Human Resources Department
PO Box 1995, Vancouver, WA 98668
Phone: 360.487.8414 Fax: 360.487.8418
E-mail: [email protected]
2016 Open Enrollment
COMMUTE TRIP REDUCTION PROGRAM
Full Participant Registration Form
(Non Union, AFSCME, Coalition and OPEIU)
Employees interested in continuing participation in the City’s Commute Trip Reduction (CTR) Program for 2016 must complete and
submit this registration form to Human Resources. All current enrollments will end 12/31/15 unless an updated form is received. Forms
must be submitted to Human Resources by the end of Open Enrollment, November 13th.
EMPLOYEE NAME
ADDRESS
CITY, STATE, ZIP
DEPARTMENT, EXT.
WORK LOCATION
Please check the incentive you want to receive for the type of alternative commute method you will be participating in at least 60% of your
scheduled days during the month. Free bus passes are given based on commute to work from residence. You have the option to “buyup” to a bus pass that covers more zones not related to your commute. To see more information on bus pass coverage areas go to
www.c-tran.com and click on Fare Information.
TRANSIT
BICYCLE
WALK
CARPOOL
VANPOOL (Must work at
Operations or 415 worksites
for vanpool subsidy)
(A) Free C-Tran Pass (pass type based on commute from residence)
C-Zone
All-Zone (Free for Oregon residents only)
Express (Free for Oregon residents only)
(B) Buy-up Bus Pass Options
$38 C-Zone to All Zone
$25 All-Zone to Express
$63 C-Zone to Express
(A)
$25 Taxable Incentive
(B) Free C-Tran Pass (pass type based on commute from residence)
C-Zone
All-Zone (Free for Oregon residents only)
Express (Free for Oregon residents only)
(C) Buy-up Bus Pass Options
$38 C-Zone to All Zone
$25 All-Zone to Express
$63 C-Zone to Express
(A)
$25 Taxable Incentive
(B Free C-Tran Pass (pass type based on commute from residence)
C-Zone
All-Zone (Free for Oregon residents only)
Express (Free for Oregon residents only)
(C) Buy-up Bus Pass Options
$38 C-Zone to All Zone
$25 All-Zone to Express
$63 C-Zone to Express
$25 Taxable Incentive
Up to $80 Tax-free Subsidy
Note: Subsidy amount is paid to C-TRAN. Employee is responsible for payment of monthly vanpool fare
above $80 and can have that amount deducted pre-tax from bi-monthly pay. Participant is required to
complete and submit an additional Vanpool Agreement form.
All participants must read and sign certifying agreement with the program guidelines below:
 Utilize the above mode of commuting and will commute to and from work at a minimum 60% of your scheduled days during the month.
 Track work commute on the Commute Tracker Calendar at www.ClarkCommute.org.
 Submit the report to Employee Transportation Coordinator, Jan Bowers, by the 5th of the following month.
 Failure to submit a monthly report may result in a temporary or permanent loss of the CTR incentive.
 Should any change occur in my participation in this program I will promptly notify Human Resources.
 Replacement of any lost bus pass will be the responsibility of the employee.
 I agree to repay, with interest, any program incentives received by me, but not earned.
 If I fail to meet the 60% commitment but want to continue with the program I will need to repay the fund or commute and report without a
subsidy or transit pass until account is satisfied.
 If I fail to meet the 60% commitment for two months I will be terminated from the program for the remainder of the calendar year and will
not be eligible to enroll again until the next calendar year.
____________________________________
EMPLOYEE SIGNATURE
Updated 10/2015
_________________
DATE