INSTRUCTIONS FOR THE ISSUANCE OF A SIKORSKY AIRCRAFT CONTRACTOR ACCESS PHOTO BADGE To obtain a contractor s access photo badge ( Badge ) and/or a Computer Account for a non-sikorsky individual working on Sikorsky s premises ("Contractor ), the Sikorsky employee shall submit to Security Headquarters: 1. A Written Request, including management authorization; 2. a Completed Contractor Information Form; 3. Proof of US Person; 4. a satisfactory Background Investigation; and 5. an Independent Contractor Certification (where applicable) 1. Written Request To request a Badge, an authorized Sikorsky employee shall submit a written request to Security Headquarters ( Request ). The Request shall state the Contractor s name, the name of the Contractor s company, and the duration of the Badge. The requesting Sikorsky employee shall simultaneously submit written management approval for the Request. To be eligible for a Badge, the Contractor shall, at a minimum, be contracted to work at a Sikorsky s facility for thirty (30) days or more or on an irregular basis over the course of a year. No Badge will be valid for longer than a one (1) year period. 2. Contractor Information Form The Contractor seeking a Badge shall submit a Contractor Information Form. The requesting Sikorsky employee shall sign the Form on the Witness line. 3. Proof of US Person The Contractor shall present satisfactory proof of US Person to the Security personnel in Security Headquarters, simultaneously with the completed Contractor Information Form. The proof of US Person shall be an original document. Copies will not be acceptable. Acceptable proof of US Person is: 1. A United States Birth Certificate issued by a federal, state, or city agency bearing the raised seal of that agency; 2. a United States Passport; or 3. a valid Permanent Resident Card (Green Card) 4. Background Investigation Contractors, for themselves or through their employers on their behalf, shall submit a background investigation certificate satisfactory to Sikorsky. Sikorsky shall have unlimited discretion in its determination of a Contractor s eligibility for a Badge, which determination shall be final and nonreviewable. Contractors shall use LexisNexis for background investigations. The Contractor, or Contractor s employer, shall retain the underlying LexisNexis investigative report for the period that the Contractor has a Badge. Contractor shall maintain eligibility for a Badge at all times while in possession of a Badge and shall Page 1 of 8
notify Sikorsky immediately if anything occurs which in any way might affect legibility for a Badge. Once the Written Request, Contractor Information Form, LexisNexis Background, and proof of US person are submitted, reviewed and accepted, the Contractor s picture will be taken and a Badge produced. 5. Independent Contractor Certification Applicable for individuals or entities furnishing services to Sikorsky as an independent contractor rather than as an employee of an entity previously under contract with Sikorsky. Contractors or their employers, as applicable, are solely responsible for all costs associated with LexisNexis s services. LexisNexis may be contacted through: (EFFECTIVE MARCH 17 TH 2008) Background Screening Customer Service Main Number: 1.866.441.5290 utc@lexisnexis.com Hours of Operation: Monday-Friday, 7:00AM-7:00PM CST When to contact: General questions or inquiries: regarding content of reports, Additional handling required for report, Delivery questions or needs, Status of reports, Questions regarding data entry or questions regarding submitted requests Background Program Escalation Contacts Savannah Green Client Advocate Main Number: 678.694.5041 Fax Number: 770.753.1298 savanna.green@lexisnexis.com Hours of Operation: When to contact: Monday-Friday, 8:00AM-4:30PM EST *Questions or Inquires specific to UTC, Escalated Service Needs, Account Set Up Assistance, Monthly Management Reports, Billing Questions, Adding/Deleting CPScreen users or login difficulties. Drug Testing Customer Service Main Number: 1.800.939.4782 cservice@lexisnexis.com Hours of Operation: Monday-Friday, 7:00AM-7:00PM CST When to contact: Order Custody and Control Forms, Inquire about a drug screen result, Have a new location or collection site added to an account, Schedule post accident drug screen, For after-hours collection needs, problems with reporting method, problem with a collection site, questions about an account or drug testing process National Scheduling Center Main Number: 1.888.695.3465 Hours of Operation: Monday-Friday, 7:00AM-7:00PM CST When to contact: Call to schedule pre-employment drug test or check on the status of a schedule. Page 2 of 8
