Travel Road Authorization Form

TRAVEL ROAD AUTHORIZATION FORM

Company Name:    Company Address:

Authorized Party (Driver/Contractor) Name:    Contact Phone:

RECITALS

WHEREAS, Company Name: operates and coordinates vehicular transport and requires authorized personnel to undertake specified road travel; and

WHEREAS, Authorized Party Name: certifies possession of required licenses, insurance, and authorization to operate the described vehicle on behalf of the Company for the travel described herein; and

NOW, THEREFORE, the parties agree as follows:

SCOPE OF WORK

VEHICLE & OPERATOR DETAILS

AUTHORIZATION & CONDITIONS

The Company hereby authorizes the Authorized Party to operate the Vehicle described above and to undertake the Scope of Work identified herein subject to the terms below. Authorized Party shall at all times: (a) maintain valid licensure and insurance; (b) comply with all federal, state and local traffic, safety and transportation laws; (c) maintain required permits and endorsements for cargo or passenger carriage; and (d) follow Company travel safety protocols.

Authorized to operate company vehicle     Authorized to carry cargo     Authorized to cross state lines

PAYMENT TERMS

Compensation for authorized travel and services will be as set forth below. All payments are subject to the terms and schedules herein and any agreed expense documentation requirements.

TERM AND TERMINATION

This Authorization commences on Start Date: and terminates on End Date: unless earlier terminated as provided below.

Either party may terminate this Authorization for convenience upon written notice delivered at least Notice Period: days prior to termination. Company may immediately suspend or revoke authorization for cause including but not limited to material breach, loss of required licensure or insurance, or safety violations.

CONFIDENTIALITY & DATA

Authorized Party shall keep confidential all non-public information acquired in the course of performing travel under this Authorization, including routing, customer information, pricing and cargo manifests, and shall not disclose such information except as required by law. This obligation survives termination of this Authorization for a period of two (2) years.

INDEMNITY & INSURANCE

Authorized Party shall indemnify, defend and hold harmless Company and its officers, agents and employees from and against all losses, liabilities, damages, costs and expenses (including reasonable attorneys' fees) arising out of or resulting from Authorized Party's acts or omissions in connection with the travel authorized hereunder, including any breach of this Authorization. Authorized Party shall maintain insurance coverage as required above and furnish proof of insurance upon request.

COMPLIANCE WITH LAW

Authorized Party warrants compliance with all applicable laws, ordinances and regulations, including hours-of-service rules, hazardous materials regulations if applicable, and applicable licensing and permitting requirements. Authorized Party shall promptly notify Company of any citation, accident, loss, or regulatory action related to authorized travel.

GOVERNING LAW

This Authorization 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 Authorization, together with any exhibits or documents incorporated by reference, constitutes the entire agreement between the parties with respect to the subject matter herein and supersedes all prior and contemporaneous agreements, representations and understandings. Any amendments or modifications must be in writing and signed by both parties.

EMERGENCY CONTACT & LOGGING

CERTIFICATIONS

By signing below, Authorized Party certifies under penalty of perjury that the information provided in this Authorization is true and complete, that Authorized Party possesses all required licenses and insurance, and that Authorized Party will comply with all terms, conditions and applicable laws while performing travel authorized herein.

Sign Now