Notification For Autonomous Motor Vehicle Testing
Owner First Name
Owner Last Name
Organization
Business Type
State Where Incorporated
Business Principal
Business Telephone Number
Business FAX Number
Email Address
Mailing Address
Address
City
State
Zip
Physical Address
Address
City
State
Zip
List of Authorized Agents & Drivers
Upon request, make a list of authorized agents and drivers (if applicable)
| Driver's Credentials (CDL if applicable) | Vehicle beings tested | Year | Make | Model | Vehicle Identification Number |
|---|
Add Row
Level of Automation being Tested
Level of Automation being tested
Operational Design Domain being tested including:
Roadway Classification
Environmental Limitations
Testing Speeds
Geo-fencing
Description of the minimal risk condition of system failure:
Location or areas testing will occur:
Dates and frequency of testing:
Demonstration of having an instrument of insurance, surety bond, or proof of self insurance in an amount of at least $5 million (.pdf, < 10mb):
Proof of registration and licensing for each autonomous motor vehicle being tested and operated (.pdf, < 10mb):
Police Interaction Protocol (.pdf, < 10mb):