Drug Testing Medical Review Office (MRO) Main Number: 1.800.733.6676 medical_questions@lexisnexis.com Hours of Operation: Monday-Friday, 8:00AM-7:00PM CST When to contact: Clients contact for further information on non-negative (positive) results. Applicants call this number to request copy of their drug screen, review results with MRO or request a retest. Drug Screen Program Escalation Contacts Kimberly Vance Customer Service Supervisor Main Number: 630.679.5858 kimberly.vance@lexisnexis.com When to contact: *Escalated needs Michele Popek National Scheduling Center Manager Main Number: 630.679.5622 michele.popek@lexisnexis.com When to contact: *Escalated needs for National Scheduling Center Technical Support Main Number: 1.800.962.2091 employment.support@lexisnexis.com Hours of Operation: Monday-Friday, 8:00AM-8:30 EST When to contact: All technical, web site support questions Consumer Advocacy Center Main Number: 1-800.845.6004 When to contact: Applicants call this number to obtain copies of their background reports or dispute any information contained in the background report. Account Manager Greg McGowan (Strategic Relationship Manager) 845-267-8438 Direct gregory.mcgowan@lexisnexis.com Account Management Team Escalation Contacts Mike Jeffries Regional Sales Director 919.844.9556 mike.jeffries@lexisnexis.com Page 3 of 8
CONTRACTOR INFORMATION FORM Name (Last, First, Middle): Sex: Date of Birth: Social Security Number: Any Other name by which known (Alias, Maiden or Former Legal Name) List Below Your addresses for the Past Five Years NUMBER & STREET CITY STATE DATE FROM DATE TO PRESENT PREVIOUS PREVIOUS PREVIOUS US PERSON: IF BORN IN THIS COUNTRY, YOU MUST PRESENT YOUR BIRTH CERTIFICATE OR VALID US PASSPORT. IF FOREIGN BORN YOU MUST PRESENT YOUR CERTIFICATE OF NATURALIZATION OR A VALID US PASSPORT. PERMANENT RESIDENT ALIENS MUST PRESENT THEIR PERMANENT RESIDENT ALIEN REGISTRATION CARDS. ARE YOU A CITIZEN OF THE UNITED STATES? YES NO PLACE OF BIRTH ALIEN REGISTRATION NO. CITY AND COURT OF NATURALIZATION DATE OF FINAL PAPERS NATURALIZATION CERT. NO. PROOF OF US PERSON DOCUMENT REVIEWED BY RECEIVED BY EMPLOYMENT: LIST BELOW ALL PLACES OF EMPLOYMENT OR WHERABOUTS DURING THE PAST FIVE YEARS. IF UNEMPLOYED, STATE RESIDENCE AND DATES WHILE UNEMPLOYED. EMPLOYER AND ADDRESS WORK PERFORMED EMPLOYMENT DATES(FROM/TO) REASON FOR LEAVING ARRESTS: HAVE YOU EVER BEEN ARRESTED, CHARGED OR HELD BY FEDERAL, STATE OR OTHER LAW ENFORCEMENT AUTHORITIES FOR ANY VIOLATION OF ANY FEDERAL, STATE, COUNTY, OR MUNICIPAL LAW, REGULATION OR ORDINANCE? INCLUDE ALL COURT MARTIALS WHILE IN MILITARY SERVICE. TRAFFIC VIOLATIONS MUST ALSO BE INCLUDED IF THE PENALTY IMPOSED WAS $100.00 OR MORE. CHARGE DATE PLACE DISPOSITION I HEREBY CERTIFY THAT THE ANSWERS AND STATEMENTS GIVEN BY ME IN THIS FORM ARE CORRECT WITHOUT CONSEQUNTIAL OMISSIONS OF ANY KIND. CONTRACTOR SIGNATURE WITNESS DATE CONTRACTOR ENVIRONMENTAL/SAFETY BRIEFING SIKORSKY CONTACT (PRINT): TRADES EMERGENCY EVACUATION BRIEFING SIGNATURE & PHONE EXT: SERVICE Page 4 of 8
CONTRACTOR S AUTHORIZATION TO RELEASE INFORMATION TO WHOM IT MAY CONCERN: I hereby authorize any representative of LexisNexis bearing this release, or copy thereof, within six (6) months of its date, to obtain any information in your files pertaining to my employment, military service, educational records, and law enforcement records (including, but not limited to, any record of charge, prosecution or conviction for criminal or civil offenses). I hereby direct you to release such information upon request to the bearer. This release is executed with full knowledge and understanding that the information is for official use of (Name of Contractor s Employer). I hereby release you, as the custodian of such records, and any educational institution, consumer reporting agency, retail business establishment, law enforcement or criminal justice agency, including its officers, employees, or related personnel, both individually and collectively, from any and all liability