Name: Signal Health Group
Address: 10475 Crosspoint Blvd, Indianapolis, IN, 46256, US
Telephone: 800-953-6183
Price range: $$

Automobile Use Agreement
This agreement is made this day of 20 between the agency and referred to hereinafter as “Applicant.” The duties to be performed by Applicant will require the use of an automobile. The following are the conditions governing automobile use by Applicant:

Use of Insurance Coverage on an Applicant’s Automobile.
Applicant shall furnish Applicant’s own automobile to perform the duties required under this Agreement and shall keep it maintained and repaired in good driving condition. Applicant shall maintain insurance on the automobile according to minimum amounts specified by State of Indiana and/or Ohio Law. Applicant certifies by signing below that they currently have and will continue to maintain legal automobile coverage while employed with the agency and using their car to transport agency clients.

Release from Liability
In consideration of working on an agency assignment, Applicant assumes all risk of accidents or casualties, arising from or related in any way to automobile use by Applicant pursuant to this Agreement. Applicant, Applicant’s heirs, executors, administrators and legal representatives, forever releases, acquits and discharges the agency from all such claims for liability of any nature or character, including property damage, applicant injury and/or death, presented by any applicant(s)claiming injury, including Applicant or agency’s clients. In addition, Applicant certifies by signing this agreement that they will not drive an agency client’s vehicle without having the client sign an agency liability waiver.
In witness of the above, each party to this agreement has caused it to be executed at Richmond, IN on the date indicated below.
By:	Applicant:
Signature and Title	Signature
Print Name:	Print Name:
Date	Date

Automobile Use Agreement

Automobile Use Agreement

Use of Insurance Coverage on an Applicant’s Automobile.

Release from Liability