+--------------+-----------------------------------------+-------------+
| SF 7643-UCR  | #                                       | #           |
| (10-2006)    | Uncleared Contractor Badge Request Form |             |
|              |                                         |             |
| # S          |                                         |             |
| upersedes (8 |                                         |             |
| -2006) issue |                                         |             |
+--------------+-----------------------------------------+-------------+

(As you enter each field, look at the bottom of your screen for help
messages.)

(Scroll down and click on the first fill field)

+---+---------------------------------------------------------------------+
| 1 | a.  Enter the Purchase Order Number of the contract.                |
|   |                                                                     |
|   | b.  Enter the expiration date of the agreement or of the extended   |
|   |     agreement.                                                      |
|   |                                                                     |
|   | c.  Enter SNL Sponsoring Organization number and mail stop. Note:   |
|   |     this will be the org. the individual being badged will be       |
|   |     placed in, in the SNL directory -- usually of requestor/SDR.    |
|   |                                                                     |
|   | d.  Enter the name of the employer here. If this company is a       |
|   |     sub-contractor to a prime contractor, list the sub-contractor   |
|   |     company here. List the Prime Contractor in box (t) below.       |
|   |                                                                     |
|   | e.  Enter the mailing address of the company listed in (d).         |
|   |                                                                     |
|   | f.  Enter the City.                                                 |
|   |                                                                     |
|   | g.  Enter the State.                                                |
|   |                                                                     |
|   | h.  Enter the ZIP Code.                                             |
|   |                                                                     |
|   | i.  If this company is doing business as another name, enter that   |
|   |     name here.                                                      |
|   |                                                                     |
|   | j.  Enter the name of the Facility Security Officer (for FOCI       |
|   |     certified companies), Company Official (for uncleared           |
|   |     companies).                                                     |
|   |                                                                     |
|   | k.  Enter the e-mail address of the person listed in (j).           |
|   |                                                                     |
|   | l.  Enter the fax number of the company.                            |
|   |                                                                     |
|   | m.  Enter the phone number of the company.                          |
|   |                                                                     |
|   | n.  Enter the complete legal last name of the individual to be      |
|   |     badged.                                                         |
|   |                                                                     |
|   | o.  Enter the complete legal first name of the individual to be     |
|   |     badged.                                                         |
|   |                                                                     |
|   | p.  Enter the complete legal middle name (not initial) of the       |
|   |     individual to be badged.                                        |
|   |                                                                     |
|   | q.  Enter the Social Security Number of the individual being        |
|   |     badged.                                                         |
|   |                                                                     |
|   | r.  Enter the date of birth of the individual being badged.         |
