2010-2011 Bicycle Enclosure Locker Rental Agreement

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2010-2011 Bicycle Enclosure Locker Rental Agreement Powered By Docstoc
					The University of Arizona Parking and Transportation Services PO Box 41750 Tucson AZ 85717-1750 (520) 626-PARK(7275) (520) 621-7055FAX

                                         2010-2011 Bicycle Enclosure & Locker Rental Agreement
            ACCOUNT NUMBER
                                                                        FACULTY         STAFF       STUDENT        OTHER:
 SID/EID                                                                                                                        (COMPANY/DEPARTMENT)

 LAST NAME                                                FIRST NAME                                               MIDDLE INITIAL


 CITY                                                                        STATE                                 ZIP CODE

 E-MAIL ADDRESS:                                                       LOCAL    OR   CELL PHONE #:____________________________

        The individual named above is authorized to use the bicycle locker or garage enclosure specified and agrees to:

   1.   Release Parking and Transportation Services (PTS), any officers thereof, The University of Arizona and the State of Arizona, of any
        liability related to the use of locker or enclosure. This includes, but is not limited to, any injury, loss, theft or damage to parts of or the
        entire authorized bicycle accessories or other personal property occupying a locker or enclosure.
   1.   Pay a $80.00 refundable key deposit for locker (conditions apply see below).
   2.   Locker rented at current rate of $90 for the period of May 17, 2010 to May 13, 2011
        Base Rental Fee prorates daily. Refunds are not given after April 1, 2011
   3.   Enclosure rented at current rate of $35 for the period of May 17, 2010 to May 13, 2011
        Base Rental Fee prorates daily. Refunds are not given after April 1, 2011.
   4.   Register the bicycle(s) and keep PTS advised of any changes in name, address, phone number, or ownership of authorized bicycle(s). The
        permit issued shall be prominently displayed on the bicycle and may be used in enforcement activities pertaining to the bicycle locker or
        and abide by these rules for operating and parking at the University.
   5.   Assigned locker/enclosure shall only be used for the purpose of storing a bicycle and/or bicycle related commuter accessories. Locker/
        enclosure shall not be used in, or in connection with, any activity prohibited by law.
   6.   Sharing the locker key or enclosure code otherwise allowing unauthorized bicycles entry shall be grounds for voiding locker/enclosure
        agreement and forfeit of key deposit or enclosure space.
   7.   PTS is to be advised when locker/enclosure is vacated; upon which locker key must be returned to PTS and all contents are to be removed
        at termination of rental agreement.
           •   Any articles left in vacated locker will be considered abandoned and discarded.
           •   Key deposit will be forfeited if key is not returned to PTS within 5 working days after contract is terminated.
           •   Refundable key deposit will be mailed in approximately 10 working days provided there are no damages to the locker and key has
               been returned to PTS.
   Failure to comply with any provisions of the Bicycle Locker Rental/Enclosure Agreement is cause for termination, retention of key deposit, and the
   disposal of property remaining in the locker in accordance with the law.
   Renter will assume responsibility to ensure locker/enclosure is kept clean, locked, and to report any damages, or problems promptly to

   The undersigned waives any claim to the right to privacy and expressly consents to allow PTS or the University to open and inspect the
   locker, and contents thereof at any time without prior notice: in an emergency; to determine whether a health or safety hazard exists; to
   maintain locker or locking mechanism; to determine if any term of this agreement is being violated or for any other administrative

   PTS reserves the right to terminate this Agreement for its convenience at any time and/or to modify this Agreement as necessary for the
   safety or administrative purposes.

   I have read and fully understand the stated provisions, and do hereby agree to the conditions set forth in this agreement.

    Signature                                                                           Date
             Bicycle Enclosure & Locker Rental Agreement

Payroll deduction is available to benefits eligible Faculty and Staff of The University of Arizona.
    Payroll deductions begin with the first paycheck in September for academic employees.
    Deductions begin with the second paycheck in August for annual employees

                                                                                                                                 LOCKER/ENCLOSURE PERMIT NUMBER
    Payroll deduction periods may decrease depending on the purchase date of the locker or enclosure.
    1. The employee must regularly use the bicycle for a substantial portion of the travel between the employee's
      residence and the place of employment.

                                                                                                                                                                  FOR OFFICE USE ONLY
    2. The employee does not receive other qualified transportation benefit. (Parking permit, shuttle pass, bus pass,
    3. PTS may deduct bicycle enclosure/locker fees and any outstanding citations from my paycheck. (Notification of
       outstanding citations will be sent quarterly)
   4. Bicycle Enclosure Rental fee will be taken in one deduction. Bicycle Locker Rental fee will be taken in 4 pay
      periods. Payroll deduction will not cover locker key deposit.
   5. Signing this form attests to the fact I have read and understand the conditions of payroll deduction, and will
      abide by all stipulations.

Method of Payment (Cash not Accepted)
  Check or money order (payable to The University of Arizona) Check #:_________
  Credit Card (Visa, MC, AmX) Card Number ___________________________________ Exp Date ___________
Print name as it appears on card:_____________________________________                                 Security Code ________
Required for credit card payment:             Signature:__________________________________________

                                                                                                                                LOCKER KEY NUMBER

                                                                                                                                                                         FOR OFFICE USE ONLY