AUTONOMOUS VEHICLE TECHNOLOGY DEMONSTRATION/TESTING ADDENDUM
The entity named herein agrees to comply with the requirements of the New York State Police as specified in this addendum.
Direct supervision by the New York State Police shall be determined for purposes of the demonstration or test by the Superintendent
or his designee in consultation with the entity named herein prior to any such demonstration/test. The supervising member of the
New York State Police is authorized to terminate such demonstration/testing if that member believes continued operation is a threat
to safety. If the demonstration/testing jeopardizes safety, the entity applying to demonstrate/test shall assume any and all liability,
and be subject to suspension or revocation of any permit issued.
The applicant demonstration/test entity shall submit with this application a law enforcement interaction plan to inform law enforcement
officers and first responders how to safely interact with the demonstration/test vehicle(s) in emergency and traffic enforcement situations.
The plan shall include the intended operational design domains in which the entity intends to operate, as defined in the Federal
Automated Vehicles Policy. The law enforcement interaction plan shall also include, but not be limited to, the following:
1. Contact phone number for the representative responsible for demonstration/testing;
2. How the vehicle will be identified/distinguished from other conventional vehicles;
3. How to safely immobilize, disable and tow the vehicle if it is involved in a crash;
4. How to recognize if the vehicle is being operated in an autonomous mode;
5. How to disengage an autonomous mode in the event the operator is incapacitated; and
6. Any other public safety concerns during operation or in the event of a collision, including any that may impact law enforcement,
fire, EMS, or towing professions.
The Law Enforcement Interaction Plan shall be reviewed regularly by the demonstration/test entity and updated as needed to ensure
safety, but at least annually.
The applicant test entity named herein certifies that each demonstration/test vehicle operator shall be adequately trained
in the safe operation of the vehicle to ensure both legal and safe operation. Each test vehicle operator shall be listed below:
Additional operators may be listed on separate page(s) as necessary.
PART II: TEST VEHICLE OPERATORS
PART I: LAW ENFORCEMENT INTERACTION PLAN
AV-2 (6/18)
Operator Name Date of Birth
License
Jurisdiction
License Number
Expiration Date
Entity Name
(Please Print):
BY, (Sign)
X
Print Name:
Title:
Date: / /
(mm/dd/yyyy)
PART III: SIGNATURE/CERTIFICATION
I certify that I am duly authorized to submit this addendum and its component information on behalf of, and with the power to bind,
the entity named herein, and all information I have provided relating to this addendum is true and to the best of my knowledge. The
entity named herein agrees to comply with all conditions set forth during this application process.
WARNING: Intentionally making a false statement or providing false or misleading information in connection with this application is
a criminal offense that may subject you to criminal prosecution under the Law.
APPROVAL
Approval Date: ______/______/__________
George P. Beach II
Superintendent
New York State Police
