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Form #1576MEMORANDUM OF EMPLOYEE AUTOMOBILE EXPENSE ALLOWANCE
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MEMORANDUM OF EMPLOYEE AUTOMOBILE EXPENSE ALLOWANCE
WHEREAS, The employee whose signature appears below agrees to furnish his own automobile to perform his duties hereunder and shall keep it maintained and repaired in good driving condition; and
WHEREAS, for the employee's benefit, the employee shall maintain insurance on the automobile in at least the following amounts: Bodily injury liability, __________(1)________ Dollars ($_______________) for each person injured, ____________(2)______________ Dollars ($________________) for each occurrence; property damage liability _____(3)_____ Dollars ($________________) for each accident; _________(4)____________ Dollars ($___________) deductible comprehensive coverage, _____________________(5) _______________ Dollars ($_________________); ________(6)__________ Dollars ($________________) deductible collision coverage at fair market value; and
WHEREAS, a certification of the employee's insurance showing those coverage�s will be filed by the employee with the company; and
WHEREAS, all of the requirements of this section shall be complied with at the employee's cost.
NOW THEREFORE, In consideration of the above, the company shall pay the employee _____________(7)__________ Dollars ($_______________) per week for the use of his automobile during the period from ___________(8)___________, _____(9)_____, to ________ (10)__________, ______(11)______. Those payments shall be charged to the employee's account as an automobile allowance. The payments shall be made weekly, but neither the payments nor this agreement shall make the company the owner, bail or lessee of said automobile, nor shall the company be responsible for any damage to the automobile.
___________(12)________________ Employer
___________(13)________________ Employee
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These forms are provided to assist business owners and others in understanding important
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