Vendor PIV Request Form

VENDOR PIV REQUEST FORM AND ACCESS AGREEMENT

Recitals

WHEREAS Vendor Name: (the "Vendor") is retained to perform services for Sponsor Organization: ; and

WHEREAS Sponsor requires issuance of a Personal Identity Verification credential (PIV) to the Vendor to permit authorized access to controlled facilities, information systems, or services under terms designed to protect security and privacy; and

WHEREAS the parties agree to the terms and conditions set forth below governing the request, issuance, use, revocation, and return of the PIV credential and any related access tokens or badges.

Scope of Work

Vendor Information

Request Details and Security Requirements

Credential(s) requested: PIV Card PIV-I Card Remote Access Token Temporary Badge

Background investigation completed: Yes Pending Not required

Issuance, Use, Revocation and Return

The Vendor acknowledges that issuance of the PIV credential is conditioned upon completion of required background checks, identity verification, and Sponsor authorization. The PIV credential remains the property of the Sponsor and must be carried and displayed in accordance with Sponsor rules. Unauthorized transfer, duplication, or misuse of the credential is strictly prohibited and may result in immediate revocation of access, criminal or civil liability, and administrative sanctions.

The Vendor agrees to immediately report loss, theft, or suspected compromise of the credential to the Sponsor and to surrender the credential upon request, termination of the agreement, or at the end of the engagement. Sponsor reserves the right to revoke the credential at any time for security, compliance, or suitability reasons.

Payment Terms

Vendor payment for services associated with this request will be governed by the following terms. The Vendor represents that any fees for credential issuance, processing, or special access that are the Vendor's responsibility are set forth below.

Term and Termination

This Agreement commences on Start Date: and terminates on End Date: unless earlier terminated in accordance with this section.

Either party may terminate this Agreement for convenience upon Notice Period (days): days' written notice. Sponsor may immediately suspend or terminate access where necessary to protect security or comply with law.

Confidentiality

The Vendor acknowledges that, in the course of performing services and using the PIV credential, the Vendor may receive or access confidential, proprietary, or sensitive information. The Vendor agrees to maintain strict confidentiality, to use such information only for authorized purposes, and to implement and maintain reasonable administrative, technical, and physical safeguards to protect such information from unauthorized disclosure, use, or access.

The obligations in this Confidentiality clause survive termination or expiration of this Agreement.

Governing Law and Entire Agreement

Governing Law: The laws of State / Jurisdiction: govern this Agreement, without regard to conflict-of-law rules.

Entire Agreement: This document, together with any attached schedules or addenda signed by the parties, constitutes the entire agreement between the parties with respect to the subject matter and supersedes all prior negotiations, representations, or agreements, whether written or oral.

Certifications and Acknowledgements

The Vendor certifies that the information provided on this form is true and complete to the best of the Vendor's knowledge. The Vendor understands that deliberate falsification or omission of material information may result in denial of the credential request, termination of contract, and potential legal consequences.

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