Cape Canaveral Air Force Station (Ccafs) Badge Application and Instructions

Patriot Contract Services, LLC

CAPE CANAVERAL AIR FORCE STATION (CCAFS) BADGE APPLICATION AND INSTRUCTIONS

In accordance with a directive from the Department of the Air Force, please ensure that the identity and status of visitors is validated through a physical check of their picture ID’s. Check at least two forms of ID. One form must be from the primary list below:

1. Primary - Drivers License; State ID Card; DoD, State or Local Gov ID Card; US Passport; Resident Alien ID Card; F/N Passport; US Coast Guard Merchant Marine

2. Secondary – U.S. Birth Certificate; Certificate of US Citizenship; Certificate of Naturalization; Unexpired Temporary Resident Card; Voter Registration Card; Native American Tribal Document; US SSN Card; Certificate of Birth Aboard issued by Dept. of State.

Visitors must present their (2) two forms of ID to the Pass & ID Office upon picking up their visitor badges. Badges authorized by Patriot are to be used only for work ordered by our company. Seat belts must be used. Speed limits must be obeyed. Hand held cell phones cannot be used while driving on the CCAFS. If an employee leaves your employment while the badge is still valid, please collect the badge and return it to Patriot. Badged applicants agree to enter and depart CCAFS only through the Port Gate. When the Port Gate is closed, then badged applicants will enter and leave CCAFS only from the South Gate and drive directly to, and from, the Port by the most direct route. Travel elsewhere on CCAFS is not permitted.

Unescorted entry white badge is issued only if the person has a demonstrated history with your company or agency. If the visitor does not have a history, he or she must be issued an escorted pink badge. Foreign nationals, this includes personnel with alien registration cards, receive a green badge and must be escorted at all times when on CCAFS or the ship.

It is Patriot’s policy not to request a badge for a visitor for a longer period of time than the length of time that person has been employed by the requesting company.

Requests must be submitted at least two working days prior to issue date to complete required checks. Patriot will not be responsible for delay due to failure to timely provide badge application information.

Please acknowledge receipt of these instructions by signing this form. Then return this form with the attached application.

This form may be filled in using Microsoft Word or printed and filled in manually.

Name: Signature:

Position: Date:

Fax completed forms with signatures to: (877)-573-1094 Confirmation/Questions: (757) 291-4760

CAPE CANAVERAL AIR FORCE STATION (CCAFS) BADGE APPLICATION

Home Office: 1661 Tice Valley Blvd, Suite 200, Walnut Creek, CA 94595 Phone (925)296-2000 Virginia Office: PO Box 12155, Newport News, VA 23612-2155 (757)825-0088 Port Engineer: (757) 291-4760 Patriot Contract Services, LLC

Company Name

Company Address

Most Recent Drivers Full Length of U.S. Background Investigation SSN# License Date of First-Middle-Last Employ Citizen (If Applicable) (000-00-0000) Birth Name State (X.X) (Y/N) Date Number Type (XX) Completed Yrs N/A

Yrs N/A

Yrs N/A Dates of work on USNS WATERS to

Home Office: 1661 Tice Valley Blvd, Suite 200, Walnut Creek, CA 94595 Phone (925)296-2000 Virginia Office: PO Box 12155, Newport News, VA 23612-2155 (757)825-0088 Port Engineer: (757) 291-4760 Patriot Contract Services, LLC

Date/time of arrival for badge pick-up: MAR 9, 2009 from 1200-1400

Based on information provided from two forms of ID as listed in the instructions, I certify that the employees listed above are U.S. citizens. (Must be signed by a manager of the employee.)

Name: Signature:

Position: Phone: Date Signed:

Home Office: 1661 Tice Valley Blvd, Suite 200, Walnut Creek, CA 94595 Phone (925)296-2000 Virginia Office: PO Box 12155, Newport News, VA 23612-2155 (757)825-0088 Port Engineer: (757) 291-4760