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