HomeMy WebLinkAbout4816
Contract Number: 4816
Vendor:
LICENSING - DEPT OF
Subject:
Data Sharing
Department:
Municipal Court
File Class:
LEG 12-1
Begin Date:
03/31/2009
End Date:
01/31/2013
Review Date:
10/01/2012
Vault Date:
Comments:
(WA STATE)
DOL Contract No. K1152
DATA SHARING CONTRACT
BETWEEN
STATE OF WASHINGTON
DEPARTMENT OF LICENSING
AND
BREMERTON MUNICIPAL COURT
This Contract is made and entered into by and between the Department of Licensing, hereinafter
referred to as "DOL", and the
Bremerton Municipal Court
900 Pacific Ave
Bremerton, WA 98337
Telephone:
FAX:
E-Mail:
(360) 473-5242
(360) 473-5262
Theresa.ewinq<.Q2ci. bremerton. wa. us
Hereinafter referred to as the "Contractor"
PURPOSE
The purpose of this Contract is to set out the terms and conditions under which the Department will
provide to the Contractor Internet access to DOL driver data. The use of the data shall be exclusively for court
proceedings and to assist the individual named in determining requirements to reinstate their Washington
driving privilege, and shall not be divulged by the Contractor to any third party, except for lists of FTAs and/or
reinstatement data and status which may be divulged to the individual named or his/her attorney. Said
information shall be disseminated only to authorized entities and persons and used by them only for the
purposes set out in this Contract and in accordance with federal and state law and Chapter 46.61.513 RCW -
Criminal history and driving record.
In Consideration of the terms and conditions contained herein, the parties agree as follows:
SPECIAL TERMS & CONDITIONS
STA TEMENT OF WORK
The Contractor shall furnish the necessary personnel, equipment, material and/or services and otherwise
do all things necessary for or incidental to the performance of work set forth in the
. Statement of Work, Attachment "An
. Internet Query System (IHPS) Appropriate Use oecelartion, Attachment "0",
. Internet Query System (IHPS) User List, Attachment "E", and
. Internet Query System (IHPS) User List Modification, Attachment "F"
which are attached hereto and incorporated by reference herein.
PERIOD OF PERFORMANCE
Regardless of the date of signature and subject to its other provisions, this Contract shall commence upon
execution, and end on January 31, 2013, unless terminated sooner or extended upon mutual agreement
between DOL and the Contractor. This Contract may be extended multiple times under written mutual
consent of the parties. .
PA YMENT
There are no costs associated with this contract.
RECORDS MAINTENANCE.
Each party shall maintain books, records, documents and other evidence, which sufficiently and properly
reflect all direct and indirect costs expended by either party in the performance of the services described
herein. These records shall be subject to inspection, review, or audit by personnel of both parties, other
personnel duly authorized by either party, the Office of the State Auditor, and federal officials so
authorized by law. All books, records, documents, and other material relevant to this Contract will be
File Name: K1152.docx
Special Terms & Conditions
Page 1 of 13
3/13/2009
. .
DOL Contract No. K1152
retained for six (6) years after expiration and the Office of the State Auditor, federal auditors, and any
persons duly authorized by the parties shall have full access to and the right to examine any of these
materials during this period.
Records and other documents, in any medium furnished by one party to this Contract to the other party,
will remain the property of the furnishing party, unless otherwise agreed. The receiving party will not
disclose or make available this material to any third parties without first giving notice to the furnishing
party and giving it a reasonable opportunity to respond. Each party will utilize reasonable security
procedures and protections to assure that records and documents provided by the other party are not
erroneously disclosed to third parties.
RIGHTS OF INSPECTION
The Contractor shall provide right of access to DOL, or any of its officers, or to any other authorized agent
or official of the state of Washington or the federal government at all reasonable times, in order to monitor
and evaluate performance, compliance, and/or quality .assurance of internal policies and procedures,
and/or records relating to the safeguarding, use, and disclosure of Personal Information obtained or used
as a result of this Contract. The Contractor shall make available information necessary for DOL to comply
with the client's right to access, amend, and receive an accounting of disclosures of their Personal
Information. The Contractor agrees to accommodate DOL's request for inspection, review, or audit on
one (1) working day notice and to allow on-site audits during regular business hours.
