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Conditions of Acceptance and Agreement
for TDAP Speech Generating Devices
Please READ and SIGN the form that indicates you
understand and agree to comply with the following conditions
upon acceptance of all TDAP Speech Generating Devices (Equipment):
n All Equipment is the property of the State of Oregon and I will use it in compliance with Oregon laws and
regulations, including Oregon Administrative Rule Chapter 860 Division 033.
n I will not offer for sale, sell, give away, or loan any Equipment to anyone. I am financially responsible for any
damage to any Equipment that is not caused by normal wear and tear or acts of nature or disaster. [Note: A
price list of the most current prices for previously used and current Equipment is available upon request.]
n I am responsible for the appropriate care of all Equipment and will use it for accessing telephone and related
services.
n I will not remove the protective case from the Equipment. I will not damage or deface the Equipment (e.g.,
removing any property of Oregon identifying labels, altering the laser etching, etc.).
n I understand that the Equipment may have a web filter installed to prohibit access to websites containing
unlawful, adult or inappropriate content. The TDAP office and TDAP Vendors have my permission to monitor
the Equipment to ensure proper use.
n I will return defective or damaged Equipment at the PUC’s expense. The PUC will repair or replace the returned
Equipment at its discretion.
n If any Equipment is stolen, I will notify the local law enforcement agency within 24 hours of the time the theft is
discovered. I will provide a copy of the police report to the TDAP office within five (5) business days of the date
that I reported the theft.
n If floods, storms, fire, or other acts of nature damage the Equipment, I will submit a fire department, insurance,
police or other appropriate report about the event to the TDAP office within five (5) business days after the date
the event occurred.
n If I move to another place in Oregon, I will report my new address to the TDAP office within thirty (30) calendar
days of the move.
n I am responsible for the purchase of Equipment supplies, such as headphones, and the costs related to the
use of the Equipment, such as Wi-Fi service.
n I will return all Equipment to the TDAP office before I permanently move out of Oregon. I am liable for the
replacement cost of any Equipment I fail to return before moving out of Oregon.
n I will obtain written permission from PUC’s TDAP Manager before I travel out of the State of Oregon with any
Equipment for more than 90 days.
n If I have signed this Agreement on behalf of a minor or as a guardian for an adult, I will notify the TDAP office
about a change in responsibility within five (5) calendar days of the event (for example, the minor reaches 18 or
there is a change of guardian). I understand that TDAP will bill me for any Equipment if the minor does not sign
a new Condition of Acceptance and Agreement within 30 calendar days after the minor’s 18th birthday and I
am responsible for paying that bill.
n I understand that all Equipment is provided on a “first come, first served” basis and its availability is
contingent upon adequate funding.
All statements I have made in this application are
true and correct to the best of my knowledge.
Signature of Applicant or Parent / Guardian (If Applicant is under 18) Date
*Please provide a copy of the Power of Attorney/guardianship documentation if signing on behalf of applicant.
FM608SGD (Revised 01/22/2020)
