AFTER HOURS USE OF DMS-MANAGED FACILITIES

1. / The requester shall use this form to providehis/her request via e-mail () to the Tallahassee office. The requester shall also send a copy of the completed form to his/her Department of Management Services (DMS) Facilities Building Manager.
Shall include:
a.)written statement for usage and total number person(s) that will be working
b.)name of the requester
c.)requester’s agency name and specific division/office, if applicable
d.)requesting agency’s mailing address for billing
e.)requester’s phone and fax number
All requests shall be received in our Tallahassee office 48 hours prior to the actual usage date and by 4:30p.m. on the last normal working day of the week. If the air conditioning or heat is not on as requested or there is an emergency, please contact our main controls building at 850-487-3651. Additionally, if the air conditioning or heat can be turned off early, contact the main controls line to do so.
2. / The written request shall include the DMS facility name, the floor(s), suite or room number(s) and date(s) for this additional run with the daily start (on) and stop (off) times requested.
3. / Use of facilities after hours could increase utility consumption/costs. Any additional costs to DMS due to afterhours usecould result in an hourly charge to the requesting agency. Via this request, the agency is authorizing the DMS Division of Real Estate Development and Management to invoice for these additional costs, if needed. DMS will notify the requester upon approval of this form if an additional cost for utilities is required.
4. / If there is no ’Security Personnel’ at the facility, the requesting agency shall provide a staff member to cover the front desk or main entrances, to escort people to the meeting area or office, and to ensure that all persons that are either working or attending a meeting stay within designated areas. Should the agency permit children in, there shall be no running of children around the public areas, main corridors, restrooms, etc., and if there are children in the facility they must be under the direct supervision of a responsible adult or parent at all times.
5. / After each additional run time, DMS will inspect for clean up and vandalism. The agency will be charged extra if it becomes necessary for DMS to perform additional cleaning and repairs.
6. / Should the agency cause any false fire alarms, elevator calls, etc. that requires dispatching of personnel, all charges shall be the sole responsibility of the requesting agency utilizing the facility beyond DMS’ standard or building operating hours.
7. / The requesting agency shall provide a contact name and after hours phone number of the individual(if not requester) that will be on-site at the facility and responsible for any emergency.
DMS FACILITY NAME:SUITE OR ROOM #(s):
REQUEST REASON:
NUMBER OF PERSON(S):
REQUESTER: AGENCY:
AGENCY ADDRESS FOR BILLING:
PHONE:FAX: E-MAIL:
RUN DATE(S) M/D/Y / START TIME / STOP TIME
(A.M.) P.M. (circle one) / A.M. (P.M.) (circle one)
(A.M.) P.M. (circle one) / A.M. (P.M.) (circle one)
(A.M.) P.M. (circle one) / A.M. (P.M.) (circle one)
(A.M.) P.M. (circle one) / A.M. (P.M.) (circle one)
ON-SITEAGENCY CONTACT (see #7):PHONE #:
Requester’s Signature: DATE:

REVISED 07/26/10