SAFEGUARDING OF PERSONAL INFORMA TlON
Each party shall not use"or disclose Personal Information in any manner that would constitute a violation of
federal law, and applicable provisions of Washington State law. The Contractor agrees to comply with all
federal and state laws and regulations, as currently enacted or revised, regarding data security and
electronic data interchange of all Personal Information, including but not limited to Washington State
Department of Information Services Board IT Portfolio Security Policy, Standards and Guidelines
(http://isb.wa.qov/policies/securitv.aspx).
The Contractor shall protect Personal Information collected, used, or acquired in connection with this
Contract, against unauthorized use, disclosure, modification or loss. The Contractor shall ensure their
directors, officers; employees, subcontractors or agents use it solely for the purposes of accomplishing
the services set forth in this Contract. The Contractor agrees not to release, divulge, publish, transfer,
sell or otherwise make it known to unauthorized persons without the express written consent of DOL or
as otherwise required by law. The Contractor agrees to implement physical, electronic, and managerial
policies, procedures, and safeguards to prevent unauthorized access, use, or disclosure. The Contractor
shall make the Personal Information available to amend as directed by DOL and Incorporate any
amendments into all the copies maintained by the Contractor. The Contractor shall certify its return or
destruction upon expiration or termination of this Contract, shall retain no copies and by completing the
Certification of Data Disposition, Attachment C. If the Contractor and DOL mutually determine that return
or destruction is not feasible, neither party shall use the Personal Information in a manner other than
those permitted or required by state and federal laws.
DOL reserves the rights to monitor, audit, or investigate the use of personal information collected, used or
acquired by the other party through this Contract.
The Contractor shall notify DOL in writing within five (5) working days of becoming aware of any
unauthorized access, use or disclosure. The Contractor agrees to indemnify and hold harmless DOL for
any damages related to unauthorized use or disclosure by the other party their officers, directors,
employ~es, subcontractors or agents.
Any breach of this clause may result in termination of the Contract.
DA TA DISPOSITION
Each party shall certify the return or destruction of all data sets as described herein upon expiration or termination
of this Contract (Reference: Certification of Data Disposition, Attachment C) and shall retain
no copies. If the parties mutually determine that return or destruction is not feasible, neither party shall use
File Name: K1152.docx
Special Terms & Conditions
Page 2 of 13
3/13/2009
DOL Contract No. K1152
the Confidential Information in a manner other than those permitted or authorized by state and federal laws.
INDEPENDENT CAPACITY
The employees or agents of each party who are engaged in the performance of this Contract shall continue
to be employees or agents of that party and shall not be considered for any purpose to be employees or
agents of the other party.
CONTRACT AL TERA nONS AND AMENDMENTS
This Contract may be amended by mutual Contract of the parties. Such amendments shall not be binding
unless they are in writing and signed by personnel authorized to bind each of the parties.
MEMO OF UNDERSTANDING (MOU)
Any instructions that either Contract Manager determines to address more than day-to-day concerns, but
do not modify the terms of this Contract, shall be documented by a written, numbered Memo of Understanding.
TERMINA nON FOR CONVIENENCE
DOL may terminate this Contract upon thirty (30) calendar days prior written notification to the Contractor.
If this Contract is so terminated, the Contractor shall be liable only for performance rendered or costs
incurred in accordance with the terms of this Contract rendered prior to the effective date of termination.
TERMINA nON FOR CAUSE
If for any cause, the Contractor does not fulfill in a timely and proper manner its obligations under this Contract,
or violates any of these terms and conditions, DOL will give the other party written notice of
such failure or violation. The Contractor will be given the opportunity to correct the violation or failure
within fifteen (15) working days. If the failure or violation is not corrected, this Contract may be terminated
immediately by written notice from DOL to the Contractor.
