ࡱ> MPL~o@ Ybjbj p p Poo* .8E4E|1.(V(~~~~F\,%1%1%1%1%1%1$~3R5hI1!~~I1~~j1vvvj~~\,v\,v~v\)*~aF PDq+Z(*+101B*860864*86*vI1I1$CONTRACTOR SECURITY AGREEMENT Michigan Department of Information Technology Contractor Name FORMTEXT       As a user of services provided by the Department of Information Technology, I accept and agree to the following: To comply with the State of Michigan Computer Crime Law and to use State of Michigan's systems to perform my job function to the exclusion of all other uses. (Public Acts 1979-No. 53)1 To not copy or infringe upon the rights granted to the owner of a product with a Copyright or Patent. To comply with the Michigan Civil Service Commission Rules governing Conflict of Interest. Rule 2-8.1.2 To keep confidential all computers and network system access codes issued to me. To report to the appropriate supervisor or the Office of Enterprise Security immediately any suspected threat to or violation of State of Michigan system security. To report to the appropriate supervisor or the Office of Enterprise Security, the loss or theft of any key or magnetic card / access key which was supplied to me, which allows access to any State of Michigan facility. To not loan or transfer to anyone else the access cards / keys, which were supplied to me, for access to any State of Michigan facility. To comply with Michigan State Government Network Security Policy Procedure 1410.173, issued 1/6 1997 and the Acceptable Use Policy for the Information Technology Resources 1460.00 issued 9/1/2003. To comply with federal laws regarding confidentiality to protect an individuals rights and privacy. To not leave my workstation unattended without either being logged off or invoking a hotkey password supported screen saver. To comply with HIPPA Confidentiality requirements. To ensure that privacy rights of enrollees are respected, you are required to only use any protected health information you access for the purpose of ensuring proper plan operation and administration. You also are prohibited from disclosing any protected health information to any outside party without written authorization of the Privacy Official of the Employee Benefits Division of the Michigan Department of Civil Service or the Privacy Official's designee. Contractor SignatureDate1 Public Acts 1979 No. 53 (URL:http://www.michiganlegislature.org) 2 Michigan Civil Service Commission Rule (URL:  HYPERLINK "http://www.state.mi.us/mdcs/Rules2002/crule2.htm#Section2-8bottom" http://www.state.mi.us/mdcs/Rules2002/crule2.htm#Section2-8bottom) 3 Michigan State Government Network Policy Procedures 1410.17 (URL: http://www.state.mi.us/adminguide/1400/1410-17.htm)  DIT-0928 3/04  PAGE 1 of  NUMPAGES 1  ( H f s t u v l m ; < G H $%z{úúh&C hAhh h OJQJ h hjhy,OJQJ hjhj hjhAhhjOJQJhjH*OJQJhjhAhhAhH*OJQJjhWL UmHnHujhWL UhWL jhWL Uh hAh/<z $IfgdLikd$$Ifl+(, t0644 la %$IfgdAh *$IfgdAh*XZMikdf$$Ifl+(, t0644 la.dP$IfgdWL gkdi$$Ifl+(, t0644 la v m H {3d$If]gd 3 & F >d$If]`>gdj3 & F d$If]gdj3 & F d$If]gdAh3d$IfgdAh 3d$IfgdAh|| $IfgdLgkd$$Ifl+(, t0644 la3d$If]gd {{ .