COMMERCIAL WORKSHEET FOR CITY OF PHOENIX DATA

COMMERCIAL WORKSHEET FOR CITY OF PHOENIX DATA

This document represents the Verified Statement of

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NAME OF REQUESTING PARTY

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NAME OF FIRM

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ADDRESS OF FIRM

submitted to the City of Phoenix, Information Technology Department, requesting a copy of certain Geographic Information System data files, and confirming that the information will be used for the purposes indicated below:

Commercial purposes
Non-commercial purposes

Commercial purposes include any question below answered "Yes."

Do you, or does anyone for whom you are acting as agent, directly or indirectly intend to:

Sell or resell the data?
Yes
No

Sell or resell any of the information contained in the data?
Yes
No

Use any of the information contained in the data to produce a document or application for sale?
Yes
No

Use any of the names or other information from the data for the purpose of solicitation?
Yes
No

Do you anticipate that you will receive monetary gain from either the direct or indirect use of the data?
Yes
No

The requestor, listed above, hereby declares that I have read the information and instructions herein, or Section 39-121.03, A.R.S., itself, and understand the contents therein. I further declare under penalty of perjury that the foregoing is correct and true.

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SIGNATURE OF REQUESTING PARTY DATE

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EMPLOYER'S NAME

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EMPLOYER'S ADDRESS