Dignita AL-100 Lease Agreement

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CLIENT DETAILS

Client Name *

Company Name (if applicable)

Client Billing Address *

Address Line 1

City

State / Province / Region

Postal Code

Client Mobile / Home Phone Number *

Client Business Phone Number

Client Email address *

Client Drivers Licence Number *

Identification – File Upload *

Click or drag files to this area to upload. You can upload up to 4 files.

Please upload an image or PDF of two forms of ID (ie. drivers licence, Medicare card, concession card, birth certificate, passport).

ABN *

Installation Service Centre Name *

Installation Service Centre address *

Address Line 1

City

State / Province / Region

Postal Code

Please note the interlock will be shipped directly to the Installation Service Centre

Installation Service Centre Phone number *

VEHICLE DETAILS

Vehicle Make and Model *

Vehicle Year *

Vehicle Registration *

By selecting yes you confirm you are agreeing to the below Terms of Service

I accept that by submitting this form I agree to the terms of service as follows. This Equipment Lease is the agreement between the client named in the Schedule (“Client”) and Guardian Interlock Australasia Pty Limited (“GUARDIAN”) for the lease of equipment during the Hire Period of the Equipment. The Client agrees to lease the equipment set out in the Schedule (“Equipment”) on the terms and conditions set out in this agreement. The Equipment includes the Handset identified in the Schedule and all cables and other accessories installed with the Equipment in the Vehicle. ID: The Client agrees to provide two forms of identification, one being licence showing current address, and the other either Medicare Card, Health Care Card, Pension Card, Birth Certificate or Passport. VEHICLE: The Client warrants that they are the owner of the vehicle identified in the Schedule (“Vehicle”) or the owner of the Vehicle has consented to the Equipment being installed in the Vehicle. GUARDIAN is to install the Equipment in the Vehicle. FEES AND CHARGES: The Client agrees to pay $90.00 per calendar month (in advance) and all fees and charges arising under this agreement. The Client agrees to pay the cost to repair any damage to the Equipment or the cost to replace the Equipment if it is lost, unrepairable or the cost of to repair the Equipment exceeds the cost to replace it. The Client is not required to pay to repair reasonable wear and tear to the Equipment. HIRE PERIOD: The Hire Period of this Agreement is set out in the Schedule. The Client is to return the equipment to GUARDIAN or its agent on or before the Termination Date. If the Client fails to return the Equipment by the Termination Date, the Client’s obligations under this Agreement continue, including the obligation to pay fees for each month, or part thereof, for which the Equipment has not been returned. Should the Client wish to terminate the agreement within the first 6 months of hire the Client will be required to pay the minimu, lease amount of 6 months. AUTHORISATION: The Client authorises and directs GUARDIAN, its agents, employees and/or contractors, to install the Equipment in the Vehicle and to repair, maintain and, when necessary or at the end of the Term, remove the Equipment. TERMS AND CONDITIONS 1.0 Acknowledgements: This Agreement involves the installation of the Equipment including any equipment or components that may from time to time be substituted or installed as replacements therefore, by certified motor repairers. 2.0 Ownership of Equipment, etc: The Equipment is owned by and shall remain the sole and exclusive property of GUARDIAN. The Client shall not, directly, or indirectly, encumber or otherwise impair the GUARDIAN’s title to the Equipment. Upon termination of this Agreement the Client shall have the equipment removed by GUARDIAN or its agent. 3.0 Payments: The Client agrees to pay GUARDIAN a security bond of two (2) months’ lease payments together with the first monthly lease payment in advance. The Client is to pay the lease payments monthly in advance thereafter. GUARDIAN will refund the unused portion of the security bond and lease payments once the Equipment has been returned to GUARDIAN and checked for damage. All payments can be made in the form of direct deposit or Visa/Mastercard. 4.0 Early Termination The Client accepts the minimum lease term of 6 months and any outstanding fees are payable on termination. The bond may be used as part of this payment. 5.0 GUARDIAN’s Responsibility: GUARDIAN agrees that the Equipment will be supplied in good working order. The liability of GUARDIAN shall be limited to repair or replacement of defective components. Such work shall be carried out during normal business hours by GUARDIAN or a designated Service Centre and by prior arrangement with the Client. 6.0 Client Responsibility: The Client agrees that whilst the Equipment is installed in the Client’s vehicle, the Client will be liable for any damage or loss arising from theft, water damage, fire, and the like. The value of the equipment is $1650.00. The Client is required to list the Equipment on their Insurance Policy. 7.0 General Provisions: The Client acknowledges that it has not relied on any representations, warranties, or agreements, express or implied, save and except those set out in this Agreement. This Agreement may only be amended by the parties in writing. This Agreement is personal to the Client, and shall not be transferred or assigned, directly or indirectly. Any purported transfer or assignment of this Agreement shall be null and void.