$IfgdLzkd $$Ifl0"+}" t0644 laijk&()*1289?@ABFGQRSTymemXmememXmh!0J8CJmHnHuhAh0J8CJjhAh0J8CJU hWL CJ hAhCJh)%hvnCJ aJ h8uuh8uuOJQJaJh4Ah8uu0J?OJQJaJ'jhWL hWL OJQJUaJjh8uuOJQJUaJh8uuH*OJQJaJh&COJQJaJh8uuOJQJaJ h8uuH*h&Ch&CCJOJQJ!y $IfgdL|kdw$$Ifl0"+}"  t0644 la $Ifgd&Cikd$$Ifl`+(, t0644 la'(xxxx d$Ifgd8uuzkdQ$$Ifl0 +m  t0644 la()*VWXY88~$If$ ! !%)gdLgkd$$Ifl+(, t0644 laTUVWXY88888,8.8B8D8F8J8L8N8P8d8f8h8r8t8v8x88888888888888888¼Ÿ¼¼Ÿ¼¼¼¼¼xŸ¼¼kj@ hijCJUj* hijCJUj.hijCJUjLhijCJUjhijCJUmHnHujfhijCJU hijCJjhijCJUhijjhijUh hijhh)%hvnCJ aJ h!hAh hAhCJhWL 0J8CJ*1 0&P:p8uu/ =!@"@#$@%@g$$If!vh5(,#v(,:V>l t65(,/  / U$$If!vh5(,#v(,:V>l t65(,/ D\Text1Enter the Contractor NameY$$If!vh5(,#v(,:V>l t65(,/ G$$If!vh5(,#v(,:V>l t65(,k$$If!vh5}"5 #v}"#v :V>l t65}"5 / }$$If!vh5}"5 #v}"#v :V>l t65}"5 / / Y$$If!vh5(,#v(,:V>l` t65(,/ $$If!vh5m 5#vm #v:V>l t65m 5/ / / / / DyK  yK bhttp://www.state.mi.us/mdcs/Rules2002/crule2.htmSection2-8bottomU$$If!vh5(,#v(,:V>l t65(,/ $$If!vh5,#v,:V l405,/ 4af4$$If!vh5,#v,:V l405,/ 4af4DITEMROW7Enter the sequential number for the item being entered.D Text126Optional for agency staff. 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SectionsProtectedForForms UnprotectDITdl 6nt/&H00000000 Module=NewMacros Module=Review Name="TemplateProject" HelpContextID="0" VersionCompatible32="393222000" CMG="D7D540BBC0459349934993499349" DPB="AEAC3994C7BC9FBD9FBD9F" GC="858712C93EA13FA13F5E" [Host Extender Info] &H00000001={3832D640-CF90-11CF-8E43-00A0C911005A};VBE;&H00000000 [Workspace] ThisDocument=0, 0, 0, 0, C NewMacros=0, 110, 492, 445, C Review=61, 41, 443, 376, Z ThisDocumentThisDocumentNewMacrosNewMacrosReviewReview  FMicrosoft Word Document MSWordDocWord.Document.89qo@ 6ZMbjbj p p Pool6l6^?^?^?^?^?r?@PEElEE4E|r?$MmFoHoHoHoHoH JJ\LLLLLLL$NRDQL-^?KoHoHKKL^?^?oHoHLKKKK^?oH^?oHLKKLKKKsK^?^?&CKoHaF PDq+@KKKL0$MKDQKDQKr?r?^?^?^?^?DQ^?KKKKKKKKKLLr?r?d@Kr?r?@ -  PAGE  -   FORMTEXT    FORMTEXT       FORMTEXT 3 FORMTEXT      FORMTEXT       FORMTEXT       FORMTEXT  =text13*text16 00  FORMTEXT        FORMTEXT      FORMTEXT        FORMTEXT       Michigan Department of Information Technology  FILENAME   FILENAME \p   FORMTEXT        FORMTEXT        FORMTEXT        FORMTEXT       Name FORMTEXT      Date of Birth FORMTEXT      Relationship to applicant(s) FORMTEXT     8 8"8$8&8*8,8IGBG & FWkd$$Ifl4+,04 lf4$IfWkdF$$Ifl4+,04 lf4,8N8v8888 9T9 $$If]a$$If8888888889 9 99"9$9D9F9H9J9L9N9P9R9T9V9X9Z9n9p9~9999999999999999R:ߵ}jXhijUjhijUj+hijUjRhijUjhijUhij hij5j, hijCJUhijCJmHnHuj4 hijCJU hijCJjhijCJUmHnHujhijCJU-T9V9X999986420kd $$Ifl֞v !&,vT*04 l99P:R:l::::;,;6;^;z;; d$If R:T:h:j:l:n:::::::::::::::::;;;;;*;6;8;L;N;P;Z;\;^;z;|;;;;;;;;;;ujGhijOJQJU"jhijOJQJUmHnHujhijOJQJUhijOJQJjhijOJQJUj hijUjhijUjhijUjhijUjhijUhij hijhjhijUh.;;;LL L2LCA?Ekd$$If940@ >+2 4 9f4 d$Ifhkd$$If9\bz!