FACILITIES SERVICES DEPARTMENT AUTHORIZATION FORM: PART I AIM™ / FIXIT ACCOUNT USE AUTHORIZED USER (PLEASE PRINT – ALL FIELDS ARE REQUIRED TO BE FILLED OUT) Name: GWID Title: Email: @ gwu.edu Phone: Fax: By my signature, I certify that I: 1) understand and agree that my use of Fixit is required as part of my employment at The George Washington University (the “University”) and is in support of the University’s activities only; and, 2) will act in accordance with the computing guidelines and restrictions as stated in the University’s Code of Conduct for Users of Computing Systems and Services, which can be found at http://my.gwu.edu/files/policies/CodeofConductComputingFINAL.pdf. User Signature Date: Department: DEPARTMENTAL APPROVALS (PLEASE PRINT) The above person replaces __________________________________________ who is no longer with this department. The above person is a new employee in this department. Department Location (Campus): Foggy Bottom Mount Vernon Loudoun Banner Indices / Oracle Aliases for which the above employee is authorized to commit expenses: Primary Oracle Alias*: Alias: Dept Name Additional Oracle Alias: Alias: Dept Name Additional Oracle Alias: Alias: Dept Name * The PRIMARY Alias will be the default account charged for any requests submitted by this User unless a different account is specified. My signature below certifies that I have read and understand GW Financial Management Responsibility Policy regarding Authorization of Expenses and that granting access to FIXit / AiM™ for the above named person is in compliance these Policies. I further certify that the above named person is authorized to obligate expenses for the above named Banner Index (Indices) / Oracle Alias(es) (subject to the $4,000 limit). Financial Director Name (Print): Signature: Date: Expiration Date (if any) for Above User’s Focus Access My signature below certifies that: I have read and understand GW Financial Policies regarding Authorization of Expenses and that granting access to FIXit/AiM for the above named person is in compliance these Policies; and, I agree to notify Facilities Services (to the attention of the person at bottom of page) when this employee leaves his / her position in my Department. I further certify that the above named person is authorized to obligate expenses for the above named Banner Index (Indices) / Oracle Alias(es) (subject to the $4,000 limit). Department Head/Dean Name (Print): Title (Print): Signature: Date: Please return completed form to: Alex Weller, Facilities Services, 2025 F St., NW, Room 212A, Washington, DC 20052 Last revised January 31, 2011 II A. Check all Buildings for which this Power User will be submitting Chargeable Requests. It is important to fill out all three sections: A, B & C. For more information on Chargeable Requests, please visit the Facilities Website http://facilities.gwu.edu/ and select Getting Work Done / Academic & Administrative Buildings Building Building Name