Use of RSU#3 Transportation Request

Trip Date*
MM slash DD slash YYYY
Requester Name:*
Email*
Contact Phone Number*
Group/Person Requesting Trip:*
Destination:*
Destination Address*
Street Address City State ZIP Code
Estimated Departure Time:*

: Hours

Minutes

AM/PM
Departure Location*
Street Address Address Line 2 City State ZIP Code
Estimated Return Time:*

: Hours

Minutes

AM/PM
Return Location*
Same as Departure Location

Street Address Address Line 2 City State ZIP Code
Approximate Number of People Attending:*
Reason For Trip:*
Vehicle Requesting:*
# of Buses/Vans needed*
Additional Needed Information
For an understanding of the fee schedule, please reference RSU#3 District Policies EEB & EEB-R at this link .
I agree to*
- Provide a certificate of insurance naming RSU#3 as an additional insured and loss payee
- Reimburse the district for driver pay, including overtime and other expenses such as meals.
- Pay for fuel and other expenses related to vehicle use, as per EEB-R, including insurance, maintenance, and depreciation.
Disclaimer*
- By submitting this form, you are stating that you have read through and agreed to all terms within the RSU#3 District Policy EEB & EEB-R. You are also stating that you understand that this request is subject to approval by the RSU#3 Superintendent and/or designee
Signature*