Fillable CONTRACTOR ID FORM MARICOPA COUNTY SECURITY SERVICES DIVISION (Maricopa County Telecommunications)

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CONTRACTOR ID FORM MARICOPA COUNTY SECURITY SERVICES DIVISION (Maricopa County Telecommunications)

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The CONTRACTOR ID FORM MARICOPA COUNTY SECURITY SERVICES DIVISION (Maricopa County Telecommunications) form is 1 page long and contains:

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  • 11 check-boxes
  • 15 other fields

Country of origin: US
File type: PDF

U.S.A. forms for Maricopa County Telecommunications

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Rev. 10/10/2019
CONTRACTOR ID FORM
MARICOPA COUNTY SECURITY SERVICES DIVISION
301 W. Jefferson St. Ste. 160, Phoenix, Arizona 85003-2195
=========================================================================
Open Monday – Friday, 7am – 5pm (closed County holidays)
PHONE: 602 506-8580
++Walk-ins welcome for groups of 4 or fewer people++
=========================================================================
*Applicant Name: ______________________________________ Phone #: ____________________
*Title: ____________________________________________________________________________
*Company Name: ___________________________________________________________________
*Company Location and Phone #: ______________________________________________________
ID Verification Information
*Driver’s License #: ___________________ *State Issuing License: _____________________
*Is this a new badge? ☐ Yes ☐ No
*Is this replacing a lost badge? ☐ Yes ☐ No
*Is this replacing a damaged badge? ☐ Yes ☐ No
=========================================================================
All badges must be returned to Security Services office upon termination or completion of job.
=========================================================================
++FOR MARICOPA COUNTY USE++
HOURS AND AREAS OF ACCESS
*Hours of Access: ☐ Business Hours ☐ 24 Hour
*Access Schedule: ☐ Monday – Friday ☐ Monday – Sunday ☐Other (Specify): _________
*List of Buildings (include building name or address and specify access areas):
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
*County Authorized Signature: _______________________________________ Date: __________
(Maricopa County Project Manager or other County Representative)
*Applicant Signature: ______________________________________________ Date: ___________
*Security Services Authorized Signature: _______________________________ Date: __________
========================================================================
* Required Fields
========================================================================
**Contractor badges require access renewal on 6/30 and 12/31 until contract expiration date**
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CONTRACTOR ID FORM MARICOPA COUNTY SECURITY SERVICES DIVISION (Maricopa County Telecommunications)

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Completed 18 July 2020

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