This application and usage agreement is to be completed and signed by the carpool coordinator.
Vanpool Coordinator Name:
Please indicate your commute mode prior to applying for a vanpool incentive (select one):
One way vanpool commute miles (total):
Approximate number of vanpool trips taken per week:
Briefly explain why the group is interested in utilizing a vanpool:
Please check each box
I understand that the Vanpool Incentive Program shall terminate upon depletion of program funding or by a decision of the Yolo TMA Board of Directors. The Yolo TMA shall be under no obligation to honor requests received following the depletion of program funding or termination of the program.
The purchaser agrees to complete a Usage Survey at the end of each month for the first two months, as well as an annual report if applying for the one-year bonus. In the event any of these terms are not met, the incentive shall be returned to the Yolo TMA.
Vanpool Coordinator agrees to notify the TMA if the vanpool coordinator's residential address or worksite changes.
Vanpool members agree to defend, indemnify and hold harmless the Yolo TMA and Yolo-Solano AQMD, their officers, agents, employees and volunteers from any and all losses, costs, damages, fines or expenses (including attorney fees, court costs and expert fees) or liability of any kind or character to any person or property arising from, or alleged to arise from, any breach of the responsibilities required of the participant by this Agreement or which are related in any way to the vanpool incentive program or other incentives received.
Name of Vanpool Coordinator:
Name of Transportation Coordinator:
Date of application: