Form AV-1 "Autonomous Vehicle Technology Demonstration/Testing Application" - New York

What Is Form AV-1?

This is a legal form that was released by the New York State Department of Motor Vehicles - a government authority operating within New York. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on April 1, 2020;
  • The latest edition provided by the New York State Department of Motor Vehicles;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a fillable version of Form AV-1 by clicking the link below or browse more documents and templates provided by the New York State Department of Motor Vehicles.

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Download Form AV-1 "Autonomous Vehicle Technology Demonstration/Testing Application" - New York

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AUTONOMOUS VEHICLE TECHNOLOGY
DEMONSTRATION/TESTING APPLICATION
This application must be submitted and approved prior to any use, test or demonstration of motor vehicles equipped with autonomous
vehicle technology on public highways in New York State. This application may only be completed by manufacturers of “autonomous
vehicle technology,” or entities creating such technology working in conjunction with manufacturers. The term “autonomous vehicle
technology” is defined as the hardware and software that are collectively capable of performing part or all of the dynamic driving
tasks on a sustained basis. “Dynamic driving tasks” include all of the real-time operational and tactical functions required to operate
a vehicle in on-road traffic, excluding the strategic functions such as trip-scheduling and selection of destinations and waypoints.
The applicant agrees to comply with the following conditions for the duration of any approved demonstrations/tests:
The operation of motor vehicles equipped with autonomous vehicle technology on public highways will be restricted to
l
demonstration or testing.
All demonstrations/tests will be conducted under the direct supervision of the New York State Police. (Provide a completed
l
State Police Addendum, form AV-2).
A natural person holding a valid license for the operation of the class of motor vehicle equipped with autonomous vehicle
l
technology will be present in the driver’s seat in such vehicle for the duration of the time it is operated on public highways, and
shall be prepared to and will assume vehicle control when required to operate safely and lawfully.
All demonstration/test vehicles will comply with all Federal Motor Vehicle Safety Standards (FMVSS).
l
All demonstration/test vehicles will comply with all applicable New York State inspection standards.
l
).
All demonstrations/tests will comply with Vehicle and Traffic Law (VTL) Article 22 and VTL Title VII (with the exception of section 1226
l
*
PART I: APPLICANT’S IDENTIFICATION
Denotes a required field
Entity Information
*
Full Legal Name of Entity Applying to Demonstrate/Test
Other Names Entity Uses (DBA/Assumed Name):
*
Entity’s Physical Street Address
*
*
*
*
City
State
Zip Code
Telephone Number
(
)
Mailing Address (If different than Physical Street Address)
City
State
Zip Code
Contact Person Information (all correspondence will be addressed to the individual listed)
*
Name
Title
*
Mailing Address
*
*
*
*
City
State
Zip Code
Telephone Number
(
)
*
Email address
PART II: AGREEMENT TO REPORT PARAMETERS AND RESULTS OF DEMONSTRATION/TESTING
The applicant agrees to submit a report on the demonstration/testing, undertaken by your company pursuant to a DMV permit, to
the Commissioner of Motor Vehicles no later than March 1, 2021. Please send the report to nysdmvautonomous@dmv.ny.gov or
mail to the attention of Autonomous Vehicle Testing & Demonstration, New York State Department of Motor Vehicles, 6 Empire State
Plaza, Room 410B, Albany, NY 12228. Such report shall include:
The purpose of the demonstrations and tests;
l
The date(s) on which the demonstrations and tests were performed;
l
A description of the parameters of the demonstrations and tests;
l
The location or locations where demonstrations and tests were conducted;
l
The total miles traveled with autonomous technology engaged during the demonstrations and tests; and,
l
Any findings relating to impact on:
l
o
Safety
o
Traffic control
o
Traffic enforcement, or
PAGE 1 OF 2
AV-1 (4/20)
o
Emergency services
AUTONOMOUS VEHICLE TECHNOLOGY
DEMONSTRATION/TESTING APPLICATION
This application must be submitted and approved prior to any use, test or demonstration of motor vehicles equipped with autonomous
vehicle technology on public highways in New York State. This application may only be completed by manufacturers of “autonomous
vehicle technology,” or entities creating such technology working in conjunction with manufacturers. The term “autonomous vehicle
technology” is defined as the hardware and software that are collectively capable of performing part or all of the dynamic driving
tasks on a sustained basis. “Dynamic driving tasks” include all of the real-time operational and tactical functions required to operate
a vehicle in on-road traffic, excluding the strategic functions such as trip-scheduling and selection of destinations and waypoints.
