Departmental Request for Contractor ID Card Services

Departmental Request for Contractor ID Card Services

To be completed by the University department responsible for managing contractor service.
Date Received*

MonthDayYear
Date
UAlbany Department Contact*

First NameLast Name
The department representative requesting Contractor ID Card(s) agrees to complete this form and submit it to ID Card Services for processing.

Once the ID Cards are produced, the department representative will be informed when and where the Contractor Primary Point of Contact may pick up the ID Card(s). The Primary Point of Contact agrees to provide official photo identification to receive the ID Card(s).

Additionally, the Contractor agrees to abide by all ID Card policies, including:
1. To guard and keep safe the ID Card(s) issued.
2. To notify ID Card Services immediately upon learning that any ID Card(s) needs to be terminated due to contract termination, employee termination, or a lost/stolen ID Card. The notification can be emailed to IDCard@albany.edu during regular business hours (8:30 a.m. to 4 p.m. Monday through Friday). If being reported outside of regular business hours, the notification must be also called in to the University Police Department at 518-442-3131.
3. Pay a $20 card replacement fee if the card is lost or stolen.
Door access will be allowed on the ID Card(s) issued for the dates specified below (no more than 12 months). The department representative will be required to submit a newly completed form to extend door access service.
UAlbany Department Address*
UAlbany Department Phone Number*
Please enter a valid phone number.
Contractor Company Name*
The Primary Point of Contact agrees to provide official photo identification and sign this form upon receiving the ID Card(s). Additionally, the Contractor agrees to abide by the ID Card policies, including: 1. To guard and keep safe the ID Card(s) issued. 2. To immediately notify the Card office if the ID Card(s) issued need to be terminated due to contract termination, employee termination, lost ID Card or stolen ID Card. The Card office (442-5989) can be notified during regular business hours (M-F 8:30 am-4:30 pm, and summer hours M-F 8 am- 4 pm) or the University Police department (442-3131) can be notified after business hours and /or on the weekend. 3. Pay a $20 card replacement fee in the event that the card is lost or stolen. 4. Door access will be allowed on the ID Card(s) issued for the dates specified above (no more than 12 months). The department representative will be required to submit a newly completed form in order to extend door access service.
Contractor Primary Point of Contact *

First NameLast Name
Contractor Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Contractor Phone Number*
Please enter a valid phone number.
Type of Request *

New ID Card(s) RequestContinuing ID Card(s) Access
Contractor Names that will be handling the cards
Ignore if these are general access cards
Number of cards to be issued/ Continuing Card # *
Door Access Locations (Specify Doors) *
Specify Start and End Dates:
Start *

MonthDayYear
Date
End*

MonthDayYear
Date
Specify times of day to allow access *
Attachments

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