|   |                                                                     |
|   | s.  Citizenship must be approved by somebody other than the         |
|   |     individual. This box must be signed for or the request will be  |
|   |     rejected. For sub-contractor companies this must be the person  |
|   |     that verified the I-9 documents.                                |
|   |                                                                     |
|   | t.  If applicable, enter the name of the Prime Contract Company.    |
|   |     Leave blank if none.                                            |
|   |                                                                     |
|   | u.  Print name of Prime Contract Company Official. Prime Contract   |
|   |     company official MUST also sign here.                           |
|   |                                                                     |
|   | v.  Check the box of the work site.                                 |
|   |                                                                     |
|   | w.  Check the box of category type.                                 |
|   |                                                                     |
|   | x.  Enter the job title of the contractor.                          |
+---+---------------------------------------------------------------------+
| 2 | Training -- Applies to ALL construction personnel who will perform  |
|   | or direct work on a job site. A company official MUST sign here     |
|   | acknowledging that training has been completed.                     |
+---+---------------------------------------------------------------------+
| 3 | > *Issue Uncleared Badge* -- self-explanatory                       |
|   | >                                                                   |
|   | > -OR-                                                              |
|   | >                                                                   |
|   | > *Start Process for Foreign National Request (FNR)* --             |
|   | > self-explanatory                                                  |
+---+---------------------------------------------------------------------+
| 4 | > Fill in the information for the person who is going to be         |
|   | > responsible for the individual. The person listed here will       |
|   | > receive all correspondence in regards to the individual, such as  |
|   | > e-mail notification when badge is ready.                          |
+---+---------------------------------------------------------------------+
| 5 | > Fill in the information for the approving manager and have        |
|   | > manager sign.                                                     |
+---+---------------------------------------------------------------------+

+---------+---------------------------------------------------+-------+
| SF      | # UNCLEARED CONTRACTOR BADGE REQUEST FORM         |       |
| 7       |                                                   |       |
| 643-UCR |                                                   |       |
| (1      |                                                   |       |
| 0-2006) |                                                   |       |
|         |                                                   |       |
| Sup     |                                                   |       |
| ersedes |                                                   |       |
| (       |                                                   |       |
| 8-2006) |                                                   |       |
| issue   |                                                   |       |
+---------+---------------------------------------------------+-------+

A minimum of 5 business days required for processing

<table>
<colgroup>
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<col style="width: 1%" />
<col style="width: 8%" />
</colgroup>
<tbody>
<tr class="odd">
<td colspan="108"><h2
id="contractor-badge-office-new-mexico-ms-1306">CONTRACTOR BADGE OFFICE:
NEW MEXICO, MS 1306</h2></td>
</tr>
<tr class="even">
<td colspan="47"><strong>Facilities Contractors – Fax: 505-284-4087;
Phone: 505-845-3359</strong></td>
<td colspan="61"><strong>MESA Contractors – Fax: 505-284-3745; Phone:
505-844-5917</strong></td>
</tr>
<tr class="odd">
<td colspan="63"><strong>1. Information</strong></td>
<td colspan="45"></td>
</tr>
<tr class="even">
<td colspan="33"><p>Purchase Order/Contract Number</p>
<p><strong>a.</strong>      </p></td>
<td colspan="36"><p>Agreement Expiration Date</p>
<p><strong>b.</strong>      </p></td>
<td colspan="39"><p>SNL Sponsoring Org./Mail Stop</p>
<p><strong>c.</strong> Org.      , MS-     </p></td>
</tr>
<tr class="odd">
<td colspan="22"><p>Legal Company Name or Consultant Name</p>
<p><strong>d.</strong>      </p></td>
<td colspan="44"><p>Mailing Address</p>
<p><strong>e.</strong>      </p></td>
<td colspan="26"><p>City</p>
<p><strong>f.</strong>      </p></td>
<td colspan="10"><p>State</p>
<p><strong>g.</strong>   </p></td>
<td colspan="6"><p>ZIP Code</p>
<p><strong>h.</strong>      </p></td>
</tr>
<tr class="even">
<td colspan="108"><p>Doing Business As (DBA) (if applicable)</p>
<p><strong>i.</strong>      </p></td>
</tr>
<tr class="odd">
<td colspan="33"><p>Facility Security Officer or Company Official (if
applicable)</p>
<p><strong>j.</strong>      </p></td>
<td colspan="38"><p>E-mail address</p>
<p><strong>k.</strong>      </p></td>
<td colspan="26"><p>Fax No.</p>
<p><strong>l.</strong>      </p></td>
<td colspan="11"><p>Phone No.</p>
<p><strong>m.</strong>      </p></td>
</tr>
<tr class="even">
<td colspan="18"><p>Individuals Last Name</p>
<p><strong>n.</strong>      </p></td>
<td colspan="24"><p>Individuals First Name</p>
<p><strong>o.</strong>      </p></td>
<td colspan="29"><p>Individuals Middle Name</p>
<p><strong>p.</strong>      </p></td>
<td colspan="26"><p>Social Security No.</p>
<p><strong>q.</strong>      </p></td>
<td colspan="11"><p>Date of Birth</p>
<p><strong>r.</strong>      </p></td>
</tr>
<tr class="odd">
<td colspan="33" rowspan="6"><blockquote>
<p><em>(Company Official must sign here)</em></p>
</blockquote></td>
<td colspan="75" rowspan="4"><p><strong>s.</strong> Citizenship</p>
<p><strong>Citizenship Certification by Company Official. Somebody other
than the individual must sign here.</strong></p>
<p> U.S. Foreign (contact Foreign Interactions Office for
processing)</p></td>
</tr>
<tr class="even">
</tr>
<tr class="odd">
</tr>
<tr class="even">
</tr>
<tr class="odd">
<td colspan="36"><strong>     </strong></td>
<td colspan="10"></td>
<td colspan="29"></td>
</tr>
<tr class="even">
<td colspan="36">Name (Print)</td>
<td colspan="10"></td>
<td colspan="29">Signature</td>
</tr>
<tr class="odd">
<td colspan="38"></td>
<td colspan="5"></td>
<td colspan="30"></td>
<td colspan="13"></td>
<td colspan="22"></td>
</tr>
<tr class="even">
<td colspan="27"><strong>t.</strong> Prime Contract Company (if
applicable):</td>
<td colspan="81"><strong>     </strong></td>
</tr>
<tr class="odd">
<td colspan="21"><strong>u.</strong> Prime Contract Company
Official:</td>
<td colspan="43">     </td>
<td colspan="4"></td>
<td colspan="40"></td>
</tr>
<tr class="even">
<td colspan="26"></td>
<td colspan="31">Name (Print)</td>
<td colspan="4"></td>
<td colspan="47">Signature</td>
</tr>
<tr class="odd">
<td colspan="4"><strong>v.</strong> Work Site:</td>
<td colspan="39"> On Sandia premises, at Kirtland Air Force Base</td>
<td colspan="16"> Other</td>
<td colspan="35"><strong>     </strong></td>
<td colspan="14"></td>
</tr>
<tr class="even">
<td colspan="10"><strong>w.</strong> Category Type:</td>
<td colspan="24"> Key Mgmt. Personnel (KMP)</td>
<td colspan="12"> Contractor</td>
<td colspan="31"> Staff Augmentation</td>
<td colspan="13"> Other:</td>
<td colspan="18"><strong>     </strong></td>
</tr>
<tr class="odd">
<td colspan="7"><strong>x.</strong> Job Title:</td>
<td colspan="101">     </td>
</tr>
<tr class="even">
<td colspan="14"><strong>2. Training:</strong></td>
<td colspan="10"> SEC 050</td>
<td colspan="15"> 10-hour OSHA</td>
<td colspan="26"> 01065 ES&amp;H Spec.</td>
<td colspan="42"> Contract-Specific Safety Plan</td>
<td></td>
</tr>
<tr class="odd">
<td colspan="108">** Company Official signing below certifies that the
required training in (<strong>a</strong>) above has been
completed.**</td>
</tr>
<tr class="even">
<td colspan="6"></td>
<td colspan="14"></td>
<td colspan="20"><strong>Training Certified by:</strong></td>
<td colspan="38">     </td>
<td colspan="7"></td>
<td colspan="23"></td>
</tr>
<tr class="odd">
