CERTIFICATION OF CONSENT TO THE TOWING AND RELEASE TO AN INSURER OF A MOTOR VEHICLE |
TO: ______________________________________________________________ ("Releasor") |
(Name of Tow Company or Person Currently in Possession of Vehicle Described Below) |
An insurer must obtain consent from the owner of a motor vehicle, or the owner's authorized agent, to take possession of the motor vehicle from an operator of a tow car. The owner's authorized agent must not be a representative, employee or other agent of the insurer. |
Vehicle Information |
Make: _______________ Model: _______________ Year: ______ VIN: __________________ |
Vehicle Owner: ________________________________________________________________ |
Owner's Authorized Agent (if applicable): _____________________________ |
Insurer: ______________________________________________________________________ |
Insurer's Employee or Authorized Representative: ____________________________ |
Policy Number: _______________________ Claim Number: ___________________________ |
STATEMENT OF CONSENT: "On behalf of the Insurer, I hereby warrant that the Insurer has obtained the explicit consent of the Vehicle Owner or the Owner's Authorized Agent to have the vehicle towed and released to the Insurer. I warrant that the Insurer has documented such consent and will be able to produce evidence of such documentation at the request of the Owner or the Owner's Authorized Agent. This form does not, in any manner, transfer ownership of the vehicle and does not waive any rights or prerogatives pertaining to such ownership. The Vehicle Owner retains all other rights, as provided under applicable Nevada law, to consent to the subsequent treatment of the vehicle within the Insurer's claim-handling process." |
STATEMENT OF INDEMNIFICATION: "On behalf of the Insurer, I hereby warrant that the Insurer will indemnify the Releasor for any liability relating to the release of the motor vehicle to the Insurer." |
AFFIRMATION OF TRUTH: "On behalf of the Insurer, I declare under penalty of perjury, and all other applicable penalties under Nevada law, that the foregoing is true and correct." |
_____________________________________________________________________________________ _____________________________ |
Employee of Insurer or Insurer's Authorized Representative Date |
__________________________________________________________ _____________________________________________________ |
(Name of tow company taking possession of vehicle on Insurer's behalf) (Telephone number of tow company taking possession of vehicle) |
_____________________________________________________________________________________________________________________ |
(Address of tow company taking possession of vehicle) |
No towing on behalf of the Insurer may commence until the consent of the Owner or the Owner's Authorized Agent has been obtained and this form has been completed by an employee of the Insurer or the Insurer's Authorized Representative. |
Nev. Admin. Code § 690B.380
NRS 679B.130, 706.4481