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| Date (mm/dd/yy) |
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| Day of the Week |
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| Time |
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Rideshare
Participant Information
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| First Name |
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| Last Name |
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| Employer |
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| Work Address |
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| City |
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| Zip |
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| Work Phone |
-
-
Ext.
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| Fax |
-
-
(optional) |
| E-mail Address |
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| Home Address |
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| Home City |
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| Home Zip |
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| Cell Phone |
-
-
(optional) |
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Commute
Information
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| Please check the rideshare mode you used today and provide the additional appropriate information. |
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Carpool |
Carpool Partner
Work Phone
-
-
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Vanpool |
Van
Driver
Work Phone
-
-
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Train |
Origin
Station
Pass Serial Number
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| Bus |
Route(s)
Pass Serial Number
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| Bicycle |
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| Walk |
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| Detailed description of emergency. |
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Eligibility
Guidelines
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- Qualified
Uses - If you commuted to work today using a rideshare mode,
you may use an Emergency Ride Home (ERH) if you or a family
member suffers an illness or severe crisis, if you are required
to work unplanned overtime or if your normal carpool or vanpool
driver has to leave due to the same above mentioned circumstances.
Unscheduled cancellation of public transit service qualifies
for an ERH if the transit provider does not offer alternative
service.
- Non-Qualified
Uses - An ERH may not be used if you did not rideshare today,
for personal errands, pre-planned appointments, business travel,
injury on the job covered by workers compensation or planned
overtime. The ERH Program is not intended to deliver commuters
to work.
- An individual
is eligible for up to four (4) Emergency Rides Home in a continuous
twelve month period. We will notify you how many uses you have
had in the previous twelve months.
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Rideshare
Participant Responsibilities
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| Please check the correct mode that your Spectrumotion representative indicated you would receive and read your responsibilities. |
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Rental Car (15+ commute miles) - You must be at least 21 with a valid CA driver's license. You will have the use of the car for 24 hours with unlimited mileage and damage waiver. The damage waiver waivers or reduces your responsibility for loss of, or damage to, the rental vehicle. You may wish to voluntarily purchase Personal Accident or Supplemental Liability insurance at your expense. The coverages provided are optional and not required to receive your Emergency Ride Home. These coverages may duplicate your existing coverages and you should review your personal insurance policies before you voluntarily decide to purchase these coverages. You are responsible to return the car to the same rental location within 24 hours with a full tank of gas (or to the nearest home-end rental car office if you won't be returning to work the following day). If a rental car is needed on Friday, the car must be returned to the nearest home-end rental car office before 12:00 p.m. (noon) on Saturday. Obtain a receipt from the rental car office at the time you return the car. This is your proof of when and where the car was returned. You will be responsible for any additional
charges if the car is not returned on time or has not been re-fueled.
CA Driver's License Number/ CA Identification Card
Taxi (Up to 15 commute miles) - It is not necessary to tip taxi drivers. Spectrumotion has a contract with the taxi company that covers driver gratuity. Spectrumotion will not reimburse
for additional gratuities. Please be ready for the taxicab
when it arrives.
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Certification
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| I
have reviewed the information provided by me and it is true and
accurate. I have read the eligibility guidelines of the ERH Program
above and certify that I meet the guidelines. Further, I have read
and understand my responsibilities in accepting an ERH as outlined
above. I agree to reimburse Spectrumotion for the cost of my ERH
if any of the information I have provided is found to be inaccurate. |
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I Agree
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