Form 07-011 "Request for Assigned Vehicle/Suv Justification" - Oregon

What Is Form 07-011?

This is a legal form that was released by the Oregon Department of Administrative Services - a government authority operating within Oregon. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on September 5, 2018;
  • The latest edition provided by the Oregon Department of Administrative Services;
  • 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 07-011 by clicking the link below or browse more documents and templates provided by the Oregon Department of Administrative Services.

ADVERTISEMENT
ADVERTISEMENT

Download Form 07-011 "Request for Assigned Vehicle/Suv Justification" - Oregon

Download PDF

Fill PDF online

Rate (4.7 / 5) 11 votes
State of Oregon
Fleet & Parking Services
1100 Airport Rd SE
Request for Assigned Vehicle / SUV Justification
Salem, OR 97301-6082
503-378-4377
503-378-5813 fax
Additional/Exchange Vehicle – Long-term or Seasonal
fleet.office@oregon.gov
Form 07-011
https://www.oregon.gov/DAS/FleetPark
Form Completed By
Agency Name
Division or Unit
Six-digit Agency Number
Date of Request
Phone #
Cost Center or Billing Number
Date Vehicle Needed
Please specify purpose of request
Vehicle for Long-term assignment
Police Vehicle
(fill out sections A – E)
(fill out sections A, C, D, and E)
______
Vehicle for Seasonal assignment (minimum 1 month, maximum 6 months). Estimated end date
.
(fill out sections A – E)
______
Exchange current vehicle license #
for a different type of vehicle.
(fill out sections A – E)
______
Replace current vehicle license #
due to accumulated miles (criteria: 130k for standard vehicles, 150k for hybrids).
(fill out sections A – E)
Driver/Agency Contact Information:
Driver License # - LAST 4 DIGITS ONLY
Driver/Agency Contact Name (last name, first name) – VEHICLE WILL BE ASSIGNED TO THIS PERSON
State
Driver/Agency Contact Office Physical Address
City
State
ZIP
A
Driver/Agency Contact Office Mailing Address (if different from above)
City
State
ZIP
E-mail – (all electronic correspondence will be sent to this address)
Office Phone Number
MOBILE Phone Number
To Best Accommodate the Needs of Your Agency, Please Answer the Following:
1. Describe, in detail, the primary function of this vehicle. Please note if the vehicle is used to transport inmates, patients or clients and if so, how often.
2. What is the frequency of use
3. How many miles is this vehicle
4. Will this vehicle travel “off road”? If yes, what
5. What counties in Oregon will this
(days/week)?
estimated to travel each month?
percentage of the time?
vehicle service?
6. How often will the vehicle drive in adverse weather conditions; i.e.
7. What type of cargo will this vehicle carry? What is the approximate weight?
B
snow, ice (estimated days/year)?
8. How many passengers will this vehicle typically carry? How often will it
9. Will the vehicle replace or prevent reimbursement of private mileage to employees? If so, will
carry multiple passengers (days/month)?
private mileage reimbursement be reduced and by how much? (miles and dollars per month)
10. Is ground clearance an issue? If yes, please explain in detail.
Fleet & Parking Services will use the information provided above to match your request to the most appropriate vehicle to meet your
agency’s needs. Fleet & Parking Services has final approval over which type of vehicle is assigned to this request.
Preferred Type of Vehicle:
Sedan
Standard Gas FWD
Gas/Electric Hybrid FWD
Natural Gas FWD
Police Package RWD
SUV
Compact AWD (Ford Escape
Intermediate AWD (Ford
Carryall 4x4 (Chev
Police Package 4x4
size)
Explorer size)
Suburban size)
(Requires
Agency Head
Required: Explain why a 4x4 crew-cab pickup (with or without a canopy) of comparable size will not suit your needs
C
Approval )
Vans
7 Passenger Mini
12 Passenger Full Size
Cargo Van:
Mini
¾ Ton
1 Ton
Pickup
Compact
¾ Ton
Standard Cab
Crew Cab
Short Box
4x2
½ Ton
1 Ton
Extended Cab
Cab-Chassis
Long Box
4x4
Driver/Agency Contact Certification:
I understand only state employees are authorized to drive this vehicle for official business and that my agency is responsible to ensure all drivers will operate it in
conformance with all applicable laws, rules, and regulations. Failure to perform these responsibilities can result in suspension of official vehicle use privileges. DAS Fleet &
D
