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Pe Cash Reque <br /> Person requesting cash (Print) ` <br /> <br /> 5upervisvr's approval KEY AGREEMENT <br /> Request for Reimbursement ~tWeell <br /> (To request advance, use ne~~t box.) UGENE ~"City"} <br /> ~j~ , And <br /> pie ~ Custodian s mtials <br /> Ex enditures ~ ~ Employee' sig ure GIB ~"Individual"} <br /> p <br /> ~eement is to provide Eugene citizens with the <br /> Request far Advance of Funds <br /> {To requesf reimbursement, use previous box) ~1Cycle accessories ~n and have access to a <br /> :e following criteria are met: <br /> Date Custodian's intials <br /> Amount Employee's initials <br /> '.ds the City, its officers, agents and employees <br /> Expenditures Custodian s initials <br /> coons liabilities costs including attorney fees <br /> Money returned Employee's signature ' ' ' <br /> Amount due g out of or related to the individual's use of the <br /> to employee <br /> . I <br /> Vendor and item Purchased th and abide by all laws and regulation relating <br /> . <br /> ',11 times;. <br /> i} years of age; <br /> w ~ ~ ~ for storage of bicycle and bicycle accessories <br /> ker will result in immediate.termination of this <br /> Acc c ~ ution to the full extent of the law; <br /> - ~ - ~ - ~ ~ ~ ~ ^ _ - ~ - ~ - ~ ^ ~ ~ - otherwise canceled the bike locker a Bement <br /> . ~ . <br /> - ~ ~ ~ ~ - ~ ~ ~ - ~ ~ ~ ~ - ~ ~ ~ ~ ~ ~ - the date of si in and must be renewed ezther <br /> ~ g <br /> _ , _ _ _ _ _ _ _ _ _ _ _ _ ~ - iths thereafter; <br /> ~e,~~~s, ~ TC1TAl~: ~ - fy deposit of $10.00 at the time the agreement <br /> _ . _ r ~ a _fundable fee of $10.00 to replace any lost key. <br /> Agreed to: <br /> . i <br /> ~s <br /> I 1 ; <br /> Individ Si ature Date -~ind ~Clar Date <br /> ~ ~ <br /> - ~ Trans o~a~~ n tions Coordinator <br /> ~ ~ p op <br /> H ~ e Ad ess City of Eugene, Public works Engineering <br /> U~ ~ ~ ~ ~ ~ 85 S Pearl Street <br /> City Zip Eugene aR 97401 <br /> ~ } <br /> . J' ~ 541 682-5285 <br /> Phone anon-work} <br /> Lockl Key #_[____108 Location: Pearl Street across from 858 <br /> $10.00 De r Check ~ Cash <br /> P <br /> Date ~ Received by: <br /> i <br /> T:IALT M4DES1 BIKEIBike LockerslBIKE LOCKER KEY AGREEMENT.dac 616/2005 I'~ <br /> <br />