Autonomous Vehicle Pilot Program
Application for Permit to Test an ADS-Equipped Vehicle
Chapter 800: Autonomous Vehicle Pilot Program Rules / Secon 3
Safety Driver Information (List All Applicable Employees, Contractors, and Designees)
List aached. ATTACHMENT / 2
Vehicle Information (List All Applicable Test Vehicles, and Designees)
List aached. ATTACHMENT / 3
Legal name:
Driver license number:
State or country issued:
Background check, including driving record: Yes
Description of safety training:
License plate number:
State issued:
VIN number: ( if not available, a Manufacturer Certicate of Origin )
Manufacturer Cercate of Origin – ATTACHMENT / 3. c
Proof of Current Registraon – ATTACHMENT / 3. e
Current motor vehicle inspection date:
Note: The State of Maine recognizes the registration, title, and plate issued by another titling jurisdiction for purposes of testing.
Tester/Applicant Information
Tester name: Mailing address (if different from address):
Principal point-of-contact for tesng (lead person)
Name: Title:
Telephone number: Email address:
Physical presence in the state of Maine or elsewhere
Name: Email address:
Telephone number: Address:
Evidence of the Financial Capacity of the Tester – ATTACHMENT / 1. f
Prospective Testers who wish to apply for a permit must complete and submit the following application to the Commission. In developing its
recommendations to the Executive Council, the Commission will require information from the prospective Tester as follows:
Applicants must have nancial resources sufcient to develop, launch and sustain a Pilot Project,
and to adjust to any changes in conditions that occur or steps that may be necessary to conduct and
complete the project.
Description of Prospective Pilot Project:
a. Purpose, including transportation needs it will address and aspects of the ADS that are being tested:
Descripon aached. ATTACHMENT / 4. a
b. Description of the ODD including:
i. Geographic boundaries (geo-fencing).
i. Time of day (daytime, nighttime).
ii. Weather conditions.
iii. Road typologies and speeds (functional classication, single or multiple lanes, minimum and
maximum operating speeds).
iv. Situational constraints (construction and active work or school zones, signalized intersections,
unprotected left turns, non-signalized crosswalks, rotaries and roundabouts, areas where
pedestrians tend to cross non-channelized, other).
Descripon aached. ATTACHMENT / 4. b
c. Identication of any partners in the development and operation of the Pilot Project (e.g., municipalities, other
governmental entities, or other public institutions).
d. Proposed time frame and duration of the Pilot Project.
e. Proposed routes and specic roadways of the Pilot Project.
f. Characterization of the type of fallback (e.g., natural human Operator in the vehicle, a natural human Operator
controlling the vehicle remotely, or other type of administrator of a fully automated driving system).
g. Explanation of whether a natural human Operator will be present in the vehicle, and if not, why a human
presence is not necessary.
h. Description of how the Tester (and partner entities, if applicable) will reach out to and educate members of
the public about safety around ADS-Equipped Vehicles.
Tester must demonstrate nancial
ability to satisfy a judgment for damages for
personal injury or property damage of at least ve
million dollars per occurrence. This requirement
may be met by submitting to the Commission
proof of liability insurance, self-insurance or a
surety bond of at least ve million dollars for
damages by reason of personal injury, death or
property damage caused by a fully autonomous
Voluntary Safety Self-Assessment
Data Collection:
Description of what data
will be collected, how it will be used, how privacy
will be protected, and how security will be
maintained, including customer feedback in the
conduct of the Pilot Project and crash data.
Descripon aached. ATTACHMENT / 7
Partnership with Municipalities, Other
Government Entities, or Other Public
Municipalities, other government
entities, or other public institutions may wish to
partner with a Tester to conduct a Pilot Project
within local jurisdictions or realms of authority.
In such cases, the Tester and partner entity(ies)
must enter into a multi-party Memorandum of
Understanding (MOU) to conrm and memorialize
a commitment of support from appropriate local
elected ofcials or appropriate authorities from
other partner entities. A copy of the MOU shall be
included with the application.
Memorandum of Understanding (MOU)
9. Submittal of the Application: The
application shall be submitted to the Chief Engineer
of MaineDOT at 16 State House Station, Augusta,
Maine 04333-0016 or submitted electronically
through the Maine Department of Transportation
Website. The Chief Engineer will send back a notice
of the date the application is considered complete
or request additional information as needed. Once
the application is complete, the Commission will
review the application.
a. A detailed account of the safety record,
including any crash history and subsequent xes,
of the ADS Equipped Vehicle intended to be
used in Pilot Project and associated ADS prior to
commencement of the Pilot Project in Maine
Descripon aached. ATTACHMENT / 5. a
b. A description of public safety precautions that
will be taken during the Pilot Project to ensure the
safety of the public.
Descripon aached. ATTACHMENT / 5. b
c. A description of any previous Pilot Projects or
live implementation of the Pilot Project vehicle and
associated ADS, noting any difculties identied or
encountered in any prior activities.
Descripon aached. ATTACHMENT / 5. c
d. A detailed description of a rst responder
interaction plan addressing how state, county or
municipal law enforcement ofcials and emergency
response personnel will be informed and educated
about the Pilot Project, including instructions about
how to proceed if unsafe or obstructive conditions
occur. A description on how rst responders can
disable the vehicle in an emergency must be included.
Descripon aached. ATTACHMENT / 5. d
e. In lieu of the requirement of sections 5(a)
through 5(d), above, a Tester may submit with the
application a copy of its Voluntary Safety Self-
Assessment as submitted to the National Highway
Trafc Safety Administration.
Voluntary Safety Self-Assessment
Safety and Risk Mitigation
In lieu of the requirement of secons 5(a) through
5(d), see 5(e)
Autonomous Vehicle Pilot Program
Application for Permit to Test an ADS-Equipped Vehicle
Chapter 800: Autonomous Vehicle Pilot Program Rules / Secon 3