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Mobile Communication Device Program Entry Form I, the undersigned, understand that I am employed by the City of Laramie in a position that requires the use and possession of a mobile communication device. I will be required to possess an operable mobile communication device for as long as I am enrolled in the program. I understand that the restrictions of this program are as follows: 1. I will be entered into the Mobile Communication Device Program effective . 2. I will be required to possess a mobile communication device. A limited number of these devices are owned by the City and available for use by employees in mobile communication device required positions. If such a City-owned device is not available at this time then I will be required to purchase one of my own, at my own expense. 3. I will be required to acquire and maintain service so that I may send and receive calls on my mobile communication device. This service agreement, plan, or package will be sufficient for me to make and receive the calls that are necessary for my position. 4. I will submit my mobile communication device number to my supervisor, who will make that number available to all necessary City personnel. 5. I will be responsible for paying any fees and expenses related to this mobile phone service. The City of Laramie will add a allowance to my regular paycheck in order to cover the costs of purchasing the mobile phone and acquiring the requisite service for it. I understand that this allowance will be taxable it will be subject to federal income taxes). The amount of my allowance will be (CHECK ONE): $15 per month, for a basic calling plan $25 per month, for a high usage calling plan $50 per month, for a high usage calling and data plan* 6. When traveling on City business, I will be eligible for reimbursement for roaming charges on business related calls. “Roaming” is defined as an extra charge added to the bill on a per-minute basis for voice phone calls that are made or received while the device is outside of its home coverage area. In order to receive reimbursement, I must highlight the eligible phone charges on my bill and submit it to the Administrative Services Department using the normal travel reimbursement procedures. ---PAGE BREAK--- 7. Other than roaming associated with business travel, no other charges are eligible for reimbursement except under extraordinary circumstances. If extraordinary circumstances exist, my department head may make an exception to this clause and authorize other mobile communication device related reimbursements. Such exceptions will be granted on a case-by-case basis. 8. If asked, I will present my mobile phone to my supervisor to demonstrate that I am in compliance with the rules of this Program. If my phone ever ceases to function due to damage, expiration of service, or for any other reason, I will notify my supervisor as soon as reasonably possible, and I will endeavor to replace and re-establish phone service as quickly as reasonably possible. 9. In addition to these requirements, I have read and will abide by all the requirements detailed in the City of Laramie Mobile Communication Device Policy. Signed: Employee Signature Date Employee Name (Please Print) Program Entry Authorized by: