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Vehicle Use Agreement

(To be completed by persons operating state vehicles, who are not employees of the State of Montana)

I,__________________________________________(driver's name), understand and agree that my use of the ______________________ (name of the entity's vehicle), vehicle license #______________________, shall be exclusively for the fulfillment of the MSU Great Falls College of Technology business for which I have been engaged.

I understand that I am not to use the vehicle for any other reason whatsoever (human life threatening medical emergency excepted). I agree to operate this vehicle in a safe, prudent, and lawful manner at all times and to comply with the state ' s motor vehicle laws and policies.

Seat belts will be worn at all times by all vehicle occupants when the vehicle is in motion. I will not permit any other person to operate the vehicle, unless such use is made part of this agreement. I will not carry or consume alcoholic beverages in a state vehicle or drive a state vehicle out of the State of Montana without prior approval of a state agency.

I truthfully state that I have a valid, non-conditional driver's license and that my license is not currently under suspension. I do truthfully state that I have been convicted in the past 36 months of the following motor vehicle violations (please list):

Type of Conviction________________________________________________ Date:__________________

Others: Please attach additional pages if necessary.

The agency shall review the convictions above in accordance with §61-11-203, MCA. It total conviction points received (after 10/12/01) within the past 36 months exceed 15 points the driver may not operate a state vehicle.

I understand that any material false statement or use of the vehicle not permitted by this agreement will require me to assume the full legal and financial consequences of my actions.

Important Notice to Driver: Do not sign below unless you have read and understood this document.

_____________________________________________________ ________________________________
Driver Signature Date

Office Use Only

By signing below, the agency head authorizes a non-state employee to drive a state vehicle. In the event of an crash, all physical damage to the vehicle is the responsibility of the agency unless the agency has required the independent contractor to carry coverage on the state vehicle through a non-owned endorsement or the state vehicle is covered for comprehensive/collision damage through prior agreement with the Risk Management & Tort Defense Division.

_____________________________________________________ _______________________________
(Signature of Agency Head or Authorized Designee) (Phone Number)

______________________________________________________ _______________________________
(Title) (Date)

Please bring this form with you to the Motor Pool or provide to the agency whose vehicle you are driving PRIOR to the use of the vehicle.

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VEHICLE USE AGREEMENT SAMPLE

We recommend that each agency assure that its employees read and understand the Vehicle Use Rule. One way to do this is to have each employee sign the attached vehicle use agreement. Copy to be kept in the employee's personnel file. Agencies may develop their own forms or processes.

This is intended to provide an example

I,_______________________________, understand and agree that my use of the _______________ (name of the entity ' s vehicle), vehicle license #_____________, shall be exclusively for the fulfillment of the _________________(name of entity) business for which I have been engaged.

I also understand that I am not to use the vehicle for any other reason whatsoever (human life threatening medical emergency excepted). I agree to operate this vehicle in a safe, prudent, and lawful manner at all times and to comply with the state ' s motor vehicle laws and policies.

I will wear seat belts at all times and assure that all vehicle occupants do the same when the vehicle is in motion. I will not permit any other person to operate the vehicle, unless such use is made part of this agreement. I will not carry or consume alcoholic beverages in a state vehicle or drive a state vehicle out of the State of Montana without prior approval of a state agency.

Type of Conviction________________________________________________ Date:__________________

Others: Please attach additional page and explain or provide a copy of your driver's record to your supervisor.

I understand that, in accordance with §61-11-203, MCA, if my total conviction points received (after 10/12/01) within the past 36 months exceed 12 points, or in excess of 5 points for a single infraction, I will the report the infraction to supervisor. If my conviction points exceed 15, I understand that I may not be allowed to operate a state vehicle.

I understand that any material false statement or use of the vehicle not permitted by this agreement will require me to assume the full legal and financial consequences of my actions.

Important Notice to Driver: Do not sign below unless you have read and understood this document.

____________________________________________________ ________________________________
Driver Signature Date

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