Building Access Request

Requests must be submitted 48 hours prior to the date of any project/work. Thank you.

All fields are required.

Your Name:                       
Your Agency or Section:
Your Email:                        
Your Phone Number:      

Permission is requested to access and/or to bring electronic equipment into a Courthouse(s) for the following purpose:

Date(s) of Service:(Ex: 10/14/2015 or 10/14/2015 - 10/19/2015)
Time(s) of Service: (Ex: 8:00 am-5:00 pm)                                       

Courthouse(s): Wilkie D. Ferguson, Jr. Courthouse, MiamiC. Clyde Atkins U.S. Courthouse, MiamiJames Lawrence King Federal Justice Building, MiamiU.S. Federal Building and Courthouse, Fort LauderdalePaul G. Rogers Federal Building and U.S. Courthouse, West Palm BeachSidney M. Aronovitz U.S. Courthouse, Key WestAlto Lee Adams, Sr. U.S. Courthouse, Fort Pierce
Location: (Ex: Judge X's chambers, Executive Office)
Purpose of Visit: (ex: delivery, repair, etc)                      

Vendor Company Name:

Individuals Entering and Their Clearance (Check One):
1- Name: Background clearance completed - approvedNot ClearedSix (6) month tempHSPD-12 clearedUnknown
Has a GSA ID Badge?Yes
List any Electronic Equipment:                       
List the purpose for electronic equipment:

2- Name: Background clearance completed - approvedNot ClearedSix (6) month tempHSPD-12 clearedUnknown
Has a GSA ID Badge?Yes
List any Electronic Equipment:                       
List the purpose for electronic equipment:

3- Name: Background clearance completed - approvedNot ClearedSix (6) month tempHSPD-12 clearedUnknown
Has a GSA ID Badge?Yes
List any Electronic Equipment:                       
List the purpose for electronic equipment:

4- Name: Background clearance completed - approvedNot ClearedSix (6) month tempHSPD-12 clearedUnknown
Has a GSA ID Badge?Yes
List any Electronic Equipment:                       
List the purpose for electronic equipment:

5- Name: Background clearance completed - approvedNot ClearedSix (6) month tempHSPD-12 clearedUnknown
Has a GSA ID Badge?Yes
List any Electronic Equipment:                       
List the purpose for electronic equipment:

Escorted by (Name) and Clearance (Check One):
Name:                  
Company Name:
Background clearance completed - ApprovedGSA Building ManagerHSPD-12 clearedCourt EmployeeChambers StaffNot ClearedUnknownOther
If Other:

Has a GSA ID Badge?Yes
List any Electronic Equipment:                       
List the purpose for electronic equipment:

Parking/Loading dock requested: YesNo
Parking/Loading dock is not for general parking purpose. If checked yes, what is the reason?

Vehicle Information:

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*** IMPORTANT NOTE: A confirmation email will not be sent to you, however, if you do not hear from us within 24 hours, please contact the Executive Office at (305) 523-5001. Thank you.