Commonwealth of Virginia s3

APPENDIX C COVA ENTITY eVA DESIGNATION

COVA Entity eVA

Designation Form

COVA ENTITY NAME: ______Agency Code:______

Date:______

·  As the Entity Administrative Head for the COVA Entity listed above, I am designating the individual listed below-as the:

q  Primary Entity eVA Security Officer

q  Backup Entity eVA Security Officer

·  As the Entity Procurement Director for the COVA Entity listed above, I am designating the individual listed below-as the:

q  Primary Entity eVA Lead

q  Backup Entity eVA Lead

·  The individual designated is: with no known disciplinary actions for security issues.

q  An employee of my Entity

q  Is not an employee of my Entity but is authorized to serve as the Entity eVA Security Officer for my Entity.

·  I understand that it is recommended that the designated individual have passed a criminal background check.

Signature Date

Printed Name & Title

As the Entity eVA Security Officer/ Entity eVA Lead, I acknowledge that it is my responsibility to comply with the eVA Electronic Procurement System Security Policies and Standards.

Signature Date

Printed Name & Title

______(_____)______

eMail Phone Number eVA User ID

eVA Security designation submit electronically or by mail or fax: / Department of General Services, ATTN: eVA Global Security Officer, 1111 E. Broad St, 6th floor Richmond, VA 23219/ Fax: (804) 786-5712

Page 1