DISPUTES
In the event that a dispute arises under this Contract, a dispute board shall determine it in the following
manner: Each party to this Contract shall appoint a member to the dispute board. The members so
appointed shall jointly appoint an additional member to the dispute board. The dispute board shall
evaluate the facts, contract terms and applicable statutes and rules and make a determination of the
dispute. The determination of the dispute board shall be final and binding on the parties hereto. As an
alternative to this process, either of the parties may request intervention by the Governor, as provided by
RCW 43.17.330, in which event the Governor's process will control.
GOVERNANCE
This contract is entered into pursuant to and under the authority granted by the laws of the state of Washington
and any applicable federal laws. The provisions of this Contract shall be construed to
conform to those laws.
In the event of an inconsistency in the terms of this Contract, or between its terms and any applicable
statute or rule, the inconsistency shall be resolved by giving precedence in the following order:
1. Applicable state and federal statutes and rules;
2. Special Terms and Conditions;
3. Statement of Work, Attachment A,
4. Data Classification Declaration, Attachment B,
5. Certification of Data Disposition, Attachment C,
6. Any other provisions of the Contract, including materials incorporated by reference.
ASSIGNMENT
The work to be provided under this Contract, and any claim arising thereunder, is not assignable or
delegable by either party in whole or in part, without the express prior written consent of the other party,
which consent shall not be unreasonably withh~ld.
WAIVER
A failure by either party to exercise its rights under this Contract shall not preclude that party from
subsequent exercise of such rights and shall not constitute a waiver of any other rights under this
Contract unless stated to be such in a writing signed by an authorized representative of the party and
File Name: K1152.docx Page 3 of 13 3/13/2009
Special Terms & Conditions
DOL Contract No. K1152
attached to the original Contract.
SEVERABILITY
If any provision of this Contract or any provision of any document incorporated by reference shall be
held invalid, such invalidity shall not affect the qther provisions of this Contract which can be given effect
without the invalid provision, if such remainder conforms to the requirements of applicable law and the
fundamental purpose of this Contract, and to this end the provisions of this Contract are declared to be
severable.
CONTRACT MANAGEMENT
The contract manager for each of the parties shall be responsible for and shall be the contact person
for all communications and billings regarding the performance of this Contract.
The Contract Manager for the Contractor is: The Contract Manager for DOL is: .
Theresa Ewing Mike Dennison
Bremerton Municipal Court Department of Licensing
900 Pacific Ave PO Box 9020
Bremerton, WA 98337 Olympia WA 98507-9020
Phone (360)473-5242 Phone: (360) 902-3851
FAX: (360) 473-5262 E-Mail: mdennison@dol.wa.Qov
E-Mail: Theresa.ewinQ@cLbremerton.wa.us
ALL WRITINGS CONTAINED HEREIN
This Contract contains all the terms and conditions agreed upon by the parties. No other understanding,
oral or otherwise, regarding the subject matter of this Contract shall be deemed to exist or to bind any of
the parties hereto.
IN WITNESS WHEREOF, the parties have executed this Contract.
Bremerton Municipal Court
State of Washington
Department of Licensing
QJ2
03)20JO&)
(Date)
~\G~
Julie Knittle
DOL Contracts Officer
'- ~, ~\ \ \:S'
\ \,
(Date)
(Signature)
- A
(~:;;~S~ ~'lYLj
~u....+ SerO)QS Alo.t"V)..~
(Title)
L1 , LP OC:> \23 \
(Federal Identification Number)
APPROVED AS TO FORM ONLY
(SIGNATURE) ON FILE
Jerry Anderson, AAG
Assistant Attorney General
2/1212009
(Date)
File Name: K1152.docx
Special Terms & Conditions
Page 4 of 13 .
3/13/2009
DOL Contract No. K1152
Attachment A
STATEMENT OF WORK
DEFINITIONS
As used throughout this Contract, the following terms shall have the meanings set forth below:
1. "Contractor" means that Contractor, firm, provider, organization, individual or other entity accessing drive
record information under this Contract.
2. "Contract Officer" shall mean the Assistant Director for DOL Administrative Services or the designee
authorized in writing to act on behalf of the DOL Assistant Director.
3. "Contract Manager" means the representative identified in the text of the Contract who is delegated the
authority to administer the Contract.
