By signing below, I authorize the aforementioned employee be assigned an electronic device as listed above, for one or all of the reasons listed below as per the Executive Order #2012-01 dated February 16, 2012:

• The need for the employee to conduct work away from the regular worksite;
• The need for the employee to conduct work-related research while away from the regular work site or outside of business hours;

City-provided laptops are intended to be for City business use, but will allow for only personal emergency usage.

By my signature below, I hereby certify that I have read the statement above, and by signing this form, I agree to abide by this policy. I understand that abuse of this policy will result in termination of my device.
I have read the Health Insurance Portability and Accountability Act (HIPAA) Policy and agree to adhere to the standards as described in the document.

Please enter your Grant Number OR General Fund DAX String below (Click here for the DAX Conversion Listing)

Order will not be processed without correct fiscal information.