Cellular Service Agreement Example

Name (Last, First, MI):
Doe, Jane, A.
Employee W#:
W123456789
Department: Telecommunications
Office Phone: 626-1234
Work Address: 000 University Circle, Ogden, UT 84408
eMail Address: JaneDoe@weber.edu


The following one-time compensation for purchase of a communication device is approved:

Dept. Mgr. Initials
Approved One-time $
MOBILE COMMUNICATION DEVICE DESCRIPTION: (Make & model of cellular phone, BlackBerry, SIM, etc.)
j.s.
$349.00
Android, Nexus 6
j.s.
$35.00
SERVICE ACTIVATION FEES (if applicable)
j.s.
$384.00
TOTAL APPROVED ONE-TIME AMOUNT


The following compensation for ongoing cost of a mobile communication plan is approved not to exceed one year, beginning 05/01/2006 and ending 04/30/2007:

Mobile Device (Cell) Number: (801) 000 - 0000
Dept. Mgr. Initials
Approved Monthly $
MOBILE COMMUNICATION SERVICE PLAN: (Vendor name, base minutes, data plan, special features, etc.)
j.s.
$39.99 + $20.00 tax = $60.00*
Cingular plan with 450 anytime minutes, 5000 night and weekend minutes, free mobile-to-mobile.

*Total rounded up to nearest increment of 10 to cover regulatory fees, surcharges, cell phone tax, and and tax on stipend.


Business justification and/or comment and explanation:

I am on call 24 hours a day 7 days a week. I also attend conferences throughout the year and need to keep in contact with my office.

Employee Mobile Communication Services Agreement (Cont.)

I have read and understand the employee responsibilities detailed in the Employee Mobile Communication Procedures, PPM 3-65. I understand that university compensation for the purchase of a mobile communication device, mobile communication service activation fees (if applicable) and mobile communication service plan is taxable income and is NOT part of my base salary. I also understand that any device purchased is my personal responsibility. I certify that the mobile communication device will be used for the performance of my Weber State University job responsibilities as defined by my supervisor. I am responsible for the payment of any costs that exceed the university compensation approved on this form.

I understand that I am not authorized to use a mobile communication device to conduct Weber State University business while operating a motor vehicle.

This agreement supersedes previously executed agreements.

Jane Doe
04/18/2006
Employee Signature
Date


APPROVED:

John Smith
04/18/2006
Supervisor (required)
Date


Jenny Johnson


04/18/2006
Department Head Signature (required)
Date