Parking Services vehicle use policy can be viewed or downloaded at https://www.oregon.gov/DAS/FleetPark/Pages/policy.aspx.
Name
Title
Signature
REQUESTING AGENCY APPROVAL (AGENCY HEAD/DIRECTOR APPROVAL REQUIRED FOR SUV)
Name
Title
Signature
E
MOTOR POOL USE ONLY
Vehicle License #
Assignment Date
Date to Pending
Manager Approval
U:\ADMN\Published\Forms\Request a LongTerm Vehicle.docx
07-011
Revised 9/5/2018
State of Oregon
Fleet & Parking Services
1100 Airport Rd SE
Request for Assigned Vehicle / SUV Justification
Salem, OR 97301-6082
503-378-4377
503-378-5813 fax
Additional/Exchange Vehicle – Long-term or Seasonal
fleet.office@oregon.gov
Form 07-011
https://www.oregon.gov/DAS/FleetPark
Form Completed By
Agency Name
Division or Unit
Six-digit Agency Number
Date of Request
Phone #
Cost Center or Billing Number
Date Vehicle Needed
Please specify purpose of request
Vehicle for Long-term assignment
Police Vehicle
(fill out sections A – E)
(fill out sections A, C, D, and E)
______
Vehicle for Seasonal assignment (minimum 1 month, maximum 6 months). Estimated end date
.
(fill out sections A – E)
______
Exchange current vehicle license #
for a different type of vehicle.
(fill out sections A – E)
______
Replace current vehicle license #
due to accumulated miles (criteria: 130k for standard vehicles, 150k for hybrids).
(fill out sections A – E)
Driver/Agency Contact Information:
Driver License # - LAST 4 DIGITS ONLY
Driver/Agency Contact Name (last name, first name) – VEHICLE WILL BE ASSIGNED TO THIS PERSON
State
Driver/Agency Contact Office Physical Address
City
State
ZIP
A
Driver/Agency Contact Office Mailing Address (if different from above)
City
State
ZIP
E-mail – (all electronic correspondence will be sent to this address)
Office Phone Number
MOBILE Phone Number
To Best Accommodate the Needs of Your Agency, Please Answer the Following:
1. Describe, in detail, the primary function of this vehicle. Please note if the vehicle is used to transport inmates, patients or clients and if so, how often.
2. What is the frequency of use
3. How many miles is this vehicle
4. Will this vehicle travel “off road”? If yes, what
5. What counties in Oregon will this
(days/week)?
estimated to travel each month?
percentage of the time?
vehicle service?
6. How often will the vehicle drive in adverse weather conditions; i.e.
7. What type of cargo will this vehicle carry? What is the approximate weight?
B
snow, ice (estimated days/year)?
8. How many passengers will this vehicle typically carry? How often will it
9. Will the vehicle replace or prevent reimbursement of private mileage to employees? If so, will
carry multiple passengers (days/month)?
private mileage reimbursement be reduced and by how much? (miles and dollars per month)
10. Is ground clearance an issue? If yes, please explain in detail.
Fleet & Parking Services will use the information provided above to match your request to the most appropriate vehicle to meet your
agency’s needs. Fleet & Parking Services has final approval over which type of vehicle is assigned to this request.
Preferred Type of Vehicle:
Sedan
Standard Gas FWD
Gas/Electric Hybrid FWD
Natural Gas FWD
Police Package RWD
SUV
Compact AWD (Ford Escape
Intermediate AWD (Ford
Carryall 4x4 (Chev
Police Package 4x4
size)
Explorer size)
Suburban size)
(Requires
Agency Head
Required: Explain why a 4x4 crew-cab pickup (with or without a canopy) of comparable size will not suit your needs
C
Approval )
Vans
7 Passenger Mini
12 Passenger Full Size
Cargo Van:
Mini
¾ Ton
1 Ton
Pickup
Compact
¾ Ton
Standard Cab
Crew Cab
Short Box
4x2
½ Ton
1 Ton
Extended Cab
Cab-Chassis
Long Box
4x4
Driver/Agency Contact Certification:
I understand only state employees are authorized to drive this vehicle for official business and that my agency is responsible to ensure all drivers will operate it in
conformance with all applicable laws, rules, and regulations. Failure to perform these responsibilities can result in suspension of official vehicle use privileges. DAS Fleet &
D
Parking Services vehicle use policy can be viewed or downloaded at https://www.oregon.gov/DAS/FleetPark/Pages/policy.aspx.
Name
Title
Signature
REQUESTING AGENCY APPROVAL (AGENCY HEAD/DIRECTOR APPROVAL REQUIRED FOR SUV)
Name
Title
Signature
E
MOTOR POOL USE ONLY
Vehicle License #
Assignment Date
Date to Pending
Manager Approval
U:\ADMN\Published\Forms\Request a LongTerm Vehicle.docx
07-011
Revised 9/5/2018