Application For Non-School Bus Vehicles
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1APPLICATION FOR NON-SCHOOL BUS VEHICLES
INTENDED USE
Before an inspection can take place a “Field Trip Application” must be signed by the Superintendent or designer indicating a
Personal Vehicle if authorized in the TRANSPORTATION INFORMATION block. The vehicle operator meet display a sign in
clear view in the rear of the vehicle stating: “THIS VHICLE IS BEING USED TO TRANSPORT SCHOOL CHILDREN.”
This vehicle is to be used: ______ DAILY FOR ROUTES REMOTE TO SCHOOL BUSES (Contract); _____ APPROVED SCHOOL ACTIVITY;
_____ SPARE-OCCASIONAL USE (Field trip app. Not required)
I have reviewed the FIELD TRIP APPLICATION and determined this trip can be made in the below listed Privately Owned Vehicle.
__________________________________________________ Principal
________________________________ Date
DESCRIPTION
Type of Vehicle __________________
License # __________________________
State _________________
Make __________________________
Model: ____________________________
Model Year: ______________
Passenger Capacity: _______________
Number of occupant restraints (seatbelts) ______________________
OWNERSHIP
Owner Printed Name: _________________________________
Address: _____________________________
INSURANCE
The vehicle owner must have insurance coverage. Vehicle owner must write in the coverage amounts on the above mentioned
vehicle in the space below.
Property damage per accident
$________________
Bodily Injury Liability per Person
$________________
Bodily Injury Liability per Accident
$________________
Underinsured and Uninsured Motorist Coverage
$________________
“No Fault” Coverage per Person
$________________
I am the registered owner of the above mentioned vehicle and understand that my insurance is primary and the Board of
Education insurance is secondary. I further certify to the best of my knowledge the above information is accurate.
Owner’s Signed Name
Date
CONDITION OF VEHICLE
(Per Inspector)
GERNEAL CONDITION: __________ GOOD
________ FAIR
________POOR
Inspector’s Signed Name
Date
Approved for transportation of Madison County students for the purposes listed on the attached Field Trip Application or
previously submitted Contract.
___________________________________________ Superintendent
____________________ Date
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Parent category: Business