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52 APPENDIX C Sample Applications and Agreements Adopt A Stop TheRide has several opportunities for you to Adopt-A-Stop. Individuals, civic groups, homeowners, private companies, public agencies, churches, students and scout troops are welcome to join in the effort to make TheRide bus stops safer, cleaner and more accessible. Click here for more information. Your Name: Company Name: Address: City: Zip: Day time Phone: Extension: Evening Phone: Extension: E-mail: Bus Stop Location: Comments: Â© 2011, Ann Arbor Transportation Authority General Information 734.973.6500 Routes and Schedules 734.996.0400 Contact Us Submit
53 Delaware Transit Corporation â DART First State ADOPT-A-BUS SHELTER 2011 AGREEMENT FORM __________________________________________________________________________________________ Dart First State (DART) and _______________________________________________(Participant) agree as follows: 1. Participant agrees to adopt a bus shelter for one year. 2. DART will display one sponsoring participant decal per site. 3. Participant agrees to regularly maintain (at least once a week) the adopted bus shelter by being responsible for Trash Pickup, Shelter Cleaning and Snow Removal. DART will power wash the shelter on an as needed basis. 4. DART will perform, at the participantâs request, graffiti removal, overgrown grass removal, and shelter repairs. Participant concerns about help with snow removal are to be reported to DART. DART will provide the participant with reflective safety vests for when working around the shelter along with bags for the trash. 5. Participant is to report vandalism, disturbances, safety issues, and rider articles left at the bus shelter to DART. Suspicious packages, drug paraphernalia, and illegal looking items are to be reported to law enforcement. 6. DART will consider contracting security and/or maintenance services upon the participantâs request. Signature of Agreement by Participant Representative: _________________________________________________ Please Print Organization Name: ______________________________________________________________ Address: ________________________________________________________________________ City: ____________________________ State: __________________ Zip Code: ______________ Phone (Home)_________________ (Fax)___________________ (E-Mail) ___________________ Contact Person: ____________________________________________________ Date: ________________________ Please print the exact name of the person, organization or business to appear on the recognition decal. __________________________________________________________________________________________________ __________________________________________________________________________________________________ Location of Bus Shelter Site: ________________________________________________________________________ Schedule (Days) for Maintenance: ___________________________________________________________________ Office Use Only Bus Shelter Location: _________________________ Stop #: _________________________ Approval Date: ______________________ Decal: __________________________________
54 Adopt-A-Station Application To be completed and returned. Getting On the Right Track With NJ TRANSIT & Your Community... Date: _______________________________________ Adopter: _____________________________________ Contact Personâs Name: ______________________________________ Phone Number: _____________________________________(Day) ____________________________(Evening) Address: _________________________________________________ City/State/Zip: __________________________________ Train Station Site: 1st Choice:_____________________________________________ 2nd Choice: __________________________________________________ NOTE: Program work can consist of picking up litter and/or light landscaping and/or planting/caring for flowers, shrubs, small trees and/or other ideas yovÂ» may have. Do you agree to volunteer to perform Program work at your train station site at least four times per year, for a two-year period? ____YES ____ NO Do you plan to perform Program work more often than four times per year? ____YES ____ NO If yes, how many more times per year do you plan to perform Program work? _____TIMES PER YEAR Describe briefly the scope of work you would like to perform at your chosen station site(s): ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ (Use an additional sheet(s) if necessary) Please return completed form to: Official Use Only Deborah A. Eadie Station: Adopt-A-Station Coordinator Line: NJ TRANSIT Reg.#: One Penn Plaza YR: East Newark, NJ 07105
55 PACE ADOPT-A-SHELTER APPLICATION FORM VOLUNTEER ORGANIZATION/INDIVIDUAL/BUSINESS Date: Contact Name: Organization Name: Mailing Address: City, State, Zip: Contact Daytime Telephone: Contact E-Mail Address: Location of Shelter You Would Like to Adopt (cross streets, landmarks and community): What Would You Like to Have Printed on Your "Adopted By..." Sign (subject to approval): Signature of Contact Person (By signing this application, Volunteer agrees to the terms and conditions of the program.) Submit completed form to: Pace Suburban Bus Service Adopt-a-Shelter Coordinator 550 W. Algonquin Road Arlington Heights, IL 60005 Questions? Telephone 847-228-4257
56 ADOPT-A-SHELTER PROGRAM TERMS AND CONDITIONS In consideration of Pace providing an "Adopted by..." sign at the adopted shelter, promoting the Volunteerâs participation in the Adopt-A-Shelter program, providing window-cleaning supplies, route schedules/timetables for the shelter, and trash liners, Volunteer agrees as follows: Volunteer will remove litter at the adopted shelter at least once per month. Volunteer will clean the shelter including washing of shelter panels at least once per month. Volunteer will ensure that an up-to-date schedule for the route(s) passing this shelter is present. Volunteer will promptly remove graffiti if possible or will notify Paceâs Adopt-A-Shelter coordinator if graffiti cannot be removed by cleaning. Volunteer will report shelter vandalism to Paceâs Adopt-A-Shelter coordinator. Volunteer will maintain a monthly maintenance log and submit to the Pace Adopt-A-Shelter coordinator on a semi-annual basis. As consideration for the efforts of the Volunteer, Pace will: Affix the shelter with a semi-permanent sign acknowledging adoption of the shelter by Volunteer (upon Pace approval). Provide five round-trip tickets per month upon request which allow five free round-trips per month on Pace service. Furthermore, Volunteer understands and acknowledges that the litter may contain materials that are or are suspected to be hazardous, dangerous, heavy or unyielding. Accordingly, Volunteer shall exercise his or her judgment about handling the litter, make every effort not to touch or pick up hazardous materials, and assumes all risks of handling the litter. Volunteer shall contact the proper agency for disposal instructions for litter that may be hazardous, dangerous, heavy, or unyielding. Volunteer shall be responsible for complying with any and all applicable state and local parking and driving regulations when traveling to and from and being at the shelter as a part of his or her participation in the Adopt-a-Shelter program. Volunteer agrees that this Agreement shall be effective from the date signed by Pace and continue until terminated by either party. Pace reserves the right to terminate this Agreement for any reason at any time. Volunteer agrees that Pace may temporarily suspend this Agreement because of construction near the site or any other reason shelter may be inaccessible. Volunteer agrees to contact Paceâs Adopt-A-Shelter coordinator if Volunteer will be unable to maintain the shelter for any period of time (e.g. vacation, relocation, illness). Volunteer agrees that if this Agreement is terminated by Pace for failure or neglect to properly maintain the shelter, Volunteer will not be allowed to participate in the Adopt-A-Shelter program for a minimum of six months following termination. Volunteer shall contact Paceâs Adopt-A-Shelter coordinator at 847-228-4257 to request trash liners, repair or replacement of trash receptacle, and/or repair or replacement of "Adopted by..." sign. If there are any other questions or concerns related to the shelter, Volunteer is expected to contact the Adopt-A-Shelter coordinator. By signing the application form on the reverse side, Volunteer signifies acceptance of the above terms and conditions.
57 ADOPT-A-STOP PROGRAM FORM Thank you very much for you interest in the Adopt- A-Stop program. Submitting this form: Please save this file when you are done. Send an e-mail to firstname.lastname@example.org with this file as an attachment. Please send me the Adopt-A-Stop Agreement so I may adopt the stop on: street name at Please send me more information. Please call me. Name Daytime Phone ( ) Company or Organization Address City Zip Code I am interested in the Adopt-A-Stop Program. I would like to adopt a bus stop.