Building Access Form

State of Utah Access is Valid: Department of Technology Services 1 State Office Building, First Floor to Salt Lake City, Utah 84114 (Access may not exceed 24 months) 801-538-3666

PHYSICAL BUILDING ACCESS REQUEST FOR THIRD PARTY All Information Required

Third-Party Name: Photo ID #: I have read and understand the following: I am responsible for the use of this key and will not loan it to another person. I agree to abide by all DTS policies and regulations set within the secured access areas. I agree and understand that I may be subject to civil and/or criminal prosecution if I fail to safeguard this key or allow another person to use this key. I also agree to return the key when I no longer require access and will notify DTS immediately if I lose or damage the key.

Third-Party Signature: Date:

DTS Justification for Access:

DTS Contract Supervisor Date: Signature:

DTS Administrative Use Only Card Key #:

Entered By: Date:

State Office Building Access 6th Floor 5th Floor N/A Access Period (see section below): Early Access Late Access Weekends 24/7 Salt Lake City Data Center Access Data Center (1st Entrance): Front Counter Office Entrance: Operation Center/NOC (2nd Entrance): LAN Room Entrance: Machine Room (3rd Entrance): Vault Entrance: Printer Room Entrance: Phone/Switch Room Entrance:

Access Period (see section below): Early Access Late Access Weekends 24/7 Richfield Data Center Access Main Entrance: Office Entrance: Machine Room Entrance: Console Room Entrance: Dock Entrance: West Entrance:

Access Period (see section below): Early Access Late Access Weekends 24/7 DTS Data Center Manager (or Date: designee) Signature: Form Continues on Next Page

ACCESS PERIOD INFORMATION Access Periods

DTS Form: 511 / Revised: 7/8/.2015 Page 1 Early Access – Physical access to DTS facilities on weekdays from 5 AM to 5 PM. Late Access – Physical access to DTS facilities on weekdays from 7 AM to 7 PM. Weekends – Physical access to DTS facilities on weekends from 7 AM to 7 PM. 24/7 Access – Physical access to DTS facilities 24 hours a day, 7 days a week.

AGENCY ASSIGNMENT INFORMATION

Administrative Services DAS Human Services DHS Agriculture and Food UDAF Insurance UID Alcoholic Beverage Control DABC Labor Commission LC Board of Pardons BOP National Guard UNG Commerce DOC Natural Resources DNR Community and Culture DCC Public Safety DPS Corrections UDC Public Service Commission PSC Environmental Quality DEQ Tax Commission USTAX Financial Institutions DFI Technology Services DTS Governor’s Office GO Transportation UDOT GO Economic Development GOED Veteran’s Affairs DVA Health DOH Workforce Services DWS Human Resource Management DHRM

Department of Technology Services Enterprise Information Security Office Deliver this Request To: 1 State Office Building, Floor 1, Data Center Salt Lake City, UT 84114

DTS Form: 511 / Revised: 7/8/.2015 Page 2