WHEREAS, The employee whose signature appears below agrees to furnish his own automobile to perform his duties hereunder and shall keep it aintained 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 coverages 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)______, 20_(9)_, to ____(10)______, 20_(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, bailee or lessee of said automobile, nor shall the company be responsible for any damage to the automobile.

Employer ___________(12)________________

Employee ___________(13)________________

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