The applicant agrees to comply with the following conditions for the duration of any approved demonstrations/tests:
The operation of motor vehicles equipped with autonomous vehicle technology on public highways will be restricted to
l
demonstration or testing.
All demonstrations/tests will be conducted under the direct supervision of the New York State Police. (Provide a completed
l
State Police Addendum, form AV-2).
A natural person holding a valid license for the operation of the class of motor vehicle equipped with autonomous vehicle
l
technology will be present in the driver’s seat in such vehicle for the duration of the time it is operated on public highways, and
shall be prepared to and will assume vehicle control when required to operate safely and lawfully.
All demonstration/test vehicles will comply with all Federal Motor Vehicle Safety Standards (FMVSS).
l
All demonstration/test vehicles will comply with all applicable New York State inspection standards.
l
).
All demonstrations/tests will comply with Vehicle and Traffic Law (VTL) Article 22 and VTL Title VII (with the exception of section 1226
l
*
PART I: APPLICANT’S IDENTIFICATION
Denotes a required field
Entity Information
*
Full Legal Name of Entity Applying to Demonstrate/Test
Other Names Entity Uses (DBA/Assumed Name):
*
Entity’s Physical Street Address
*
*
*
*
City
State
Zip Code
Telephone Number
(
)
Mailing Address (If different than Physical Street Address)
City
State
Zip Code
Contact Person Information (all correspondence will be addressed to the individual listed)
*
Name
Title
*
Mailing Address
*
*
*
*
City
State
Zip Code
Telephone Number
(
)
*
Email address
PART II: AGREEMENT TO REPORT PARAMETERS AND RESULTS OF DEMONSTRATION/TESTING
The applicant agrees to submit a report on the demonstration/testing, undertaken by your company pursuant to a DMV permit, to
the Commissioner of Motor Vehicles no later than March 1, 2021. Please send the report to nysdmvautonomous@dmv.ny.gov or
mail to the attention of Autonomous Vehicle Testing & Demonstration, New York State Department of Motor Vehicles, 6 Empire State
Plaza, Room 410B, Albany, NY 12228. Such report shall include:
The purpose of the demonstrations and tests;
l
The date(s) on which the demonstrations and tests were performed;
l
A description of the parameters of the demonstrations and tests;
l
The location or locations where demonstrations and tests were conducted;
l
The total miles traveled with autonomous technology engaged during the demonstrations and tests; and,
l
Any findings relating to impact on:
l
o
Safety
o
Traffic control
o
Traffic enforcement, or
PAGE 1 OF 2
AV-1 (4/20)
o
Emergency services
PART III: TEST VEHICLE FLEET
EVERY vehicle to be used for the purposes of Autonomous Vehicle Technology Demonstration/Testing must be listed below
(attach additional sheets if necessary):
Vehicle Type
SAE International’s Level
Date(s) of
Jurisdiction of
Plate
Vehicle Identification Number
(e.g. passenger
of Automation (1-4 only)
TM
Test/Demo
Registration
Number
(VIN)
vehicle)
per J3016
rev 09/2016
Only vehicles listed above will be authorized to be used for demonstration/testing (upon application approval). If the entity would
like to test using additional vehicles, another application must be submitted and approved prior to their use.
PART IV: INSURANCE
The demonstrating/testing entity must maintain, for each vehicle listed above, financial security, at a minimum of $5 million, in the
form of a policy of insurance, a financial security bond, a financial security deposit, or qualifications as a self-insurer under section
316 of the Vehicle and Traffic Law. Financial security shall be maintained for the duration of any approved demonstrations/tests.
Attachment: Attach a copy of the binder or declarations page relative to an insurance policy, or a certificate of self-insurance as
proof of coverage for each vehicle listed above.
SIGNATURE/CERTIFICATION
I certify that I am duly authorized to make this application on behalf of, and with the power to bind, the above-named entity, and
all information I have provided in connection with this Application is true and complete to the best of my knowledge. The entity
named herein agrees to comply with all terms and conditions set forth herein. The Commissioner, or his or her designee, may
revoke my authority to demonstrate/test motor vehicles equipped with autonomous vehicle technology if the entity named herein
fails to comply with the terms and conditions set forth herein, or upon an occurrence regarding the demonstration/test that causes
any concern, in the Commissioner’s determination, regarding public health or safety.
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.
Entity Name
(Please Print):
x
BY, (Sign)
Print Name:
Title:
Date:
/
/
(mm/dd/yyyy)
OFFICE USE ONLY
DMV APPROVAL:
The above-named entity is approved to test and demonstrate the autonomous vehicle(s) designated in this application.
Approval Date: ______/______/__________
Mark J.F. Schroeder
Commissioner
New York State Department of Motor Vehicles
Signed copies of the New York State Police Addendum (form AV-2) and this form, AV-1,
PAGE 2 OF 2
AV-1 (4/20)
must be carried in every vehicle participating in the demonstration or test.
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