SPU Access Request Form
Seattle Public UtilitiesSecure Access ID (SAID) Card Application / Date:
Replace: (Check one)
Broken:
Lost/Stolen:
New Request: / RENEW EXPIRED CARD: / Update Access: / Volunteer: / Card Number:
Applicant’s Name: / Date of Birth: / Check here if requesting a Mechanical Key
Company Name and Address: / Applicant’s Supervisor Name and Phone #
Applicant Driver’s License #: / Issuing State: / Vehicle License Plate #:
Applicant’s work and mobile #s: / Email:
SPU Sponsor Name: / SPU Sponsor Signature Required:
SPONSORS COMPLETE BELOW INFO*
(*Not Required for Said Card Renewals with no changes in access)
SPONSOR: Indicate time requested - Check all locations and areas requested / Owner/Operator signature for each area REQUIRED!
List of Owner/Operators for SPU Facilities
Time Requested / Location / Area/Floor / Reason / Owner/Operator Signature
5a-7p M-F / 24/7 / Other
SMT: / 25
27
CSD -2777
HRSE-2736
31
44
45 / 46
47
48
49(exec)
49(HR)
50
50-safety
59
OCC: / 1st Floor:
2nd Floor:
South Vehicle Gate:
Other:
NOC: / 1st Floor:
2nd Floor:
Other:
Mat Lab:
AWC Bldg D:
DWW
Haller Lake: / Gates:
Other:
DWW
Charles Street: / Gates:
Other:
Time Requested / Location / Area/Floor / Reason / Owner/Operator Signature
5a-7p M-F / 24/7 / Other
Water System: (Reservoirs, Pump Stations Standpipes Tanks) / Gates:
Facilities:
Other:
Landsburg
Dam: / Main gate:
Dam Forebay Gate:
Dam Entry Gate:
Fish Hatchery Gate:
Admin Bldg:
Screen House:
Other:
Lake Youngs: / Gates:
Other:
South Transfer Station: / 1st Floor:
2nd Floor:
3rd Floor:
Scale Houses:
Other:
Duvall Shop: / Gates:
Other:
North HHW: / Gates:
Other:
Water Quality Laboratory Access
Please refer access request to Scott Carpenter via e-mail Tel: 206-233-7161
Time Requested / Area Requested / Reason / Owner/Operator
Signature
5a-7p M-F / 24/7 / Other
Cedar River/South Fork Tolt Watersheds Access
Please refer Access Request to Darian Davis via e-mail
Time Requested / Location / Area / Reason / Owner/Operator
Signature
5a-7p M-F / 24/7 / Other
Cedar Falls/ Cedar River Watershed: / Cyber Gate**:
Main Gate:
101 Gate:
50 Gate:
9 Road Gate:
Selleck Gate:
Circle Gate:
Masonry Dam Gate:
Main Office:
South Fork Tolt Watershed*: / Zone 1
Zone 2
Zone 3
Zone 4 / Pipeline:
Reg Basin:
Tolt Dam: Tolt Watershed:
*(See Tolt Watershed map for zone description)
Disqualifying Criminal Offenses
An individual has a disqualifying criminal offense if the individual has been convicted of any of the disqualifying crimes listed below in the state of Washington during the 10 years before the date of the individual’s application for unescorted access authority, or while the individual has unescorted access authority.
Any active arrest warrants will automatically bar the person from entering SPU facilities.
