Document ID: EPA-HQ-OAR-2010-0690-0010
Agency: epa
Document Type: Supporting & Related Material
Title: 
Posted Date: 2015-03-26T04:00Z

Control No. ______________		

TEST AGREEMENT

	Your vehicle is being loaned to Jacobs, a contractor for the U.S.
Environmental Protection Agency, for use in a government-sponsored
program for cleaner air.  This executed Agreement is your assurance of
full protection against any loss sustained by accident or damage to the
vehicle while in the possession of Jacobs, a contractor to the U. S.
Environmental Protection Agency, or its designated representatives.

	Jacobs agrees to be fully responsible for any and all damage to the
vehicle occurring while the vehicle is in its possession.  Possession is
hereby defined as care, control, custody, operation, inspection, or
storage between the time the vehicle is received from the owner by
Jacobs, and the time the vehicle is returned to the owner.

	Jacobs agrees to exercise extreme care in the use of the vehicle and
agrees to return the vehicle to the owner in as good exterior, interior,
and operating condition, except for normal wear and tear, as when the
vehicle was received by Jacobs.

	Jacobs agrees to indemnify and hold harmless the vehicle owner of any
repairs, damage, loss, or liability sustained by the vehicle owner by
reason of accident or damage to the vehicle while in the possession of
Jacobs, or its representatives.

	Jacobs agrees to provide primary automobile insurance on the vehicle
while in its possession.

	Jacobs reserves the right to perform any repairs and maintenance upon
the vehicle, at its sole discretion, provided all such repairs and
maintenance are performed according to the manufacturer's
specifications.

	I, ______________________________________________________, agree to
loan my vehicle 

described as a  _________ (Year)  _____________________________ (Model),
 

VIN______________________________________________ to Jacobs, for a
period of 

approximately                   weeks for a series of tests.  I
understand that I may refuse to loan my 

vehicle to Jacobs at any time and that I am under no obligation
whatsoever.

Agreed to this ______________ day of ____________________, 20____.

PARTICIPANT:

____________________________________					_______________

		Signature								Date

JACOBS REPRESENTATIVE:

_____________________________________					________________

		Signature								Date

EPA Form #5900-307                                                      
                                  OMB No. 2060-0086 Expires (###)

Privacy Act Statement

Title 42, United States Code, Section 7451, Compliance by vehicles and
engines in actual use, authorizes the collection of this information. 
The primary use is to provide an instrument by which individuals may
indicate interest in and eligibility for participating in EPA’s
Light-Duty In-Use Testing Program.  Additional disclosures of this
information may be made pursuant to published routine uses, including to
appropriate agencies for law enforcement purposes and to contractors
working for EPA who have a need to know in the course of that work.

Providing the requested information is voluntary, but failing to do so
will result in EPA’s inability to approve your participation in the
Light-Duty In-Use Testing Program.

Public reporting burden for this collection of information is estimated
to vary from 1 to 60 minutes per response, with an average of 30 minutes
per response, including time for reviewing instructions, searching
existing data sources, gathering and maintaining the data needed, and
completing and reviewing the collection of information.  Send comments
regarding the burden estimate or any other aspect of this collection of
information, including suggestions for reducing this burden, to Chief,
Information Policy Branch, PM-223, U.S. Environmental Protection
Agency,40l M St., S.W.  Washington, DC.  20460; and to the Office of
Information and Regulatory Affairs, Office of Management and Budget,
Washington, DC. 20503.