 CARPOOL INCENTIVE PROGRAM Application and Usage Agreement Submit this request for incentive to: Yolo TMA, P.O. Box 969, Woodland, CA 95776 The undersigned commuter(s), qualified applicants, apply for the carpool incentive program administered by the Yolo TMA. Maximum reimbursement per person is $50, maximum per carpool is $200. The Rideshare Incentive Program (TRIP) will provide a financial incentive of $25.00 per month for two months toward carpools formed by the first fifty (50) commuters changing their commute mode from a single occupant vehicle. Payment is per rider/driver, up to a maximum of four (4) per qualifying carpool group. The rotation of personnel in an established carpool vehicle will not be allowed, participation is on a first-come, first-served basis. Participants must be registered with SACOG’s 1-800-commute program through the Yolo TMA. TRIP participants who stay with their carpool for a period of one year and use their rideshare alternative at least ten (10) days per month, will receive a bonus incentive of $25 and a certificate for a car wash and detailing from a firm selected by the Yolo TMA Submitting an application does not guarantee selection to receive incentive. Funding will be allocated to awardees based on available funds. The incentive will be awarded when the appropriate carpool has been verified by your Employee Transportation Coordinator and application is received by the TMA. Documentation of carpool must be received within one month of qualification to guarantee awarding of the incentive. To be completed by the carpool coordinator: Name: ________________________________________________________________________ Name: ________________________________________________________________________ Name: ________________________________________________________________________ Name: ________________________________________________________________________ Name: ________________________________________________________________________ Employer Name: _______________________________________________________________ Carpool Coordinator's residential address: _____________________________________________________ Work phone number: ______________ Email address: _____________________________________ Carpool one-way commute miles (total): _____________ Briefly explain why commuters are interested in carpooling:
I understand that the Carpool 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 carpool coordinator agrees to complete a Usage Survey at the end of each month for the first two months and an annual survey 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. Carpool coordinator agrees to notify the TMA if the residential or worksite address changes. All members of above carpool agree to defend, indemnify and hold harmless the Yolo TMA and the 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 carpool incentive program or other incentives received. Commuter signature below verifies that they have read and understand, as well as agree to, comply with program policy, procedures and guidelines. Name of Carpool Coordinator (print):_____________________________________________ Signature of Coordinator: _______________________________ Date: __________ Signature of Employee Transportation Coordinator: _____________________________________________ Date: _________________ |