Yolo Transportation Management Association

Carpool Coordinator Name:
 

Email:

Residential Address:  

Employer:
 

Phone:

Additional Carpoolers:

Name

Employer:
 

Name

Employer:

Name

Employer:

Carpool one way commute miles (total):


Approximate number of single occupant vehicle trips reduced per week?


Briefly explain why you are interested in carpooling:

Please check each box

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:

Name of Transportation Coordinator:


Date of application:
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