Public Transit Incentive Program Signup

Application and Usage Agreement

Please complete and sign this Application and Usage Agreement after you have read and understood the Public Transit Incentive Program Guidelines.

Applicant’s Name:

 

Email:

Residential Address:

 

Employer:

 

Phone:

Applicant’s commute mode, prior to applying for the public transit incentive (select one):

Carpool

Vanpool

Transit

Walk

Bicycle

Telecommute

Drive Alone

Applicant’s one-way commute miles:

Approximate number of one-way public transit trips taken per week?

Briefly explain why you are interested in utilizing public transit:

Please check each box:

I understand that the Public Transit 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 applicant agrees to complete a Usage Survey at the end of each month for the initial two months, and submit an annual report, if qualified, for the one-year bonus. In the event any of these terms are not met, the incentive shall be returned to the Yolo TMA.

Applicant agrees to defend, indemnify and hold harmless the Yolo TMA, 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 public transit 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 Applicant:

Date of application: