+--------+---------------------------------------------------+--------+
| SF     | # Contractor/Consulta                             | #      |
| 76     | nt Badge/Clearance Request Form Instruction Sheet |        |
| 43-CEC |                                                   |        |
| (8     |                                                   |        |
| -2008) |                                                   |        |
|        |                                                   |        |
| # S    |                                                   |        |
| uperse |                                                   |        |
| des (3 |                                                   |        |
| -2007) |                                                   |        |
|  issue |                                                   |        |
+--------+---------------------------------------------------+--------+

+---+---+------------------------------------------------------------------+
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|   | h |                                                                  |
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|   | i |                                                                  |
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|   | . |                                                                  |
+---+---+------------------------------------------------------------------+
| * |   | > Training                                                       |
| * |   | >                                                                |
| 2 |   | > Initial Security Briefing (SEC 050) is required to ALL         |
| * |   | > personnel who require unescorted access to SNL security areas. |
| * |   | > A Company Official, FSO, or SNL Requestor must sign certifying |
|   |   | > that required training has been completed. At SNL/CA, SEC050   |
| * |   | > will be given at the time the individual obtains badge.        |
| * |   | > Disregard this section for badge renewal requests.             |
| a |   | >                                                                |
| . |   | > Only applicable to Construction Contractors -- disregard for   |
| * |   | > all other requests -- 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.                                                     |
| * |   |                                                                  |
| b |   |                                                                  |
| . |   |                                                                  |
| * |   |                                                                  |
| * |   |                                                                  |
+---+---+------------------------------------------------------------------+
| * |   | > Badge Request\                                                 |
| * |   | > Enter the date the current badge expires (if applicable).      |
| 3 |   | >                                                                |
| * |   | > New Badge Expiration Date -- enter the date you want the       |
| * |   | > individual's new badge to expire. If you want a date different |
|   |   | > from the contract expiration date (Section 1, Box b -- not to  |
| * |   | > exceed this date) enter that date here.                        |
| * |   | >                                                                |
| a |   | > Issue Uncleared Badge -- check this box if there will not be a |
| . |   | > clearance requested. Do not complete Section 4 -- Clearance    |
| * |   | > Information.                                                   |
| * |   |                                                                  |
|   |   | Clearance in Process (no uncleared badge required) -- check this |
| * |   | box if a clearance is already in process and no uncleared badge  |
| * |   | is needed during the investigation -- agreement has been renewed |
| b |   | and individual must remain on the active agreement while in      |
| . |   | process for a clearance. Do not complete Section 4 -- Clearance  |
| * |   | Information.\                                                    |
| * |   | Clearance in Process (Issue uncleared badge) -- check this box   |
|   |   | if a clearance is already in process and an uncleared badge will |