for damages of whatever kind, which may at any time result to me, my heirs, family or associates because of compliance with this authorization and request to release information, or any attempt to comply with it. I am furnishing my Social Security Account Number on a voluntary basis with my understanding such is not required by Federal Statute or regulation. I have been advised that LexisNexis will utilize this number only to facilitate the location of employment, military, law enforcement, and educational records. FULL NAME SIGNATURE: FULL NAME PRINTED: DATED: THIS day of 20 DATE OF BIRTH: SOCIAL SECURITY NUMBER: CURRENT ADDRESS: WITNESSED BY: Page 5 of 8
INDEPENDENT CONTRACTOR CERTIFICATION I, (name of individual), hereby certify that I shall be furnishing services to Sikorsky Aircraft Corporation as an independent contractor on behalf of myself or (name of Contractor). I understand that Sikorsky Aircraft Corporation (as used herein Sikorsky Aircraft Corporation includes any and all subsidiaries thereof) hires independent contractors to provide services under terms and conditions regarding intellectual property rights and obligations that are set forth in its General Provisions of Purchases for Services Agreement (if you are being hired through a Contractor, you should be aware that such Contractor is a party to such Purchases for Services Agreement). I acknowledge that I, on behalf of myself or as a person in privity with the Contractor, am obligated to comply with these terms and conditions regarding intellectual property rights. I acknowledge that I have read and understood these obligations, as set forth herein below, before signing this Certificate. ARTICLE I INTELLECTUAL PROPERTY RIGHTS AND OBLIGATIONS A. I acknowledge that any and all inventions, discoveries, improvements, original works of authorship, and/or technical/financial/business data and/or information conceived, created, developed, made, and/or perfected by me, solely or jointly, in the performance of or arising out of the services that I furnish to Sikorsky Aircraft Corporation shall be the exclusive property of Sikorsky Aircraft Corporation. B. I agree to promptly disclose to Sikorsky Aircraft Corporation all such inventions, discoveries, improvements, original works of authorship, and/or technical/financial/business data and/or information conceived, created, developed, made, and/or perfected by me, solely or jointly, in the performance of or arising out of the services that I furnish to Sikorsky Aircraft Corporation. C. I hereby agree to execute, or have executed, all documents and/or instruments, including, but not limited to assignments, patent applications, copyright registration applications, that Sikorsky Aircraft Corporation deems necessary to perfect its intellectual property rights in such inventions, discoveries, improvements, original works of authorship, and/or technical/financial/business data and/or information, or as otherwise required for compliance with the terms and conditions of this Certificate. D. To the extent that I involve any third party in the services that I furnish to Sikorsky Aircraft Corporation, I acknowledge that is my obligation to ensure that any such third party is legally obligated to Sikorsky Aircraft Corporation to the extent recited in Article I, Clauses A-C, of this Certificate. ARTICLE II DISCLOSURE AND/OR USE OF PROPRIETARY INFORMATION As used herein, Proprietary Information is data and/or information that: (1) is the property of a party; (2) is not generally known by others; (3) provides the owning party with a competitive advantage; and (4) is subject to restrictions regarding disclosure and/or use. Page 6 of 8
A. I warrant and represent that no third party Proprietary Information will be wrongfully used on behalf of or disclosed to Sikorsky Aircraft Corporation by me in the performance of or arising out of the services I furnish to Sikorsky Aircraft Corporation, and I further warrant and represent that any data and/or information created, developed, and/or disclosed by me in the performance of or arising out of the services I furnish to Sikorsky Aircraft Corporation may be disclosed and/or used by Sikorsky Aircraft Corporation without restriction. B. I shall not disclose to any third party or use for my own benefit or the benefit of any third party any Proprietary