐It‐All 04/16/2018 04/30/2018

Last, First mm/dd/yyyy S‐321‐222‐222 Inspect‐It‐All 04/16/2018 04/30/2018

Last, First mm/dd/yyyy N‐123‐333‐222 Inspect‐It‐All 04/16/2018 04/30/2018

Last, First mm/dd/yyyy B‐123‐444‐222 Inspect‐It‐All 04/16/2018 04/30/2018

Last, First mm/dd/yyyy S‐123‐555‐222 Inspect‐It‐All 04/16/2018 04/30/2018

Last, First mm/dd/yyyy S‐321‐222‐222 Inspect‐It‐All 04/16/2018 04/30/2018

Last, First mm/dd/yyyy N‐123‐333‐222 Inspect‐It‐All 04/16/2018 04/30/2018

Last, First mm/dd/yyyy N‐123‐333‐222 Inspect‐It‐All 04/16/2018 04/30/2018

Camp Grayling Access Roster STANDARD FORM (CG JMTC Rev 1.0)

Office Symbol SUBJECT: Access Roster, Camp Grayling Joint Maneuver Training Center (CG JMTC)

3. Project/Contractor Lead POC is:

Rank, Firstname

Lastname;

officephone, cellphone, email.

The military POC shown below has indicated that we will conduct primary administrative work from building number ______ CG JMTC during the period of the assigned work. Other areas of the installation will be provided by the military POC on a daily basis, or as required by CG

DPTMS Operations, Bldg. 545.

4. The military representative and point of contact for this memorandum is LTC David

Gillahan, office (517) 481-7558, mobile (989) 745-1911 david.m.gillahan.mil@mail.mil.

(Authorized Signature)

John S. Smith

TITLE

Send Copy to:

DK Security campgrayling@dksecurity.com Camp Grayling AT/FP Officer/NCO clifford.r.mayhew.mil@mail.mil Military POC david.m.gillahan.mil@mail.mil