| * |   | be needed during the investigation. Do not complete Section 4 -- |
| * |   | Clearance Information.                                           |
| c |   |                                                                  |
| . |   | Issue Cleared Badge-- check this box if individual holds a       |
| * |   | current active clearance either with SNL or another facility and |
| * |   | the clearance is to be transferred to SNL. If an immediate       |
|   |   | transfer or a transfer is being requested, complete Section 4 -- |
|   |   | Clearance Information and include the Clearance                  |
|   |   | Request/Recertification/Suitability Form (DOE F 472.1C).         |
|   |   |                                                                  |
|   |   | No badge required (KMP, Off-Site or Extension) -- check this box |
|   |   | if individual is either a KMP, off-site contractor or has a      |
|   |   | current clearance with another DOE site and is also working on   |
|   |   | contract with SNL. Individual will use badge from Primary        |
|   |   | facility, no SNL standard badge will be issued.                  |
+---+---+------------------------------------------------------------------+
| * |   | > Clearance Information (Access Authorizations will not be       |
| * |   | > processes for Foreign Nationals)                               |
| 4 |   | >                                                                |
| * |   | > Complete this section only if one of the following clearance   |
| * |   | > actions is being requested: (1) initial clearance request, (2) |
|   |   | > upgrade, (3) downgrade, (4) extension, (5) clearance transfer, |
|   |   | > or (6) reinstatement. Complete and submit DOE F 472.1C with    |
|   |   | > request.                                                       |
+---+---+------------------------------------------------------------------+
| * |   | > SNL Requestor                                                  |
| * |   | >                                                                |
| 5 |   | > The SNL employee assuming responsibility for the individual    |
| * |   | > completes this section. The SNL Requestor receives e-mail      |
| * |   | > notifications when badge is ready and when to re-submit a new  |
|   |   | > request once the current request is expiring. This person can  |
|   |   | > be different from the Approving Manager.                       |
+---+---+------------------------------------------------------------------+
| * |   | > Approving Manager                                              |
| * |   | >                                                                |
| 6 |   | > The SNL approving manager authorizing this form completes this |
| * |   | > section.                                                       |
| * |   |                                                                  |
+---+---+------------------------------------------------------------------+

+---------+---------------------------------------------------+-------+
| SF      | # OUO                                             |       |
| 7       |                                                   |       |
| 643-CEC |                                                   |       |
| (       |                                                   |       |
| 8-2008) |                                                   |       |
|         |                                                   |       |
| Sup     |                                                   |       |
| ersedes |                                                   |       |
| (1      |                                                   |       |
| 1-2007) |                                                   |       |
| issue   |                                                   |       |
+---------+---------------------------------------------------+-------+

CONTRACTOR/CONSULTANT BADGE/CLEARANCE REQUEST FORM

<table>
<colgroup>
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</colgroup>
<tbody>
<tr class="odd">
<td></td>
<td colspan="58"><strong>1. Information</strong></td>
<td colspan="44"></td>
</tr>
<tr class="even">
<td></td>
<td colspan="29"><p>Purchase Order/As Ordered Agreement (AOA)</p>
<p><strong>a.</strong>      </p></td>
<td colspan="34"><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></td>
