(this document is a sample only - PSAPs should feel free to develop reasonable substitutes)

_{Print Full Name}

enhanced 911 center in Kentucky that I may have access to information considered to be confidential and proprietary that is provided by wireless and/or wireline telephone companies (carriers). Such data, information, and/or documents includes but is not limited to customer data (i.e. names, phone numbers, addresses, etc.), descriptions of carrier networks and equipment, and counts of customers for a specific carrier, etc. In accordance with 202 KAR 6:030E, such information, where possible, will be marked as confidential.

I agree that my access to data, information, and/or documents considered confidential and proprietary by carriers will be subject to the following terms and conditions.

1. I agree (in accordance with KRS 65.7639), regardless of its source, to protect such information from distribution, disclosure or dissemination to anyone except as authorized in this agreement or as authorized in writing by the carrier owning the information.
2. I shall use all such information only for the purpose of providing emergency responses to E911 calls or for development, implementation, and/or maintenance of my E911 system.
3. I shall make no copies of information provided to me except as authorized in this agreement.
4. I understand that (in accordance with KRS 65.7639) the information provided to me is not subject to subpoena nor is it to be otherwise released to any person other than those authorized in the statute or those necessary to provide an effective emergency response to a 911 call.
5. I understand (in accordance with KRS 65.7637) that, except for willful or wanton misconduct, carriers, their employees, directors, officers, or agents are not liable for any omissions or errors in the information provided to me, or for any damages in a civil action for injuries, death or loss to person or property incurred by any person as a result of any act or omission in connection with developing, adopting, implementing, maintaining or operating a 911 system.
6. I understand that no license to me under any trademark, patent or copyright is either granted or implied by the carrier’s disclosure of such information to me.
7. This Agreement shall remain in effect throughout my employment in the 911 center unless nullified in writing.

Supervisor: Employee:

By:_______________________________ By:_________________________________

(Signature) (Signature)

By:_______________________________ By:_________________________________

(Printed Name) (Printed Name)

Title:______________________________ Title:________________________________

Date:______________________________ Date:________________________________