Loss Protection Plan (optional) *

If you select Yes the plan information will be provided below. Tick the option below to accept this plan at an additional $8.14 per month.

Loss Protection Plan Acceptance *

I agree that by submitting this form I accept the Loss Protection Plan as detailed here. LOSS PROTECTION PLAN: The Client acknowledges and accepts financial responsibility for any damage to or loss of the System, however caused. GUARDIAN offers the Client an optional Loss Protection Plan. The Client may accept the Loss Protection Plan by signing in the space provided under this clause. If the Client does not accept the offer of the Loss Protection Plan, this clause does not bind the Client or GUARDIAN, but the rest of this Agreement is unaffected. If the Client accepts the Loss Protection Plan, the Client agrees to pay the Loss Protection Plan fee of $8.14 per month. If the Equipment is lost or damaged the Client’s financial responsibility for damage to or loss of the Equipment is limited to a maximum of $250.00 per occurrence. However, the Loss Protection Plan does not cover the Client’s financial responsibility for damage to or loss of the Equipment caused by a wilful act or omission on the part of the Client or other permitted users of the Vehicle. The Client must present a copy of a Police report, along with any other evidence of loss, and pay the $250.00 liability limit within 72 hours of loss. The Loss Protection Plan is in addition to all other fees under this Agreement and payment of the Loss Protection Plan fees cannot be credited to any outstanding lease fees even if the Client does not make a claim on the Loss Protection Plan.

HIRE PERIOD

Term of Hire *

Hire Commencement Date *

Hire Termination Date *

DEVICE SETTINGS

The AL-100 can be customised to a clients requirements using the Digisoft software. The recommended settings are displayed by default. Please complete all fields and contact Guardian on 02 8853 6200 if you have any queries regarding the settings

Service Date (1 – 730 days) *

Grace Period (1 – 250 days or OFF) *

Period before device will lock out after calibration expiry

Retest / Multi-Retest *

Retest requests after initial test to start vehicle

Retest Time Minimum (1-250 minutes) *

Minimum time before a retest will be requested after starting the vehicle

Retest Time Maximum (2-250 minutes) *

Minimum time before a retest will be requested after starting the vehicle

Multi-Retest Time Minimum (1-250 minutes) *

Minimum time before a second or subsequent retest will be requested after starting the vehicle

Multi-Retest Time Maximum (2-250 minutes) *

Minimum time before a second or subsequent retest will be requested after starting the vehicle

Start Period (1-60 minutes) *

Period after an initial test when vehicle will start

Restart Period (1-240 minutes) *

Period after the vehicle is turned off when vehicle can be restart without a breath test

First Blocking Time (1-60 minutes) *

Period device will temporarily lockout after a failed test

Second Blocking Time (1-60 minutes) *

Period device will temporarily lockout after a failed test

Blocking Limit *

BAC Reading at which interlock will temporarily lockout

Unit of Measure *

Reading measure

Display Mode *

Display mode Pass/Fail – please note this will display in the download. No BAC result will display.

Blow Level *

Litres of air required for test

Type of Blow *

Blowing method for test

Door Trigger *

Enables the unit to wake up when door opens

Alarm Relay *

Enables alarm on failed test

Retest Alarm *

Enables alarm on missed retests. Device allows 6 minutes to take a retest – if not taken and alarm is triggered it will allow and 15 minutes to take the test. It can be installed without lights or horns connected so any alarm is only from the device itself.

Driver Change *

Enables Driver Change to be recorded

Pin Code Override *

Enable pin code to be entered to disable interlock for nominated period

Pin Code time (1 – 2200 hours) *

Time interlock will remain overridden for. One time use – interlock must be serviced by Guardian before time expires.

Pin Code

Nominate pin code for override. A default code will be used if no pin nominated. A record of the pin will be held by Guardian. Please advise in notes if user should not be provided PIN in emergency situation.

Pin Code – Engine Blocked / Unblocked *

Requires pin code to be entered to enable test and engine start

Pin Code – Engine Blocked / Unblocked

Nominate 4 digit pin code for Engine Blocked / Unblocked.

Comments / Notes

Add any additional comments here

Agreement Submission Date