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<br />Exhibit 4-1 <br />MU125\11\850810.v2 <br />EXHIBIT 4 <br /> <br />GOVERNMENT DATA ACCESS AND NONDISCLOSURE AGREEMENT <br /> <br />1. AUTHORIZATION. The City of Mounds View (the “City”) hereby authorizes <br />___________________________________, (the “Authorized Party”) access to the following <br />government data: _______________________________________________________________ <br />______________________________________________________________________________ <br /> <br /> 2. PURPOSE. Access to this government data is limited to the objective of creating <br />summary data for the following purpose: <br />______________________________________________________________________________ <br />______________________________________________________________________________ <br /> <br />3. COST. (Check all that apply): <br /> <br />______ The Authorized Party has been requested by the City to prepare summary data <br />and will be paid in accordance with City policy. The estimated total is: <br />$_____________. <br />______ __________________________________ is the person who requested the <br />summary data and agrees to bear the City’s costs associated with the preparation <br />of the data which has been estimated to be $____________. <br /> <br />________________________________________________________________________ <br />Signature of Requestor Date <br /> <br />4. SECURITY. The Authorized Party agrees that it and any employees or agents under its <br />control must protect the privacy interests of individual data subjects in accordance with the terms <br />of this Agreement. <br /> The Authorized Party agrees to remove all unique personal identifiers which could be <br />used to identify any individual from data classified by state or federal law as not public which is <br />obtained from City records and incorporated into reports, summaries, compilations, articles, or <br />any document or series of documents. <br /> Data contained in files, records, microfilm, or other storage media maintained by the City <br />are the City’s property and are not to leave the City’s custody. The Authorized Party agrees not <br />to make reproductions of any data or remove any data from the site where it is provided, if the <br />data can in any way identify an individual. <br /> No data which is not public and which is irrelevant to the purpose stated above shall ever <br />be disclosed or communicated to anyone by any means. <br /> <br />The Authorized Party warrants that the following named individual(s) will be the only <br />person(s) to participate in the collection of the data described above: <br /> <br />________________________________________________________________________ <br />Complete name (printed) Title (printed)