C
SECTION
Conditions of Acceptance for TDAP Equipment
Please completely READ and SIGN this form indicating that you understand
and agree to comply with the following conditions upon acceptance of all
TDAP Equipment:
All TDAP Equipment (Equipment) provided to me is the property of the State of Oregon, and I will use the
Equipment in compliance with Oregon laws and regulations, including OAR Chapter 860, Division 33.
I am responsible for the appropriate care of all Equipment and the costs related to the use of all Equipment
(Including, but not limited to: batteries and phone or Internet service).
I will not sell, lease, give away, or loan any Equipment to anyone. I will not use any Equipment as collateral for a
loan of any type or as a pledge for a pawn loan.
I am financially responsible for any damage to any Equipment that is not cased by normal wear and tear or acts
of nature or disaster, or if the Equipment is lost.
If floods, storms, fire or other acts of nature damage the Equipment, I will submit a fire, insurance, or other
incident report to TDAP within five (5) business days of the event.
If any Equipment is stolen, I will notify the local law enforcement agency within 24-hours of the the time the theft
is discovered. I will provided a copy of the police report to TDAP within 5 business days of the date the theft was
reported.
I will not attempt to repair any Equipment. If the Equipment is in need of repair, I will contact TDAP. I will return
the defective or damaged Equipment at TDAP's expense. TDAP will repair or replace the returned Equipment at
their discretion. Upon request, TDAP will ship the repaired or replaced Equipment to me.
I will not remove any protective case from the Equipment. I will not damage or deface the Equipment by removing
any property of Oregon identifying labels or alter the laser etching.
I understant that the Equiment may have a web filter installed to prohibit access to websites containing unlawful
content. TDAP and TDAP vendors have my permission to monitor the Equipment to ensure proper use.
If I disconnect my phone service, I will return all Equipment to TDAP within thirty (30) days at TDAP's expense. If
I move to another place in Oregon, I will report my new address to TDAP within thirty (30) days of the move. I will
return all Equipment to TDAP before I permanently move out of Oregon.
I will obtain written permission from the TDAP Manager before I travel out of Oregon with any Equipment for moe
than ninety (90) days.
I will return the Equipment to TDAP within forty-five (45) days of a request from TDAP.
If I have signed this on behalf of a minor or as a guardian for an adult, I agree to notify TDAP about a change in
responsibility within five (5) calendar days of the event (for example, the minor turns 18 or if there is a change of
guardianship).
I understand that I am financially responsible for the replacement cost of all Equipment if I do not comply with any
of the above conditions. I further understand I am financially responsible for any collection costs associated with
failure to pay the replacement cost.
I understand that all Equipment is provided on a first come, first served" basis and its availability is contingent
upon adequate funding.
All statements I have made in this application are
true and correct to the best of my knowledge.
Signature of Applicant or Parent / Guardian (If Applicant is under 18) Date
*Please provide a copy of the Power of Attorney/guardianship documentation if signing on behalf of applicant.
PAGE 3
FM608 (Revised 4/26/19)