4. . "Personal Information" means information identifiable to any person, including, but not limited to,
information that relates to a person's name, health, use or receipt of governmental services or other
activities, addresses, social security numbers, driver license numbers, other identifying numbers or
Protected Health Information, and other information that may be exempt from disclosure to the public or
other unauthorized persons under either RCW 42.17.310 or other state and federal statutes.
5. "RCW" shall mean the Revised Code of Washington. All references in this document to RCW chapters or
sections shall include any successors, amended, or replacement statues.
6. "USER" shall mean the Contractor, the Contractor employee(s) or agent(s) or entity performing on behalf
of the primary Contractor and who will access the IHPS data system.
ProQram Support
The program support Iiason for the Contractor shall be the primary contact for all communications regarding:
. Operation of IHPS;
. Registration process of the digital certificate and SecureAccess Washington;
. User acceptance testing for system updates;
. Proccess for modifying, adding, terminating employees from User List and/or general questions;
. Notifications of system maintenance
',.' .
The Program Support for DOL is:
Department of Licensing IHPS Support
PO Box 9030
Olympia WA 98507-9030
For questions about computer or browser-related problems:
Please contact the desktop support staff within your agency.
For questions about registering with SecureAccess Washington:
Please contact the Department of Information Services (DIS) Service Desk:
. Email: Servicedesk~dis.wa.Qov
. Phone: (360) 753-2454 or 1-888-241-7597
For questions about the Digital Certificate:
Please contact IdenTrust Customer Support:
. Email: helpdesk~identrust.com
. Phone: 1-888-248-4447
. Fax: (801) 326-5438
. Hours: Monday-Friday, 6 a.m. to 5 p.m.
For questions about the Interagency Agreement, use of the IHPS
File Name: K1152.docx
Statement of Work, Attachment A
Page 5 of 13
3/13/2009
DOL Contract No. K1152
application, or if you cannot gain access to the application during normal
business hours:
Please contact Department of Licensing IHPS Support:
. Email: doldldsihpssupport@dol.wa.qov
. Phone: (360) 902-0154
. Fax: (360) 570-7858
. Hours: Monday-Friday, 8 a.m. to 5 p.m.
USERS Shall:
1. Take all steps necessary to ensure the application is accessible and used only by the authorized
personnel to accomplish their official job functions.
2. Notify DOL in writing of employees who are eligible for access to the IHPS system using the IHPS
User List template incorporated herein by reference.
3. Be responsible to immediatelv notify DOL in writing of any changes to the access eligibility by
using the IHPS User List Modificiation template incorporated herein by reference.
4. Ensure the USER and USER's employees and agents will maintain the confidentiality of driver
records by:
a. Protecting their account numbers and passwords;
b. Regularly changing passwords, by instructing users to change their password every 90 days, as
recommended for security enhancement and by using hard to guess passwords; particularly
when there are changes in personnel;
c. Instituting penalties for misuse of data; and
d. Ensuring that employees are familiar with the provisions of this contract.
5. Have the ability and are responsible to cancel its SecureAccess account.
6. Require USER employees to apply for and receive either a digital certificate from IdenTrust or
registration with SecureAccess Washington for each employee accessing the IHPS application.
7. USER is provided the following options for access to the DOL IHPS system, IdenTrust and
SecureAccess Washington or may elect to use both options.
. IdenTrust (Fee Applies)
The USER will pay IdenTrust for the digital certificates along with a certificate renewal fee every
two years. As a licensed, regulated entity, IdenTrust must comply with Washington law RCW
19.34 and operate under the rules set forth in chapter 434-180 of the Washington Administrative
Code.
. SecureAccess (No Fee)
SecureAccess WA is a single sign-on application gateway created by Washington State's
Department of Information Services and allows Internet access to multiple online government
services with the use of a unique single self-generated User-ID and password.
OELlVERABLES & OA TA RESPONSIBILITIES
The parties as indicated will share the data identified below:
1. Purposes of data sharing.
It is the purpose of this Contract to set out the terms and conditions under which DOL will provide the
Contractor staff, access to certain information from DOL's driver license records. Access to driver
license record information will only be made available to the Contractor's staff to accomplish their
official job functions. The use of said driver record information shall be exclusively for court proceedings
and to assist the individual named in determining requirements to reinstate their Washington driving
privilege.
