Access Authorization Request

Access Authorization Request

RECITALS

WHEREAS, Requestor Name: represents the individual seeking access, acting on behalf of Organization: ; and

WHEREAS, Authorizing Entity: operates the systems, facilities, or resources to which access is sought and has authority to grant or deny such access; and

WHEREAS, the parties desire to set forth the scope, conditions, compensation for any fee-based access, and the terms under which access will be authorized and governed;

REQUEST SUMMARY

SCOPE OF WORK

The Authorizing Entity shall provision access to the Resource identified above for the Requestor for the following authorized activities and limitations. The Requestor and Authorizing Entity agree that access shall be limited to the minimum necessary to accomplish these activities and shall not be used for unauthorized purposes.

PAYMENT TERMS (IF APPLICABLE)

Compensation for access or services, if required by the Authorizing Entity, will be as follows:

TERM AND TERMINATION

This Authorization becomes effective on Start Date: and will expire on End Date: unless earlier terminated in accordance with this section.

Either party may terminate this Authorization for convenience by providing written notice to the other party not less than Notice Period (days): days prior to the effective termination date. Immediate termination may occur for material breach, security incident, misuse of access, or nonpayment where applicable.

CONFIDENTIALITY

For purposes of this Authorization, "Confidential Information" means non-public information disclosed by either party in connection with the access and performance of the authorized activities. The Requestor and Authorizing Entity each agree:

(a) To maintain Confidential Information in strict confidence and not to disclose it to third parties except as expressly permitted herein; (b) To use Confidential Information solely to perform obligations under this Authorization; and (c) To implement and maintain administrative, technical and physical safeguards appropriate to protect Confidential Information against unauthorized access, disclosure, alteration or destruction. The obligations in this section survive termination of this Authorization for a period of three (3) years or as required by applicable law, whichever is longer.

SECURITY AND COMPLIANCE

The Requestor shall comply with all security policies, acceptable use rules, and regulatory obligations applicable to the Resource. Required prerequisites prior to access (select all that apply):

RESPONSIBILITIES OF REQUESTOR

The Requestor affirms that access will be used only for legitimate business purposes described in this Authorization, that credentials will not be shared, and that any suspected compromise or misuse will be reported immediately to the Authorizing Entity. The Requestor shall return or destroy access credentials and any Confidential Information upon termination.

LIMITATION OF LIABILITY

Except to the extent caused by gross negligence or intentional misconduct, neither party shall be liable to the other for consequential, special, incidental or punitive damages arising from the provision or denial of access under this Authorization. Each party's aggregate liability for claims arising from this Authorization shall be limited to direct damages not to exceed the amounts actually paid under the Payment Terms for the twelve (12) month period preceding the claim.

GOVERNING LAW

This Authorization shall be governed by and construed in accordance with the laws of State: without regard to conflicts of law principles.

ENTIRE AGREEMENT

This document, together with any attachments or referenced statements of work, constitutes the entire agreement between the parties with respect to the subject matter hereof and supersedes all prior and contemporaneous understandings, proposals, negotiations and agreements, oral or written. Any amendment must be in writing and executed by authorized representatives of both parties.

ACKNOWLEDGMENT AND AUTHORIZATION

By signing below, the parties certify that the information provided in this Access Authorization Request is true and complete. The Authorizing Entity's signature constitutes formal authorization to provision access in accordance with the terms set forth herein.

CONTACT INFORMATION

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