<td colspan="22"><p>Legal Company Name or Consultant Name</p>
<p><strong>d.</strong>      </p></td>
<td colspan="39"><p>Mailing Address</p>
<p><strong>e.</strong>      </p></td>
<td colspan="21"><p>City</p>
<p><strong>f.</strong>      </p></td>
<td colspan="11"><p>State</p>
<p><strong>g.</strong>   </p></td>
<td colspan="9"><p>ZIP Code</p>
<p><strong>h.</strong>      </p></td>
</tr>
<tr class="even">
<td></td>
<td colspan="102"><p>Doing Business As (if applicable)</p>
<p><strong>i.</strong>      </p></td>
</tr>
<tr class="odd">
<td></td>
<td colspan="29"><p>Facility Security Officer (FSO) or Company
Official</p>
<p><strong>j.</strong>      </p></td>
<td colspan="37"><p>E-mail address</p>
<p><strong>k.</strong>      </p></td>
<td colspan="24"><p>Phone No.</p>
<p><strong>l.</strong>      </p></td>
<td colspan="12"><p>Fax No.</p>
<p><strong>m.</strong>      </p></td>
</tr>
<tr class="even">
<td></td>
<td colspan="17"><p>Individuals Last Name</p>
<p><strong>n.</strong>      </p></td>
<td colspan="19"><p>Individuals First Name</p>
<p><strong>o.</strong>      </p></td>
<td colspan="26"><p>Individuals Middle Name</p>
<p><strong>p.</strong>      </p></td>
<td colspan="34"><p>SSN and SNL ID</p>
<p><strong>q.</strong>      </p></td>
<td colspan="6"><p>Date of Birth</p>
<p><strong>r.</strong>      </p></td>
</tr>
<tr class="odd">
<td></td>
<td colspan="36"><p>Individuals current city and state of residence</p>
<p><strong>s.</strong>      </p></td>
<td colspan="66"><p>Individuals e-mail address</p>
<p><strong>t.      </strong></p></td>
</tr>
<tr class="even">
<td colspan="30" rowspan="4"><p>(FSO/SNLRequestor/Company Official must
certify here)</p>
<table>
<colgroup>
<col style="width: 100%" />
</colgroup>
<tbody>
<tr class="odd">
<td><p><strong>v.</strong> Prime Contract Company (if applicable):</p>
<p>     </p></td>
</tr>
</tbody>
</table></td>
<td colspan="73"><p><strong>u.</strong> U.S. Dual Citizen</p>
<p><strong>U.S. citizenship verified by If Dual Citizen, please list
Countries</strong></p></td>
</tr>
<tr class="odd">
<td colspan="73">     </td>
</tr>
<tr class="even">
<td colspan="38">Name (Print)</td>
<td colspan="3"></td>
<td colspan="32">Signature</td>
</tr>
<tr class="odd">
<td colspan="19"><strong>w.</strong> Category Type:</td>
<td colspan="32"> Key Mgmt. Personnel (KMP)</td>
<td colspan="18"> Contractor</td>
<td colspan="4"> Consultant</td>
</tr>
<tr class="even">
<td colspan="30"></td>
<td colspan="19"></td>
<td colspan="32"></td>
<td colspan="18"></td>
<td colspan="4"></td>
</tr>
<tr class="odd">
<td colspan="7"><strong>2. Training:</strong></td>
<td colspan="25"><strong>a.</strong> Initial Security Briefing SEC
050</td>
<td colspan="23"><strong>b.</strong> 10-hour OSHA</td>
<td colspan="25"> 01065 ES&amp;H Spec.</td>
<td colspan="23"> Contract-Specific Safety Plan</td>
</tr>
<tr class="even">
<td colspan="103">** FSO/SNL Requestor/Company Official signing below
certifies that the required training above has been completed.</td>
</tr>
<tr class="odd">
<td colspan="34"><strong>Training Certified by:</strong></td>
<td colspan="38">     </td>
<td colspan="4"></td>
<td colspan="27"></td>
</tr>
<tr class="even">
<td colspan="33"></td>
<td colspan="39">Name (Print)</td>
<td colspan="4"></td>
<td colspan="26">Signature</td>
<td>Date</td>
</tr>
<tr class="odd">
<td colspan="33"><strong>3. Badge Request</strong> <em>(Fill in
applicable box)</em></td>
<td colspan="39"></td>
<td colspan="4"></td>
<td colspan="26"></td>
<td></td>
</tr>
<tr class="even">
<td colspan="3"><strong>a.</strong></td>
<td colspan="24">Present Badge Expiration Date (if applicable):</td>
<td colspan="19">     </td>
<td colspan="10"><strong>b.</strong></td>
<td colspan="32">New Badge Expiration Date:</td>
<td colspan="15">     </td>
</tr>
<tr class="odd">
<td colspan="3"><strong>c.</strong></td>
<td colspan="100"> Issue uncleared badge only - no clearance action</td>
</tr>
<tr class="even">
<td colspan="3"></td>
<td colspan="37"> Clearance in process (no uncleared badge required) 
</td>
<td colspan="26"> Q in process</td>
<td colspan="37"> L in process</td>
</tr>
<tr class="odd">
<td colspan="3"></td>
<td colspan="28"> Clearance in process (issue uncleared badge) </td>
<td colspan="23"> Q in process</td>
<td colspan="28"> L in process</td>
<td colspan="21">Personnel Security Use Only:</td>
</tr>
<tr class="even">
<td colspan="3"></td>
