Okaloosa County BOCC — January 6, 2015 — Chairman Boyles TEAM Access Request January 2015 — reading text

Transportation Electronic Award Management System (TEAM) Grantee / Recipient User Access Request Check Applicable Box: ¥ | New User With Pin | [Modify User |Username New User Without Pin Delete User Name Change Request Warning: The information contained in this form is protected under Public Law 93-579, Privacy Act. USER INFORMATION Gender (Optional) M (® FO Nathan D. Boyles 850-689-5030 First Name* M/ Last Name* Office Phone* Chairman Title L FAX Number Okaloosa county Board of County Commissioners 5435 nboyles @ co.okaloosa.fl.us Organization Name* Recipient ID Email Addresg* Mailing Address(Street Number, City, State and ZIP Code)* {Z’( Y A /41;.,\/1.’(_‘ User's Author\lzfig Signature (Aee instructions) . 302 North Wilson Street Suite 302 Elliot L. Kampert i2f30 / 204 J ] Crestview, FL 32536 Piiied Nama of sbove " Date TTHIS 1S MIOITIanon 1S requtrea T0 6STabISh or moalfi your TEAM user account. By completing this form, you expressly attest Ihat informaton provided is true and complete to the best ot your knowledge. Invalid information will be grounds for refusal to establish a new user account or the basis for deletion of an existing TEAM account. e e A b APPLICATION ACCESS (Check all that apply). = Database Recipient PIN Functions Designated Recipient ID(s) (Indicate Below) Production Submii Application Execute Awards 5435 Quality Assurance Both Production and QA Cen‘jfy as Lawyer Recipient Access Type Cerfify as Official Inquiry Only Certify as Both Lawyer and Official Modify/Update |::|Provide Supplemental Agreement Civil Rights (No PIN Needed) DBE Reporting Metropolitan Planning Organization (MPO) ID N/A (PIN Functions require Designation of Signature Authority on Organization/Agency Letterhead. See instructions). ACKNOWLEDGMENT OF RULES OF CONDUCT FOR SYSTEM USE As a TEAM user, | understand that | am personally responsible for the use and misuse of my TEAM login ID and password. | understand that by requesting TEAM access and accepting/using such access that | must comply with the following: 1. When downloading sensitive information, | will ensure that the information has the same level of protection as FTA applications. 2. | will not permit anyone to use my TEAM access information (i.e. user ID, password or other authentication). My password (or other authentication) will be kept private, not stored in a place that is accessible by anyone other than the myself (i.e. family members, friends, etc.). If stored, the password will not be in text format. 3. | will follow standard password procedures and change my password every sixty (60) days. My passwords will be at least twelve (12) alphanumeric characters and contain at least three of the following: one (1) capital letter, one (1) lower case letter, one (1) number and one (1) special character. 4. 1 will report any security problems and anomalies in system performance to the appropriate FTA Office. 5. 1 will notify the appropriate FTA Office to eliminate my TEAM access in the event of job transfer, termination, or if TEAM access is no longer required. 6. | understand that if | am not using FTA-supplied equipment and FTA suffers a security breach or compromise that is my fault, | may be required to allow access to my equipment by authorized representatives of the Federal Government to determine the causes and to take corrective action(s). 7. 1 will lock my workstation when | leave the vicinity and not leave the application open and vuinerable to intrusion by a third party. 1 agree to and will comply with all of these conditions and understand that failure to do so will result in permanent removal of my TEAM access, and may result in other disciplinary or legal action. By signing my name in the space below, | hereby acknowledge this agreement, and certify that | understand the preceding terms and provisions and that | accept the responsibility of adhering to the same. e /e Signature Date Printed Name FTA AUTHORIZATION FTA Functional Approval FTA Operational Approval = Signature of Authorizing FTA Official Date Signature of Authorizing FTA Official Printed Name Printed Name Title / Office Title / Office — Date Processed UserlD TEAM RECIPIENT User Access Request Form Revised 4/2/2014