Building Building Name FOGGY BOTTOM: MAIN CAMPUS BUILDINGS 1918 F ST 1918 F STREET * 2140 G ST BUILDING AG 1922 F ST OLD MAIN 2140 PA AVE 2140 PENNSYLVANIA AVE 1925 F ST F STREET HOUSE 2142 G ST 2142 G STREET 1957 E ST CITY VIEW 1957 E ST CITY VIEW 2147 F ST BUILDING AN 1957 E ST 1957 E STREET * 2200 H ST PARKING LOT # 12 2000 G ST BUILDING H (LAW SCHOOL) 2201A G ST FUNGER HALL 2000 H ST LERNER HALL 2201B G ST DUQUES HALL 2002 G ST BUILDING AC 2201P VA AVE INTERNATIONAL HOUSE PARKING LOT 2003 H ST PARKING LOT # 3 2220 I ST PARKING LOT #13 2004 G ST 2004 G STREET 2300P K ST WARWICK BLDG PARKING LOT 2023 G ST LISNER HALL 2301 G ST HEALTH AND WELLNESS 2025 F ST SUPPORT BUILDING 3524 K ST 3524 K STREET 2029 G ST BELL HALL 3526 K ST 3526 K STREET 2033 G ST WOODHULL HOUSE (UPD) 520 22ND ST 520 22ND ST 2035 F ST 2035 F STREET 600 21ST ST BUILDING TT 2036 H ST SAMSON HALL 600 22ND ST SMITH CENTER 2101 F ST BUILDING AL 609 21ST ST BUILDING AM 2106 G ST BUILDING O 609 22ND ST 609 22ND STREET 2108 G ST BUILDING P 613 22ND ST BUILDING AR 2110 G ST HORTENSE AMSTERDAM HOUSE 615 22ND ST BUILDING AK 2112 G ST BUILDING X 617 22ND ST BUILDING AO 2114 G ST BUILDING BB 619 22ND ST 619 22ND STREET 2115 G ST MONROE HALL 700 20TH ST BUILDING E 2121 I ST RICE HALL 707 22ND ST STAUGHTON HALL 2125 G ST BUILDING GG 710 21ST ST HALL OF GOVERNMENT 2127 G ST BUILDING HH 714 21ST ST 714 21ST STREET 2129 G ST BUILDING D 716 20TH ST JACOB BURNS LAW LIBRARY 2129 G ST REAR BUILDING L (REAR) 720 20TH ST STOCKTON HALL (LAW CENTER) 2129 I ST ADAMS HOUSE 725 21ST ST CORCORAN HALL 2129 I ST REAR BUILDING EE 725 23RD ST TOMPKINS HALL 2130 H ST GELMAN LIBRARY 730 21ST ST LISNER AUDITORIUM 2131 1/2 G ST 2131 1/2 G STREET 800 21ST ST MARVIN CENTER * 2131 G ST BUILDING Y 801A 22ND ST PHILLIPS HALL 2131 G ST REAR BUILDING J 801B 22ND ST SMITH HALL OF ART 2134 G ST GRAD SCH OF ED & HUMAN DEV 801C 22ND ST ROME HALL 2136 G ST BUILDING AE 805 21ST ST MEDIA AND PUBLIC AFFAIRS * 2136 PA AVE 2136 PENNSYLVANIA AVE 812 20TH ST BUILDING YY 2138 G ST BUILDING AF 814 20TH ST BLDG XX (CHURCH) 837 22ND ST 837 22ND STREET KOGAN PLAZA KOGAN PLAZA SPORT CT#1 2200 BLOCK OF H STREET UNIVERSITY YARD UNIVERSITY YARD * SET UPS in these buildings cannot be requested from Facilities but must be requested directly from the Department who controls that space. FOGGY BOTTOM: RESIDENCE HALLS 1129 N HAMP ASTON HALL 514 19TH ST MITCHELL HALL 1900 F ST THURSTON HALL 522 22ND ST 522 22ND STREET 1959 E ST 1959 E STREET 600 20TH ST FRANCIS SCOTT KEY 2021 F ST POTOMAC HOUSE 603 22ND ST 603 22ND STREET 2031 F ST BUILDING JJ 605 21ST ST 605 21ST STREET 2100 F ST DAKOTA HALL 605 22ND ST 605 22ND STREET 2100 I ST LAFAYETTE HALL 607 21ST ST 607 21ST ST 2109 F ST 2109 F STREET 607A 23RD ST TOWNHOUSE ROW - A 2115 F ST GUTHRIDGE HALL 607B 23RD ST TOWNHOUSE ROW - B 2119 H ST CRAWFORD HALL 607C 23RD ST TOWNHOUSE ROW - C 2121 H ST SCHENLEY 607D 23RD ST TOWNHOUSE ROW - D 2121 F ST 2121 F STREET 607E 23RD ST TOWNHOUSE