ࡱ> npor' &bjbj AFTdTdN  SSSSSggg8<Dgk5&"AAA4444444$7G:5S_"__5SSAAE%5!!!_FSASA4!_4!!&23A,R24;50k52::(3:S3 ! 554k5____: : AUTOMOBILE INSURANCE CERTIFICATION & DRIVER SAFETY POLICY CORPORATION SECTION 1 (FOR EMPLOYEES NOT DRIVING ON CORPORATION BUSINESS) NOT DRIVING ON Corporation BUSINESS (Complete this section only) I understand that I will not drive a car on Corporation ( Corporation) business. I understand that Corporation will not cover any liability incurred while driving privately owned vehicle(s). I am personally responsible for all liability that may be incurred. Print Name Signature Date  SECTION 2 (FOR ANYONE DRIVING ON Corporation BUSINESS) DRIVING A PRIVATE VEHICLE WHILE ON Corporation BUSINESS (Review entire document; complete and submit page 3 to Corporation) If you drive or will be driving a privately-owned vehicle on Corporation business, whether you are an employee or business associate (business associate is defined as an independent contractor or state employee on travel paid for by one of our project accounts), Corporation requires that you have liability insurance coverage for your vehicle and that you possess a valid California drivers license or equivalent to legally operate the class of vehicle(s). Additionally, we require the vehicle to be equipped with seat belts. For those who will be driving 15-passenger vans, the driver must possess a valid Class B drivers license. If you use your own car for Corporation business the normal practice of insurance carriers is to allow the occasional use of privately owned automobiles on business trips without an increase in premium rates. If the privately-owned automobile is used consistently on Corporation business, an employee or business associate should contact his/her insurance carrier who may change the premium class with a corresponding increase in premium rate. If a person had not notified his/her insurance carrier of the use of a private automobile on Corporation business and he/she has an accident, the insurance company must cover the accident unless deceit on the insurance application can be proven. Employees whose job duties require them to either drive a Corporation owned vehicle or use their privately-owned vehicle more than once per week are required to provide Corporation a current DMV driving report prior to driving. This will be done upon employment for new hires and when job duties change for current employees. Driver safety policy At the Corporation, safety and the well being of all employees and other business associates driving on Corporation business is of critical importance to us. It is our responsibility to not only protect ourselves when on the road operating a vehicle but also to do our part to protecting those around us. Employees or Business Associates that drive any vehicle (either their own or one that is Corporation owned) on Corporation business for any reason at any time will be expected to consistently follow the procedures outlined below. All drivers and passengers are expected to wear seat belts at all time while in a moving vehicle being used for Corporation business; Use of handheld cell phones, smart phones (text messaging or emailing), or other similar communication devices whether personal or business-owned, while behind the wheel of a moving vehicle being used on Corporation business is strictly prohibited. The use of hands-free technology may be warranted and used if the driver has taken the proper steps to ensure they are able to drive safely and use the hands-free device; Engaging in other distracting activities including, but not limited to, eating, putting on makeup, reading or changing radio stations or music, is also strongly discouraged while driving, even when in slow-moving traffic; Use of alcohol, drugs or other substances, including certain over-the-counter cold or allergy medications that in any way impair driving ability, is prohibited; All drivers are expected to follow all driving laws and safety rules such as adherence to posted speed limits and directional signs, use of turn signals and avoidance of confrontational or offensive behavior while driving; All drivers should never allow anyone to ride in any part of the vehicle not specifically intended for passenger use and/or any seat that does not include a working seat belt; All drivers who drive commercial vehicles or who are otherwise subject to separate rules and regulations such as those dictated by state or federal law are also expected to adhere to all policies and regulations associated with the appropriate law or regulation that applies; All drivers must promptly report any accidents to local law enforcement as well as to Corporation in accordance with established procedures; All drivers are also expected to report any moving or parking violations received while driving on company business and/or in company vehicles; and Failure to adhere to these procedures may result in disciplinary action up to and including termination of employment or termination of the business relationship with Corporation. CERTIFICATION Corporation must receive this certification if you wish to be authorized to use a privately-owned vehicle on Corporation business and to be eligible to be reimbursed for mileage costs. You will need to notify Corporation in case of a liability claim, while on Corporation business, or if there is any lapse in your insurance coverage. You are not authorized to drive on Corporation business