>+TF~ 4 9;;;<LLL L L L"L0L2LLJLLLTLVLjLlLnLpLLLLLLLLLLLLLLLLLLMMM0M2MFMHMVMZMȾȾȾȾسب؝ؒ؇jZhijUjhijUjhijUjZhijUjhijUjhijUh hijhj5hijUhijUjhijUmHnHujhijUj{hijU0   FORMTEXT       Page  PAGE  of  NUMPAGES   FORMTEXT        FORMTEXT       Sincerely,  FORMTEXT        FORMTEXT    Subject:  FORMTEXT       2LnLLLLLM0MXMZM%$#"! / =!"#$% ClientCity UppercaseEnter the Addressee's City. ClientStateD date1 M/dd/yyyy#Enter the Date (Example: 4/12/1997)D FirstName Uppercase_Enter the Addressee's First Name (and Middle Initial, if known). Then, tab to Last Name Field.LastNameD FirstName2\Enter the Grantee's First Name (and Middle Initial, if known). Then tab to Last Name Field. lastname2DLastName UppercaseEnter the Addressee's Last NameD LastName2Enter the Grantee's Last NameDText10$OTHER HOUSEHOLD MEMBERS - enter NameDText11Enter Date of Birth$$IfG!vh5T55F5~ #vT#v#vF#v~ :V 95T55F5~ 44 9aHDText12iEnter Relationship to applicant(s). CTRL + F1 to add additional household members or TAB to next section.p$$IfG!vh52 5#v2 #v:V 9452 544 9af4DOtherID&Enter Other Identification, as needed.DWorkerExtension5Enter the extension number, if any, (Example: X12345)D CoPhoneNumber2Enter the 7 digit phone number (Example: 373-1234) CoExtensionD Text4 Enter the Social Security NumberD ClientState Uppercase1Enter the Addressee's 2 digit State Abbreviation. ClientZipD ClientZip UppercaseFEnter the Addressee's Zip (+4 if known) (Example: 48909 or 48909-7537)5CJOJPJQJmH sH u<O< - PAGE -_HmH sH tH hOh Captions 9pt Bold dL5CJOJPJQJmH sH u^O"^ User Input 11ptd$5CJOJPJQJmH sH ufO2f User Input 10ptd8(5CJOJPJQJmH sH uROBR Address1d8(OJQJ_HmH sH tH PORPAreaCode#CJ OJQJ_HmHnHsH tH uHObHCity#CJ OJQJ_HmHnHsH tH uLOrL Date1d8(OJQJ_HmH sH tH <O< Filename_HmH sH tH NON Filename and path_HmH sH tH TOT FirstNamed8(OJQJ_HmH sH tH VOV FirstName2d8(OJQJ_HmH sH tH ROR LastNamed8(OJQJ_HmH sH tH TOT LastName2d8(OJQJ_HmH sH tH `O` Captions 10ptd`(CJOJPJQJmH sH uPOP OtherIDd8(OJQJ_HmH sH tH BOB Page X of Y _HmH sH tH \O\PhoneExtension!#CJ OJQJ_HmHnHsH tH uVO"V PhoneNumber"#CJ OJQJ_HmHnHsH tH u^O2^ SocialSecurity#d$5CJOJQJ_HmH sH tH JOBJState$#CJ OJQJ_HmHnHsH tH uNORNZipCode%#CJ OJQJ_HmHnHsH tH u P<00}<00<00<}<00<00t}<00<00}<00<00}<00}<00- PAGE -9ptrows AddAutoNumber AddItemRowAddress1AreaCodeCityDate1DITFilename Filename and path FirstName FirstName2 LastName LastName2NameOtherID Page X of YPhoneExtension PhoneNumber Sincerely,SocialSecurityStateSubject:ZipCodeForm Title 10pt Bld- PAGE -Captions 9pt BoldNormalUser Input 10ptAddress1AreaCodeCityDate1FilenameFilename and path FirstName FirstName2LastName LastName2 Captions 10ptOtherID Page X of YPhoneExtension PhoneNumberSocialSecurityStateZipCode)6FZn7K_j~T8R:;ZM  #%(8,8T99;2LZM !"$'ZM  "%'39;GIKW\^jpr~)46DFRXZflnz%*57CIKW]jv|~!FFFFFFF"FFFFFFFFFFF4F!FFFFFITEMROWText12Text13Text16Text17Address1 SuperAreaCode ClientCitydate1 FirstName FirstName2LastName LastName2Text10Text11Text12OtherIDWorkerExtension CoPhoneNumberText4 ClientState ClientZip(<sG[o8Lk &:JYmJ^}{s hh^h`.{sij';K^ri0i0@nsg[ nn(8:LUnknownGz Times New Roman5Symbol3& z Arial=" Arial (W1)]Century SchoolbookCentury?5 z Courier New;Wingdings"0h0@?ij