<td colspan="7"></td>
<td colspan="32"></td>
<td colspan="39">Company Official (Print Name)</td>
<td colspan="7"></td>
<td colspan="22">Company Official Signature</td>
<td>Date</td>
</tr>
<tr class="even">
<td colspan="41"><strong>3. Badge Request</strong> <em>(Fill in
applicable box)</em></td>
<td colspan="48"></td>
<td colspan="16"></td>
<td colspan="3"></td>
</tr>
<tr class="odd">
<td></td>
<td colspan="27">Present Badge Expiration Date (if applicable):</td>
<td colspan="20"><strong>     </strong></td>
<td colspan="41">New Badge Expiration Date:</td>
<td colspan="16"><strong>     </strong></td>
<td colspan="3"></td>
</tr>
<tr class="even">
<td></td>
<td colspan="107"> Issue uncleared badge</td>
</tr>
<tr class="odd">
<td></td>
<td colspan="43"> Start Foreign National Request (FNR)</td>
<td colspan="26"></td>
<td colspan="38"></td>
</tr>
<tr class="even">
<td colspan="108"></td>
</tr>
<tr class="odd">
<td colspan="12"><strong>4. SNL Requestor:</strong></td>
<td colspan="18"><strong>     </strong></td>
<td colspan="5"></td>
<td colspan="16"><strong>     </strong></td>
<td colspan="3"></td>
<td colspan="21"><strong>     /     </strong></td>
<td colspan="6"></td>
<td colspan="15"><strong>     </strong></td>
<td colspan="3"></td>
<td colspan="9"><strong>     </strong></td>
</tr>
<tr class="even">
<td colspan="11"></td>
<td colspan="20">Name</td>
<td colspan="5"></td>
<td colspan="16">SSN</td>
<td colspan="6"></td>
<td colspan="14">Org./Mailstop</td>
<td colspan="8"></td>
<td colspan="15">Phone</td>
<td colspan="3"></td>
<td colspan="10">Fax</td>
</tr>
<tr class="odd">
<td colspan="2">Note:</td>
<td colspan="106">SNL Requestor will receive all administrative type
notifications (ex.: badge ready notification). This person can be
different from the Approving Manager.</td>
</tr>
<tr class="even">
<td colspan="108"></td>
</tr>
<tr class="odd">
<td colspan="16"><strong>5. Approving Manager:</strong></td>
<td colspan="33"><strong>     </strong></td>
<td colspan="4"></td>
<td colspan="40"></td>
<td colspan="7"></td>
<td colspan="8"><strong>     </strong></td>
</tr>
<tr class="even">
<td colspan="16"></td>
<td colspan="33">Name</td>
<td colspan="4"></td>
<td colspan="40">Signature</td>
<td colspan="7"></td>
<td colspan="8">Date</td>
</tr>
<tr class="odd">
<td colspan="32">Approving Manager’s</td>
<td colspan="18"><strong>     </strong></td>
<td colspan="5"></td>
<td colspan="21"><strong>     /     </strong></td>
<td colspan="7"></td>
<td colspan="10"><strong>     </strong></td>
<td colspan="7"></td>
<td colspan="8"><strong>     </strong></td>
</tr>
<tr class="even">
<td colspan="32"></td>
<td colspan="18">SSN</td>
<td colspan="10"></td>
<td colspan="14">Org./Mailstop</td>
<td colspan="8"></td>
<td colspan="11">Phone</td>
<td colspan="7"></td>
<td colspan="8">Fax</td>
</tr>
<tr class="odd">
<td colspan="108"><h1 id="for-badge-office-use-only">FOR BADGE OFFICE
USE ONLY</h1></td>
</tr>
<tr class="even">
<td colspan="9">Pending Information?</td>
<td colspan="8"> Yes</td>
<td colspan="45">     </td>
<td colspan="22"> No</td>
<td colspan="3"></td>
<td colspan="16">Start Date:</td>
<td colspan="5"><strong>     </strong></td>
</tr>
<tr class="odd">
<td colspan="5">Info in Oracle?</td>
<td colspan="8"> Yes</td>
<td colspan="10"> No</td>
<td colspan="14">CPCI Verified?</td>
<td colspan="8"> Yes</td>
<td colspan="11"> No</td>
<td colspan="28"></td>
<td colspan="4"></td>
<td colspan="16">Completed Date:</td>
<td colspan="4">     </td>
</tr>
<tr class="even">
<td colspan="8">Affiliate - Badge</td>
<td colspan="7"> Yes</td>
<td colspan="14"> No</td>
<td colspan="27">New Contractor (iPASS Input)</td>
<td colspan="11"> Yes</td>
<td colspan="24"> No</td>
<td colspan="15">Personnel Initials:</td>
<td colspan="2">     </td>
</tr>
<tr class="odd">
<td colspan="19">E-mail Company Official - Ready</td>
<td colspan="6"> Yes</td>
<td colspan="12"> No</td>
<td colspan="19">SNL/SDR Approval:</td>
<td colspan="11"> Yes</td>
<td colspan="20"> No</td>
<td colspan="14"></td>
<td colspan="7"></td>
</tr>
<tr class="even">
<td colspan="3">NOTES:</td>
<td colspan="105">     </td>
</tr>
<tr class="odd">
<td colspan="108"></td>
</tr>
<tr class="even">
<td colspan="108"></td>
</tr>
<tr class="odd">
<td colspan="108"></td>
</tr>
<tr class="even">
<td colspan="108"></td>
</tr>
</tbody>
</table>