Submit this request for incentive and a copy of your executed vanpool agreement to:
 

The undersigned commuter, a qualified applicant, applies for the vanpool incentive program administered by the Yolo TMA and attaches a copy of the signed contract with a recognized vanpool provider or attached proof of meeting IRS Section 132 (f) policies for receipt of incentive. The Rideshare Incentive Program (TRIP) will provide a financial incentive of $100.00 per month for two months to commuters who form the first three (3) vanpools. Only one payment, each month, per qualifying vanpool is allowed.   

TRIP participants who stay with their vanpool for a period of one year and use their rideshare alternative at least ten (10) days per month, will receive a bonus incentive of $250 per vanpool and a certificate for a vehicle wash and detailing from a firm selected by the Yolo TMA

To be completed by the vanpool coordinator:

Name:
________________________________________________________________________

Employer Name:
_______________________________________________________________

Vanpool Coordinator's residential address:
_____________________________________________________

_____________________________________________________

Work phone number:  ______________Email address:_____________________________________

Vanpool Coordinator's usual commute mode prior to applying for vanpool incentive (select one):
 

Vanpool's total one-way commute miles:  _____________

Approximate number of vanpool trips taken per week: ________ 

Briefly explain why group is interested in utilizing a vanpool: 
 

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
 

(printed):_____________________________________________

Signature of Vanpool Coordinator

________________________________________________ Date: __________

Signature of Employee Transportation Coordinator:

_____________________________________________      Date: __________