Information of Sikorsky Aircraft Corporation, its parent corporation, any subsidiary or affiliate of Sikorsky Aircraft Corporation, and or any third party in privity with Sikorsky Aircraft Corporation that is conceived, created, developed, made, and/or disclosed to or acquired by me in the performance of or arising out of the services I furnish to Sikorsky Aircraft Corporation or any information relating to the services I furnish to Sikorsky Aircraft Corporation without a prior written release from Sikorsky Aircraft Corporation. C. I hereby agree that I shall not remove from any Sikorsky Aircraft Corporation facility any Proprietary Information of Sikorsky Aircraft Corporation, its parent corporation, or any subsidiary or affiliate thereof that is conceived, created, developed, made, and/or perfected by me and/or disclosed to or acquired by me in the performance of or arising out of the services I furnish to Sikorsky Aircraft Corporation without a prior written release from Sikorsky Aircraft Corporation. ARTICLE III CONFLICT OF INTEREST A. I hereby warrant and represent that none of the obligations set forth in this Certificate, nor of the services that I furnish to Sikorsky Aircraft Corporation, contravenes or conflicts with any pre-existing agreement or obligation that I have with any person or entity, including but not limited to employment agreements, consulting agreements, non-disclosure agreements or agreements to assign intellectual property rights. B. I herby acknowledge that Sikorsky Aircraft Corporation conducts business with the U.S. Government and that I am obligated to refrain from any activities on behalf of Sikorsky Aircraft Corporation and/or the U.S. Government that could be interpreted as creating conflict of interest. I shall promptly notify Sikorsky Aircraft Corporation if I believe that the services being furnished to Sikorsky Aircraft Corporation would be or are contrary to the responsibilities and standards of conduct set forth in the regulations of the Civil Service Commission, 5 CFR, Part 735, Subpart C, or as applicable Subpart B, or would create a conflict of interest as such conflict is described in 18 USC 201-218. In consideration of the opportunity to furnish services to Sikorsky Corporation on behalf of myself or the Contractor and of Sikorsky Aircraft Corporation s granting me access to its facility to realize this opportunity, I hereby certify that I agree for myself, my heirs and assigns, to all of the obligations as set forth hereinabove. Page 7 of 8
ARTICLE IV LIMITATION OF LIABILITY I, as, and when I am, a visitor to Your premises, for Myself and My personal representatives, assigns, heirs and next of kin or any of them (collectively I, Me, and My ) hereby Covenant Not to Sue Sikorsky Aircraft Corporation and its parent United Technology Corporation and each of its officers, employees and agents (collectively You(r) ) and Release and Discharge You from, and Waive claims against You for, all existing and future liability for death, injury to Me or damage to My property (collectively My Damage ), and any cause of action I may have for My Damage, which results from My visit to Your premises however My Damage is caused. Further, I shall Indemnify and Defend You, and Save and Hold You Harmless from any liability, damage or cost You may incur ( Your Damage ): (1) due to My presence, or any of My actions, on Your premises and/or (2) due to My performance of services on Your premises, whether for You or others, however Your Damage is caused. I acknowledge that the foregoing Covenant, Discharge, Release, Waiver, Hold Harmless and Indemnity are intended to be as broad as permitted by Connecticut law. I acknowledge that manufacturing, and many activities associated with it, presents inherent risks on Your premises (including serious injury and death) that no amount of care can completely eliminate and that those risks may increase during any visit of mine. I assume those risks and enter Your premises voluntarily. I consent to whatever medical care might be provided on the premises and shall comply with all of Your rules and regulations which are posted on http://www.sikorsky.com/details/0,3036,cli1_div69_eti2010,00.html, Sikorsky Aircraft Supplier Resource Suppliers/Visitors website. Signature-Independent Contractor Witness -End of Certificate- Date Page 8 of 8