if there is a lapse in your insurance coverage. I certify that I have liability insurance coverage in at least the following amounts (prescribed by State Law) for my private car(s) and that I will not use my car(s) for Corporation business if my insurance is canceled. $15,000 for personal injury/death of a person; $30,000 for personal injury/death of two or more persons in one accident; and $5,000 for property damage. I hereby certify that, whenever I drive a privately-owned motor vehicle on Corporation business, I will have a valid drivers license in my possession, I will carry only passengers who are also on Corporation business, all passengers will be required to wear safety belts, and the vehicle will always be: Covered by liability insurance that is adequate for the work to be performed and covered by the minimum amount prescribed by State Law. You must also maintain evidence of current automobile liability insurance in the vehicle at all times; Equipped with safety belts in good operating condition; and Operating in good mechanical working condition. I further certify that all accidents, while using a privately-owned vehicle on official Corporation business, will be reported within 24 hours to Corporation Human Resources at (760) 750-4700. Drivers License NumberStateExpiration Date  Name of Insurance CarrierExpiration Date  I understand that permission to drive a privately-owned vehicle on Corporation business is a privilege, which may be suspended or revoked at any time. I understand that driving without insurance is considered a violation of Corporation policy and may be grounds for employment termination or the termination of a business relationship (business associate relationship). I have read and understand the Driver Safety Policy outlined above and I agree to follow all driving safety policies and procedures of Corporation. Print Name Signature Date     PAGE  Page PAGE 1 of 3 Rev. September 2010 10-01-2002   "$%9:KLMNWv 9 < M O ŹŒwmg\T\h ?CJaJhmM'hmM'CJaJ hKJCJhq05>*CJ\hq05CJ\hDjP5CJ\h ?5CJ\h85CJ\h8hq05>*CJh ?5>*CJhmM'5>*CJh8h%5>*CJ hq0CJhq0h ?CJaJhwCJaJhwhwCJaJhwhq0CJaJhwhOCJaJ%:LMN  # E F H I J   bgd8 8gdmM'gd(gd%gdf+gdwO P Y [ m ~   ! 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I am personally responsible for all liabilit          2  0 y that may     2 "M 0 be incurred.  2 "0     2 4M0     2 GM0  0  2 G}0  0  2 G0  0  2 G0  0  2 G 0  0  2 G=0  0  2 Gm0  0  2 G0  0  2 G0  0  2 G0  0  2 G-0  0  2 G]0  0  2 G0  0  2 G0  @Times New Roman---- @ !IM-- @ !`I]- --- 2 YM 0 Print Name     2 Y0    2 Y0  0  2 Y0  0  2 Y 0  0 2 Y= 0 Signature   2 Yu0  (  2 Y0  0  2 Y0  0  2 Y0  0  2 Y-0  0 2 Y]0 Date   2 Yz0     2 lM0     2 ~M0     2 M0   ---  2 M0    2 M 0 SECTION 2    2 0   .2 0 (FOR ANYONE DRIVING ON        %2 0  Corporation    2  0   2  0 BUSINESS)    2 h0  - @ !M- ---  2 M0   --- @2 M#0 DRIVING A PRIVATE VEHICLE WHILE ON            %2 0  Corporation    2 &0   2 /0 BUSINESS    2 |0    2 0    2 M0 (Review    2 0   (2 0 entire document; co  22 0 mplete and submit page 3 t   2 0 o  %2 0  Corporation    2 a0 )  2 f0     2 M0   --- 2 M 0 If you drive  (2 0 or will be driving     2  0 a privately  2 O0 - %2 U0 owned vehicle on     %2 0  Corporation    2 S0   2 Z0 business 2 0 ,  2 0 whether   0'' L2 #M+0 you are an employee or business associate (  @2 #d#0 business associate is defined as an   2 #?0   ,2 #D0 independent contractor   2 #0    0'' p2 6MC0 or state employee on travel paid for by one of our project accounts   2 60 ) 2 60 ,  %2 60  Corporation    2 60    2 60 requires that   0'' R2 HM/0 you have liability insurance coverage for your    a2 Hx90 vehicle and that you possess a valid California drivers      0'' 22 [M0 license or equivalent to l  2 [P0 egally operate the class of vehicle(s). Additionally, we require the vehicle to       2 [0    0'' 82 mM0 be equipped with seat belts.   ,2 m0 For those who will be     2 m0 driving   2 m0 15  2 m0 - G2 m(0 passenger vans, the driver must possess    0'' =2 M!0 a valid Class B drivers license.    2 0    0''  2 M0    #2 M0 If you use your  2  0 own car for   2  0  Cor   2 R0 poration  2 0   2  0 business t M2 ,0 he normal practice of insurance carriers is     2 Md0 to allow the occasional use of privately owned automobiles on business trips without an increase in          ;2 M 0 premium rates. If the privately    2 0 - I2 )0 owned automobile is used consistently on       %2 )0  Corporation    2 0     2 M0 b )2 U0 usiness, an employee   2 0   +2 0 or business associate  2 c0   _2 j80 should contact his/her insurance carrier who may change      n2 MB0 the premium class with a corresponding increase in premium rate.        C2 %0 If a person had not notified his/her     42 M0 insurance carrier of the us  42 0 e of a private automobile o   2 0 n  %2 0  Corporation    2 00   42 70 business and he/she has an   2 Mg0 accident, the insurance company must cover the accident unless deceit on the insurance application can         2 %M 0 be proven.  2 %0   @Times New Roman---  2 7M0   ---  2 JM0 E  2 JV 0 mployees  S2 J00 whose job duties require them to either drive a   %2 J0  Corporation    2 JT0   &2 J[0 owned vehicle or u  2 J0 se   0'' 2 \M0 their  2 \g0   2 \n 0 privately  2 \0 - >2 \"0 owned vehicle more than once per w    52 \0 eek are required to provide  %2 \O0  Corporation    2 \0   2 \0 a   0'' A2 oM$0 current DMV driving report prior to    h2 oB>0 driving. 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