Keyholder Agreement

I, the undersigned, have read and understand the Key Policy attached hereto and agree to adhere to it.

______________          ______________
Signature                                                         Date

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Print Name

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For Office Use Only

Keyholder Level:      [   ] Exec. Board      [   ] Reg. Board      [   ] Staff

Authorized For:

• [   ] 30 Pearl Entry
• [   ] 30 Pearl 4th Fl. Reception
• [   ] 1841 Market Gate
• [   ] 1841 Market 1st Fl. Door
• [   ] 1841 Market 4th Fl. Door
• [   ] Board Filing Cabinet
• [   ] ED Room Personnel File
• [   ] ED Room
• [   ] Deputy ED Room
• [   ] Server Room
• [   ] Board Room
• [   ] Garage
• [   ] Other: ______________

Key(s) Checked Out: ______________

Key(s) Checked In:     ______________