<td colspan="29"> Issue cleared badge (clearance on file at SNL) </td>
<td colspan="10"> Q badge</td>
<td colspan="40"> L badge</td>
<td colspan="5">EC:</td>
<td colspan="11"></td>
<td colspan="3">FC:</td>
<td colspan="2"></td>
</tr>
<tr class="odd">
<td colspan="3"></td>
<td colspan="47"> No badge required, clearance only (KMP, Off-site or
Extension)  </td>
<td colspan="28"> Q clearance</td>
<td colspan="25"> L clearance</td>
</tr>
<tr class="even">
<td colspan="103"></td>
</tr>
<tr class="odd">
<td colspan="103"><strong>4. Clearance Information</strong>
<em>(Complete if clearance action is being requested)</em></td>
</tr>
<tr class="even">
<td colspan="3"></td>
<td colspan="100"> Initiate Clearance process ((1) initial clearance
request, (2) upgrade, (3) downgrade, (4) extension, (5) clearance
transfer, or<br />
(6) reinstatement). <strong>Clearance
Request/Recertification/Suitability Form (DOE F 472.1C)</strong> must be
completed and attached.</td>
</tr>
<tr class="odd">
<td colspan="5"></td>
<td colspan="98">Clearance level: Q L</td>
</tr>
<tr class="even">
<td colspan="11"><strong>5. SNL Requestor:</strong></td>
<td colspan="24">     </td>
<td colspan="8"></td>
<td colspan="34">     <strong>/</strong>     </td>
<td colspan="4"></td>
<td colspan="22">     </td>
</tr>
<tr class="odd">
<td colspan="12"></td>
<td colspan="24">Name (Print)</td>
<td colspan="8"></td>
<td colspan="33">Org./Mailstop</td>
<td colspan="4"></td>
<td colspan="22">Phone</td>
</tr>
<tr class="even">
<td colspan="4">Note:</td>
<td colspan="99">SNL Requestor will receive all administrative type
notifications (ex.: badge ready notification, badge renewal
notifications). This person can be different from the Approving
Manager.</td>
</tr>
<tr class="odd">
<td colspan="16"></td>
<td colspan="31"></td>
<td colspan="5"></td>
<td colspan="37"></td>
<td colspan="4"></td>
<td colspan="10"></td>
</tr>
<tr class="even">
<td colspan="16"><strong>6. Approving Manager:</strong></td>
<td colspan="31">     </td>
<td colspan="5"></td>
<td colspan="37"></td>
<td colspan="4"></td>
<td colspan="10">     </td>
</tr>
<tr class="odd">
<td colspan="16"></td>
<td colspan="31">Name (Print)</td>
<td colspan="5"></td>
<td colspan="37">Signature</td>
<td colspan="4"></td>
<td colspan="10">Date</td>
</tr>
<tr class="even">
<td colspan="21"></td>
<td colspan="22">     /     </td>
<td colspan="8"></td>
<td colspan="33">     </td>
<td colspan="19"></td>
</tr>
<tr class="odd">
<td colspan="21"></td>
<td colspan="23">Org./Mailstop</td>
<td colspan="42">Phone</td>
<td colspan="17"></td>
</tr>
<tr class="even">
<td colspan="103"><h1 id="for-personnel-security-use-only">FOR PERSONNEL
SECURITY USE ONLY</h1></td>
</tr>
<tr class="odd">
<td colspan="6">FOCI certified?</td>
<td colspan="7"> Yes</td>
<td colspan="7"> No</td>
<td colspan="5"> Pending</td>
<td colspan="20">Facility Code:</td>
<td colspan="15">     </td>
<td colspan="15"></td>
<td colspan="4"></td>
<td colspan="16">Processed Date:</td>
<td colspan="8">     </td>
</tr>
<tr class="even">
<td colspan="10">HSPD-12 Required:</td>
<td colspan="9"> Yes</td>
<td colspan="3"> No</td>
<td colspan="4"></td>
<td colspan="15">Contract Level:</td>
<td colspan="17">     </td>
<td colspan="12"></td>
<td colspan="26">PPI Completed: Yes</td>
<td colspan="7"> No</td>
</tr>
<tr class="odd">
<td colspan="2"></td>
<td colspan="7">CIV Required:</td>
<td colspan="8"> Yes</td>
<td colspan="11"> No</td>
<td colspan="10"></td>
<td colspan="15"></td>
<td colspan="16"></td>
<td colspan="16">ISP Required:</td>
<td colspan="12"> Yes</td>
<td colspan="6"> No</td>
</tr>
<tr class="even">
<td colspan="2"></td>
<td colspan="7">Action required:</td>
<td colspan="8"> New</td>
<td colspan="11"> Reinstate</td>
<td colspan="10"> Transfer</td>
<td colspan="19"> Extension</td>
<td colspan="16"> Other:</td>
<td colspan="30">     </td>
</tr>
<tr class="odd">
<td colspan="14">Date QSP+      FC sent:</td>
<td colspan="15">     </td>
<td colspan="19">Date QSP Part II sent:</td>
<td colspan="26">     </td>
<td colspan="18">Date Sec. Ack. sent:</td>
<td colspan="11">     </td>
</tr>
<tr class="even">
<td colspan="8">Info in Oracle/FSA?</td>
<td colspan="7"> Yes</td>
<td colspan="9"> No</td>
<td colspan="15">Enterprise Person SNL ID:</td>
<td colspan="22">     </td>
<td colspan="4"></td>
<td colspan="25">CPCI Verified:</td>
<td colspan="10"> Yes</td>
<td colspan="3"> No</td>
</tr>
</tbody>
</table>