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 and sign this form and submit it to the Card office for processing. Once the ID Cards are produced, the department representative will be informed. The department will inform the Contractor Primary Point of Contact that he / she may pick up the ID Card(s) from the Card Office (Monday – Friday between 8:30 am and 4:30 pm).
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

Cancelof
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