Autonomous Vehicle Program

Self-Certification

Business information

Business name *

Address *

City *

State *

ZIP code *

Contact name *

Contact phone with area code (xxx-xxx-xxxx) *

Contact email *

Program requirements

Agreement *

We agree to provide written notice in advance of testing to local and state law enforcement with jurisdiction over the roadways where testing occurs.

Insurance information *

Business entity holds an umbrella liability insurance policy of not less than 5 million dollars per occurrence.

Proof of policy is attached

Attach proof of policy (5 MB maximum). *

During testing and operation, will the vehicle have a human operator? *

Yes, operator in vehicle

No operator in vehicle

Both with and without an operator in vehicle

In what local jurisdictions are testing planned? *

With human operator

Programs conducting safe testing and operation of autonomous vehicles with human operators present in the vehicles must comply with the following requirements before beginning their program:

1. Vehicles must be operated or monitored only by a trained employee, contractor, or other person authorized by the entity developing autonomous technology.

2. Vehicles must be monitored, and operator must have the ability to direct the vehicle's movement if assistance is required.

3. Individuals able to exercise operational control of an autonomous vehicle during operation must possess a valid U.S. driver license.

4. Vehicle owners must have proof of financial responsibility as required by RCW 46.30.020.

By typing your name you certify under penalty of perjury under the laws of the state of Washington, you are authorized to sign for the business and are compliant with the above requirements. *

Date signed * +

Place (city or county) signed *

Without human operator

Programs conducting safe testing and operation of autonomous vehicles without human operators present in the vehicles must comply with the following requirements before beginning their program:

1. Vehicles must be equipped with an automated driving system that performs all aspects of the driving task on a part- or full-time basis within the vehicle's operational design limits. It also must be capable of bringing the vehicle to a safe condition in the event of a system failure.

2. Vehicles must be operated in compliance with Washington State motor vehicle laws relevant to the vehicle's operational design limits.

3. Vehicle owners must have proof of financial responsibility as required by RCW 46.30.020.

By typing your name you certify under penalty of perjury under the laws of the state of Washington, you are authorized to sign for the business and are compliant with the above requirements. *

Date signed * +

Place (city or county) signed *

Comments (optional)

0/530 characters

Name of person submitting report (if different from the person authorized to sign for the business)

Email of person submitting report

Date submitted * +