Honda Takata Air Bag Agreement

AUTOMOBILE DIVISION
American Honda Motor Co., Inc.

1919 Torrance Blvd., - P.O. Box 2215
Torrance, CA 90509-9870
_____________________
Date
HONDA TAKATA AIRBAG INFLATOR REPLACEMENT

VEHICLE RETENTION/STORAGE OWNER INDEMNIFICATION AGREEMENT
I, ___________________________________________ am the owner/lessee of a _________ model year Honda
Year
Name
____________________________________________, VIN ____________________________________________

Model
(Subject Vehicle).
I am aware that the Subject Vehicle is subject to an important safety recall notice issued by American
Honda Motor Co, Inc. ("Honda")
I am aware that Honda has decided that a defect which relates to motor vehicle safety may exist in the Subject
Vehicle. In some vehicles, the driver's or passenger's front airbag inflator could produce excessive internal
pressure upon deployment. If an affected airbag deploys, the increased internal pressure may cause the inflator
to rupture and deploy abnormally. In the event of an inflator rupture, metal fragments could pass through the
airbag cushion material possibly causing serious injury or fatality to vehicle occupants.
I understand that the Subject Vehicle's driver's and/or passenger's front airbag inflator is required to be replaced
under the recall described above ("Subject Recall Repair"). I also understand that the replacement airbag inflator
needed to make the Subject Recall Repair is not available at this time. I have therefore elected to drive a loaner
car provided through an authorized Honda dealership ("Dealership") until the Subject Recall Repair(s) can be
completed.
I also understand that Honda's policy is that the Dealership retain the Subject Vehicle at the Dealership until the
parts necessary to complete the Subject Recall Repair are available.
I wish to retain the Subject Vehicle in my possession until the parts necessary to complete the Subject Recall
Repair become available. I understand this deviates from Honda's requirement that the Dealership retain the
Subject Vehicle. In order to obtain the consent of Honda and the Dealership to my retention of the Subject
Vehicle until the parts become available for the Subject Recall Repair(s), I specifically and knowingly make the
following agreements:
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I agree to not drive the Subject Vehicle while it is in my possession, custody, or control until the Subject
Recall Repair is completed other than directly to or from the Dealership.
I agree to not allow the Subject Vehicle to be driven by others, and will ensure that all keys/key fobs to
the vehicle are inaccessible to all others, until the Subject Recall Repair is completed.
I agree either to drive the Subject Vehicle directly to its place of storage or to allow the Dealership to tow
the Subject Vehicle from the Dealership to my home, at no cost to me.
I agree either to drive the Subject Vehicle directly to the Dealership or to allow the Dealership to tow the
Subject Vehicle to the Dealership after the Dealership notifies me that the parts necessary to complete
the Subject Recall Repair have become available, at no cost to me.
I agree to maintain possession of the Subject Vehicle and will not sell, alter, or modify the Subject Vehicle
until such time as the Subject Recall Repair is performed.
Should I lose possession of the Subject Vehicle before the Subject Recall Repair is performed, I agree to
notify the Dealership immediately, and no later than 24 hours after I have lost possession of the Subject
Vehicle.
I agree that I will be responsible if I cause the Subject Vehicle to be driven other than directly to or from
the Dealership prior to the performance of the Subject Recall Repair.
MY SIGNATURE BELOW INDICATES MY AGREEMENT:
_________________________________________________________________
Name (sign name)
_________________________________________________________________
Name (print name)
_________________________________________________________________
Address
_________________________________________________________________
City
State
Zip Code
_________________________________________________________________
Telephone Number
Select One
_________________________________________________________________
Status i.e. owner, lessor, lessee, etc.
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AUTOMOBILE DIVISION

American Honda Motor Co., Inc.

HONDA TAKATA AIRBAG INFLATOR REPLACEMENT

, VIN

MY SIGNATURE BELOW INDICATES MY AGREEMENT:

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