Transportation Justification Form

TRANSPORTATION JUSTIFICATION FORM

Parties and Administrative Data

Effective Date:    Project / Program:

WHEREAS (RECITALS)

WHEREAS, Requesting Party requires transportation services, including but not limited to employee travel, freight movement, or specialized conveyance, in furtherance of official business and the objectives of the Project / Program identified above; and

WHEREAS, the transportation proposed herein is submitted to document necessity, evaluate alternatives, assess costs and compliance with applicable internal policies, and to secure written authorization from an Approving Authority prior to expenditure; and

WHEREAS, the parties intend that approval of the transportation described constitutes limited authorization subject to the terms and conditions set forth in this form and any governing internal procurement, travel or safety policies.

Scope of Transportation / Work

Transportation Details

Departure Date:    Return Date:    Departure Time:

Mode of Transport (check all that apply):

Personal vehicle   Rental vehicle   Company vehicle   Public transit   Taxi / Ride-share   Freight / Cargo   Other    If Other, describe:

Estimated Round-Trip Miles:    Number of Passengers:    Freight Weight (if applicable):

Cost Estimate and Payment Terms

Fare / Ticket(s):    Estimated Fuel / Mileage Reimbursement:    Tolls / Parking:

Lodging (if applicable):    Per Diem / Meals:

Total Estimated Cost:

Late Payment Penalty (if applicable):

Payment Terms Clause: The payer shall remit approved funds in accordance with the funding source and invoice procedures. Any late payments shall be subject to the stated late fee and interest to the maximum extent permitted by applicable law. All expenses are subject to audit and must be supported by original receipts and mileage logs where required.

Term and Termination

Anticipated Start Date:    Anticipated End Date:

Notice Period for Termination: days prior written notice required for termination by either party, except in cases of safety violations or material breach where immediate suspension may be authorized.

Confidentiality

Confidential Information: All non-public information exchanged in connection with approved transportation services, including passenger manifests where privacy is required, pricing proposals, and internal routing security measures, shall be treated as confidential. Neither party shall disclose confidential information except to the extent required by law, court order, or for performance of the authorized services. Reasonable measures shall be taken to protect such information.

Governing Law and Entire Agreement

Governing Law: This form and any authorization arising from it shall be governed by and construed in accordance with the laws of the state of , without regard to conflict-of-law principles.

Entire Agreement: This document constitutes the entire written authorization and agreement between the parties for the transportation described herein and supersedes all prior verbal or written communications relevant to this request. Any amendments must be in writing and signed by both parties.

Compliance and Certification

Policy Compliance: By signing below, the Requesting Party certifies that the proposed transportation complies with all applicable organizational travel, procurement, safety and environmental policies, that costs are reasonable and allocable to the stated funding source, and that the Requesting Party has considered less costly or lower environmental impact alternatives.

Safety Acknowledgment: The Requesting Party further affirms that appropriate safety measures have been considered for the mode of transportation selected, and that any drivers or operators required to perform services are properly licensed and insured.

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