ROW - E 2123 F ST 2123 F STREET 607F 23RD ST TOWNHOUSE ROW - F 2124 I ST WEST END 607G 23RD ST TOWNHOUSE ROW - G 2135 F ST SOUTH HALL 607H 23RD ST TOWNHOUSE ROW - H 2201 VA AVE INTERNATIONAL HOUSE 607 22ND ST 607 22ND STREET 2206 F ST 2206 F STREET 611 22ND ST 611 22ND STREET 2208 F ST 2208 F STREET 616 23RD ST IVORY TOWER 2212 I ST MUNSON HALL 620 21ST ST STRONG HALL 2222 I ST JBKO 736 22ND ST MADISON HALL 2223 H ST FULBRIGHT HALL 950 24TH ST CITY HALL 2350 H ST NEW HALL 2601 VA AVE HALL ON VIRGINIA AVE GW MEDICAL CENTER BUILDINGS Building Building Name Building Building Name 2300A I ST ROSS HALL 2150 PA AVE ACC/BURNS CLINIC 2300B I ST HIMMELFARB LIBRARY 900 23RD ST GW HOSPITAL (6TH FLOOR) 2300C I ST I STREET MALL Part II: Page 1 of 4 12/21/2011 2300 K ST WARWICK MOUNT VERNON ACADEMIC / ADMINISTRATIVE 4525 W ST ALUMNAE HOUSE ACADEMIC ACADEMIC BUILDING GATE HOUSE UPD GATE HOUSE ACHESON ACHESON SCIENCE BUILDING LLOYD LLOYD GYM AMES AMES MV QUAD QUAD ATHLETIC ATHLETIC COMPLEX MVC ATHLET FAC MVC ATHLETIC FACILITIES CHAPEL HOLLIS HAND CHAPEL MVC CAMPUS GRND MVC CAMPUS GROUNDS ECKLES ECKLES LIBRARY WEBB WEBB BUILDING MOUNT VERNON RESIDENCE HALLS CLARK CLARK HALL MERRIWEATHER MERRIWEATHER HALL COLE COLE HALL SOMERS SOMERS HALL HENSLEY HENSLEY HALL WEST HALL WEST HALL VA CAMPUS - LOUDOUN 20101ACAD EXPLORATION HALL (RESEARCH 1) 45085 UNIV INNOVATION HALL (RESEARCH 2) 44983 KNOLL ENTERPRISE HALL (BUILDING 2) 45155 RESEARCH 45155 RESEARCH VA CAMPUS GROUNDS VA CAMPUS GROUNDS OTHER: LEASED SPACE IN COMMERCIAL OFFICE BUILDINGS 1555 WILSON BLVD 1555 WILSON BLVD 2121 K ST 2121 K STREET 1776 G ST 1776 G STREET 2131 K ST 2131 K STREET 1925 BALLENGER 1925 BALLENGER 2136 PA AVE 2136 PENNSYLVANIA AVE 2011 I ST 2011 I STREET 2140 PA AVE 2140 PENNSYLVANIA AVE 2020 K ST 2020 K STREET 2141 K ST 2141 K STREET 2021 K ST 2021 K STREET 2175 K ST 2175 K STREET 2029 K ST 2029 K STREET 2600 VA AVE 2600 VIRGINIA AVE 2033 K ST 2033 K STREET 3601 WILSON BLV 3601 WILSON BLVD 2100 M ST 2100 M STREET 6110 EXEC BLVD 6110 EXECUTIVE BLVD 2100 PA AVE 250 2100 PENNSYLVANIA AVE 825 21ST ST 825 21ST STREET 2120 L ST 2120 L STREET 8712 JERICHO DR 8712 JERICHO DR 950 GLEBE ROAD 950 GLEBE ROAD II B. Check all Location Types for which this Power User will be submitting Chargeable Requests. Most Power Users in Academic and Administrative Buildings will be entering Chargeable Requests for the Location Types left white below. If you are unsure if you will need access to any grayed-out Location Types, please contact Alex Weller at (202) 994-1945 or [email protected] Location Type 110 CLASSROOM 670 RECREATION 220 OPEN LABORATORY 680 MEETING ROOM 310 OFFICE 740 VEHICLE STORAGE 350 CONFERENCE ROOM 760 HAZARDOUS MATERIALS STORAGE 410 STUDY ROOM 880 PUBLIC WAITING 520 ATHLETIC OR PHYSICAL EDUCATION 950 APARTMENT 530 MEDIA PRODUCTION W05 LOBBY 590 OTHER (ALL PURPOSE) W06 PUBLIC CORRIDOR 610 ASSEMBLY W07 STAIRWAY 630 FOOD FACILITY X03 PUBLIC REST ROOM 660 MERCHANDISING II C.