Any conviction of the following offences will automatically bar the person from entering SPU facilities:
- Felony Assault - Murder
- Bribery - Possession or Distribution of Stolen Property
- Burglary - Rape or Aggravated Sexual Assault
- Espionage - Sedition
- Arson - Theft
- Felony Involving a Threat - Treason
- Felony Involving Willful Destruction of - Unlawful Possession, Use, Sale, Distribution, or
Property Manufacture of an Explosive or Weapon
- Robbery - Fraud or Misrepresentation
- Conspiracy to commit any of the aforementioned
crimes
Authorization to Conduct Criminal History Records Check
I, , hereby authorize Seattle Public Utilities, (SPU) to investigate my criminal history and ascertain whether or not I have been convicted of a disqualifying crime within the past 10 years. I understand that by granting authorization for SPU to obtain criminal history information, I may be granted or denied unescorted access to SPU occupied facilities by use of a Security Access Identification card issued to me in my name. I understand that this is a voluntary process. I understand that information with regard to any past criminal history within the past 10 years will be obtained by SPU from Judicial Information Systems and may include information from federal, state, local, and other agencies. A photocopy of this authorization shall be as valid as the original for a period of 14 days from the date of signature. This authorization may only be used by the authorized SPU personnel designated to complete criminal history checks. I understand that the criminal convictions listed above will disqualify me from obtaining unescorted access. I understand that SPU is not responsible for the accuracy and/or completeness of records that may identify me. I agree to hold SPU harmless for any records they obtain which may or may not accurately identify me. No copies of this report or information therein shall be provided to my employer or the agent of my employer. However, I understand that SPU must notify my employer if I am disqualified from obtaining unescorted access on the basis of the results of the criminal history background check. I release SPU from any and all liability for providing notice of disqualification to my employer.
Date Printed Name
Signature
Access Control for Contractors/Vendors – Additional Information
Access to SPU facilities
1. All vendors and contractors are vetted prior to obtaining unescorted access to SPU facilities.
2. Communicate with your SPU Sponsor and complete the access request form. They will obtain the appropriate approval and forward the completed form to SPU Security.
SPU Sponsor?
Your SPU sponsor is the SPU employee with whom you will coordinate access to SPU sites and facilities. This individual should be able to provide the forms and assist you in obtaining authorization from the designated asset owner/operators for each facility to which you are requesting access.
Your Security Responsibilities
1. Keep your Security Access Identification (SAID) Card on your person at all times and show it upon request while on Seattle Public Utilities property.
2. Do not give or lend your SAID card or SPU keys to anyone else.
3. Use your SAID card at all card readers for entry and exit.
4. Do not follow other people through a door without presenting your SAID card at the card reader (also referred to as “tail-gating”). Tail-gating is prohibited.
5. Make sure doors and gates are completely closed and locked behind you before you leave SPU facilities.
6. SPU will revoke your unescorted access privileges immediately if you misuse your SAID card or SPU keys or if you violate any of these security responsibilities.
7. Return your SAID card and SPU keys to SPU Security after you complete your work with SPU or upon request from SPU Security.
8. By accepting a SAID Card for unescorted access to Seattle Public Utilities facilities you agree to your Security Responsibilities.
9. Please refer any questions to the Seattle Public Utilities Security Specialist at 206-386-9061 or .
Security Personnel Cannot Authorize Access
Security personnel cannot authorize or approve access to SPU facilities. The function of the access control administrator is to process request forms and verify that forms have the proper authorization. All requests for additional access must be authorized by the designated asset owner/operators. Your SPU Sponsor will need to facilitate obtaining the required authorizations from the SPU owner/operator.
Report Lost or Missing SAID Cards immediately
Notify the Operations Response Center (24/7) immediately at 206-733-9300. SAID cards can be deactivated upon notification, which will significantly reduce the risk of unauthorized access. Your SAID card will be replaced upon receipt of the access request form signed by your SPU sponsor.
Completing an Access Request Form
The access request form provides a record of the request for asset owners, contractors and the access control administrator. Additionally, by following a standardized process for access requests, the Security office is able to coordinate your request as quickly as possible, eliminating excessive wait times. Please provide your personal and company information in the first portion of the form.
· Your sponsor will identify the facilities/sites to which you require access.
· Please ensure that your portion of the application is complete to include your signature consenting to a criminal conviction history check.
· You must provide a scanned copy of your driver’s license in order for the Security office to process your request.
· The disqualifying offenses are listed on the back of the access request form.
· The SPU Security office will not process incomplete access request forms.
Once the form and copy of your driver’s license is submitted to the access control administrator, it typically takes 24 hours or less for the approved access to be programmed (unless there are multiple access requests for a large project). In order to reduce the amount of time waiting for your SAID card, you may submit a digital photo of your face along with your access request form and scanned color copy of your driver’s license via email to your sponsor.
Questions?SPU Security Specialist
206-386-9061 / Page 5 of 5 / Please email SIGNED form to: