<p> ACKNOWLEDGMENT OF EQUIPMENT ISSUE</p><p>I, ______, acknowledge that on this date I have been issued the following item(s) for my use while in the employ of Horizon Goodwill Industries., namely:</p><p>ITEM DESCRIPTION COST + 10%</p><p>______</p><p>______</p><p>______</p><p>I understand that it is my responsibility to maintain this item(s) in a condition of good cleanliness and repair and to return the item(s) to my employer upon request or at termination of my employment. I further understand and acknowledge that, should the item(s) placed in my care be lost, stolen, or damaged through my negligence, I will reimburse my employer for the cost of the item(s) plus a 10% handling charge, as stated above.</p><p>______Employee Name (Please Print) Date</p><p>______Employee Name (Please Sign)</p><p>______Manager Signature Date</p><p>D:\Docs\2018-01-08\02238117b94b253a1b6ef1926ba8ed69.doc Updated 1/07</p>