File Name: K1152.docx
Statement of Work, Attachment A
Page 6 of 13
3/13/2009
DOL Contract No. K1152
Said information shall be disseminated only to authorized entities and persons; and used by them only
for the purposes set out in this Contract, in accordance with federal and state law.
2. Statutory authority granting access to or sharing of data.
The Contractor will comply with all statutory or administrative rules regulating the confidentiality of
information obtained from DOL databases, including but not limited to RCW 46.52.120 and RCW
46.52.130, RCW 46.61.513 and the federal Driver Privacy Protection Act 18 USC 2721.
3. Brief but clear description of the data to be shared.
DOL will provide the Contractor staff, with on-line or Internet access to DOL driver databases.
Contractor staff will update DOL's drive records with FT A adjudications.
Access will permit the Contractor staff to obtain information to be used exclusively for the purpose of
determining requirements to reinstate the named individual's Washington driving privilege. This
information is limited to:
. Failure to Appear Information (FTAs) (list);
. Reinstatement data and status;
. Middle initial search.
4. How will the data be shared?
The data shall be provided by the DOL based upon the option(s) chosen by Contractor at the time of
application either Digital Certificate with IdenTrust and/or SecureAccess Washington or both.
5. Names of individuals or employees and their working titles who are authorized access to the
shared data:
. Should be included on attachement "E".
6. Brief and clear description of the procedure or protocol for accessing the data:
Aside from preventative maintenance and database updates, the application will be available for
record access Sunday through Saturday. The Contractor will guard against unauthorized access to
DOL databases as follows:
6.1 Only Contractor's staff needs this information in the execution of their official duties will be
granted access privileges to the DOL databases specified in this Contract.
6.2 Access to DOL databases will be secured using log-on ID's/User Group Codes.
6.3 The Contractor's equipment capable of accessing these databases will be located in areas that
are not accessible to the general public.
6.4 IHPS requires a UserlD and password. SecureAccess requires user authorization.
SecureAccess allows authorized staff access from any location with UserlD and password. The
applications allow the user to read and print the data and to update DOL's drive records with FT A
adjudications.
7. How will the data be destroyed by data recipient/returned to data provider?
When information is no longer needed, it will be destroyed in the manner as other confidential client
data.
The Contractor will comply with all statutory or administrative rules including, but not limited to
Washington State Department of Information Services Board IT Portfolio Security Policy, Standards
and Guidelines (http://isb.wa.Qov/policies/securitv.aspx).
8. Security Controls. Contractor shall protect the data from unauthorized physical and electronic access
while it is in motion and at rest, as described below: .
1. Electronic Access: Contractor shall ensure electronic access is authorized using individual
accounts, hardened passwords and require changing of passwords at least every 90 days.
2. Encryption and Decryption: Contractor shall furnish encryption and decryption software
compatible with DOL's software to ensure security and confidentiality.
File Name: K1152.docx Page 7 of 13 3/13/2009
Statement of Work, Attachment A
DOL Contract No. K1152
3. Armly Security Patches: Contractor shall be diligent in the timely installation of security patches
for all information technology assets, hosts and networks, that process DOL data.
4. IT Security Policies and Procedures: Contractor shall maintain and enforce information technology
security policies and procedures consistent with this Contract, and provide an electronic copy to
DOL upon request within three (3) business days, Contractor's information technology security
policies and procedures shall include a computer incident response policy and procedure and
annual security training to their employees.
5. Protection/Intrusion Devices: All Contractors' information technology assets that store/process
DOL data shall be physically secured from unauthorized access. Contractor shall employ
adequate devices such as Intrusion Protection (IPS) and Intrusion Detection (IDS) devices and
system log monitoring to ensure unauthorized users cannot access Contractor information
technology assets in a manner that allows DOL data to be compromised.
