Form 5900-307 Test Agreement

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 (09/30/2014)

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.