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CITY OF PEQUOT LAKES <br /> CELL PHONE ENROLLMENT FORM <br /> PLAN A—CITY-OWNED CELL PHONE AND SERVICE PLAN <br /> I have been issued a City Cell Phone.l acknowledge that the Cell Phone is the property of the City. <br /> My Cell Phone Number is: <br /> Department Head Signature Date <br /> Employee Signature Date <br /> -OR- <br /> PLAN B—EMPLOYEE OWNED CELL PHONE/SERVICE PLAN <br /> I choose to have my own cell phone and service plan. I understand that this cell phone is my personal <br /> cell phone but will also be used for work-related duties.I understand that I will receive a stipend to help <br /> cover a portion of my cell phone expenses related to work related duties.The amount of the stipend is <br /> stated in the Cell Phone Policy and will be set annually by the City Council. I understand that my cell <br /> phone number will become public as long as I am an employee of the City.I also understand that in <br /> order to receive a stipend,I must complete this form and attach a copy of my current cell phone service <br /> plan. <br /> I own my cell phone and service plan <br /> My cell phone is a Smart Device <br /> My service plan consists of the following: <br /> Up to 500 minutes per month <br /> Over 500 minutes per month <br /> I attached a copy of my current cell phone service plan. <br /> My Cell Phone Number is: <br /> Department Head Signature Date <br /> Employee Signature Date <br /> 73 <br />