6. Periodic Vulnerability Scanninq and Penetration Testinq: Contractor shall periodically scan
information technology hosts and networks that process DOL data for vulnerabilities to
exploitation. '
7. Self Audits: Internal and independent audits to review Contractor's data protection and access
may be conducted at a time or times determined by DOL at the Contractor's expense and DOL
being the client.
File Name: K 1152.docx
Statement of Work, Attachment A
Page 8 of 13
3/13/2009
DOL Contract No. K1152
Attachment B
DATA CLASSIFICATION DECLARATION
DA TA CLASSIFICA TlON DECLARA TlON
Data described in this Contract is assessed by DOL to be in the following data (confidentiality) classification:
D PUBLIC
A data classification for data whose access is unrestricted. It applies to all data that is not classified as
CONFIDENTIAL or RESTRICTED CONFIDENTIAL.
[:g]CONFIDENTIAL
A data classification for data that, due to its sensitive or private nature, requires limited and authorized
access. Its unauthorized access could adversely impact the Contractor legally, financially or damage
its public integrity.
D RESTRICTED CONFIDENTIAL
A data qlassification for the most sensitive data within the Contractor. It is confidential (as defined
above); however, with a need for added protection. Its unauthorized access would seriously and
adversely impact the organization, its customers, employees or business partners.
METHOD OF ACCESS/TRANSFER
The data shall be provided by the DOL to the Contractor in the following format(s):
D Secure file transfer (FTP/PGP, SFTP - Regular ADR Sales, ADR Monitoring)
D US or CMS mail (certified or registered with 10 required)
[:g] Secure on-line application (IHPS)
D Facsimile (exceptions only)
D Other FED EX - (with 10 and return receipt required)
FREQUENCY OF DA TA EXCHANGE
DOne time: data shall be delivered by (date)
[:g] Repetitive
DAs available
AUTHORIZED ACCESS TO DA TA
Access to "Confidential" or "Restricted Confidential" information is limited to Contractor staff, who are
specifically authorized and who have a business need-to-know. In accordance with the terms contained herein
and prior to making the data available, the Contractor shall notify all Contractor staff with access to the data of the
use, disclosure and disposition requirements.
USER will be responsible for ensuring that all employees obtaining access to the IHPS application have
reviewed this contract and signed the IHPS Appropriate Use Declaration form incorporated herein by
reference. This form will be kept on file at the USER's location.
-J
File Name: K1152.docx
Data Classifcation Declaration, Attachment B
Page 9 of 13
3/13/2009
. .
DOL Contract No. K1152
Attachment C
CERTIFICATION OF DATA DISPOSITION
Date of Disposition:
Data disposition methods used upon expiration or termination of this Contract: (select all that apply).
D All copies of any data sets related to this Contract have been wiped from all data storage systems and media.
D All on-line access accounts related to this Contract have been deleted.
D All printed and hard copy materials and all non-wiped computer media containing any data related to this Contract.
have been destroyed.
By signing below, I hereby certify that the data disposition requirements as provided in DOL Contract No.
K1152, have been fulfilled as indicated above.
Bremerton Municipal Court
(Signature)
(Date)
(Print Name)
(Title)
File Name: K1152.docx
Certification of Data Disposition, Attachment C
Page 10 of 13
3/13/2009
DOL Contract No. K1152
Attachment D
INTERNET QUERY SYSTEM (IHPS)
APPROPRIATE USE DECLARATION
IHPS USERS WILL:
1. Ensure the confidentiality and privacy of the information accessed.
2. Only use the information to accomplish official job duties.
IHPS USERS WILL NOT:
1. Share the information with any persons not identified in the Internet Query System User List.
2. Use the information for personal reasons or benefit.
Misuse of this information is a felony and is punishable by fine and/or imprisonment.
I reviewed the Data Sharing Agreement with my supervisor and understand the expectations for using IHPS.
EMPLOYEE NAME (PRINTED)
EMPLOYEE SERIAL/BADGE NUMBER
DATE
X
EMPLOYEE SIGNATURE
DATE
x
SUPERVISOR NAME (PRINTED)
SUPERVISOR SIGNATURE
DATE
Signed copies of this declaration should be kept on file in your office - please do not return to DOL.
File Name: K1152.docx
IHIP Appropiate Use Declaration, Attachment D
Page11of13
3/13/2009
Attachment E
INTERNET QUERY SYSTEM (IHPS) USER LIST
MAIL OR FAX TO
DATA MANAGEMENT AND PROJECTS
DEPARTMENT OF LICENSING
PO BOX 9030
OLYMPIA, WA 98507-9030
FAX: (360) 570-7858
The IHPS agreement has been reviewed, with the users listed below, and I approve their eligibility to use IHPS
based on the criteria establis~ed by the Department.;[his inf9\mat,ion_ must be p;pvided to the department.
KreJY\Q.r-\-oC\ fY)U('\IUPo..J C~w-+ L1C)::) Yauf\c. AvL~~-\-on, LtJ AC1'o331
AGENCY NAME AGENCY ADDRESS
\he<<SR~ ~)~ ('3loO) l..\,3-57......47-
SUPERVISOR NAME (PRINTE SUPERVISOR PHONE NUMBER
X rl()~ 03\20\04
. SU~ER~~~RE DATE
IMPORTANT: Please print the employee name and check your choice of access:
. Digital Certificate (DC) or
. Secure Access (SA)
EMPLOYEE NAME
0 DC
0 SA
0 DC
0 SA
0 DC
0 SA
0 DC
0 SA
0 DC
0 SA
0 DC
0 SA
0 DC
0 SA
0 DC
0 SA .
0 DC
0 SA
0 DC
0 SA
lhueS-A 'hu'lnq
EMPLOYEE NAME ...J
~\. ~)1\ Ne,\SOYl
EMPLOYEE NAME
g~~
EMPLOYEE NAME
o DC
'fit SA
EMPLOYEE NAME
&~ Po~ VI
EMPLOYEE NAME
o DC
}ri' SA
r
EMPLOYEE NAME
&Y'\n'e GiOY"'e.mu<l
EMPLOYEE NAME
o DC
)(f SA
EMPLOYEE NAME
)~~ ~U2Q.
EMPLOYEE NAME
o DC
't)bSA
EMPLOYEE NAME
\ hefeSA S~ Y"\ \L.ra.u.S
o DC
.Kl SA
EMPLOYEE NAME
EMPLOYEE NAME
NC\ l\~ ~~ bAS
EMPLOYEE NAME
o DC
-~SA
)\~Q ~(A.~
EMPLOYEE NAME
o DC
.a. SA
EMPLOYEE NAME
5t-e,p~Y"'\\e.. ~ar~n
EMPLOYEE NAME
o DC
lsl SA
.r '"'
EMPLOYEE NAME
~C\ me-s CX:>d-er
o DC
o SA
EMPLOYEE NAME
EMPLOYEE NAME
File Name: K1152.docx
IHIP User List, Attachment E
Page 12 of 13
3/13/2009
.-, ":'
Attachment F
INTERNET QUERY SYSTEM (IHPS)
USER LIST MODIFICATION
DOL Contr~r.t No K11 fl2
MAIL OR FAX TO
DATA MANAGEMENT AND PROJECTS
DEPARTMENT OF LICENSING
PO BOX 9030
OLYMPIA, WA 98507-9030
FAX: (360) 570-7858
This template should be used to add, remove or update a user's access to the IHPS application. This
information must be provided to the department.
DOL CONTRACT NUMBER
AGENCY NAME
AGENCY ADDRESS
ADD USER
NOTE: The new employee needs to apply for a Digital Certificate or SecureAccess.
Check the type of access:
D Digital Certificate (DC) or
D Secure Access (SA)
PRINT NAME
REMOVE USER
Check the type of access the employee had; Digital Certificate (DC) or SecureAccess (SA).
D DC
D SA
PRINT NAME
UPDATE USER
CURRENT INFORMATION
Check the type of access; Digital Certificate (DC) or SecureAccess (SA).
D DC
D SA
PRINT NAME
UPDATED INFORMATION
Check the type of access; Digital Certificate (DC) or SecureAccess (SA).
D DC
D SA
PRINT NAME
File Name: K1152.docx
User List Modification, Attachment F
Page 13 of 13
3/13/2009