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1、Driver Certification for Business Use of Vehicle(s) See Instructions on page 3.Return To:Human Resources & Risk Management SDSU Research Foundation5250 Campanile DriveSan Diego, CA 92182-1945Project:Supervisor:Phone: I hereby certify that, whenever I drive an SDSU Research Foundation (SDSURF) owned
2、vehicle or a privately owned vehicle on SDSURF business:1. I will have a valid drivers license in my possession in accordance with California State law,2. The vehicle will be covered by liability insurance for at least the minimum amount prescribed by California law. I will have a current vehicle re
3、gistration and proof of insurance in the vehicle at all times while driving, as required by Vehicle Code Section 16020.3. I will carry only passengers who are also on SDSURF business,4. The vehicle will be equipped with safety belts in good operating condition and all passengers will be required to
4、wear them,5. The vehicle will be appropriate for the work performed, and6. To the best of my knowledge, the vehicle will be in safe mechanical condition as required by law.I further certify that, while using any vehicle for official SDSURF business, all accidents will be reported within 24 hours to
5、the SDSURF Risk Management Office at (619) 594-0858. I understand that permission to drive a vehicle on SDSURF business is a privilege, which may be suspended or revoked at any time, and that driving a personal vehicle on SDSURF business without meeting the requirements as stated above is considered
6、 a violation of SDSURF policy and may be grounds for disciplinary action, up to and including termination of employment.Section A - Choose the applicable driving option from the following:?I will never drive any vehicle on SDSURF business. (If checked, proceed to and complete Section C)?I will drive
7、 less than 2 times per week and agree to provide proof of insurance. (If checked, proceed to and complete Sections B and C)?I will drive on SDSURF business as part of my job at least 2 times per week and agree to provide proof of insurance, or I will drive a 10, 12 or 15 passenger van, can provide p
8、roof of Class B license, and agree to provide proof of insurance. (If checked, proceed to and complete Sections B, C and D)Section B: License and insurance information:Drivers License Number:State:Expiration Date:Insurance Carrier Name:Policy Expiration:Policy Number:Policy Period:Section C. Employe
9、e acknowledgment:Acknowledgment - If requested I agree to provide my current Motor Vehicle Record to SDSURF within 3 working days.Employee Signature:Date:Print Name and Red ID:Date Section D: Authorization for release of information:Employer Pull Notice Program Authorization for Release of Driver Re
10、cord InformationI hereby authorize the California Department of Motor Vehicles (DMV) to disclose or otherwise make available, my driving record, to my employer, San Diego State University Research Foundation (SDSURF).I understand that my employer will enroll me in the Employer Pull Notice (EPN) Prog
11、ram to receive a driver record report at least once every twelve (12) months or when any subsequent conviction, failure to appear, accident, drivers license suspension, revocation, or any other action is taken against my driving privilege during my employment.I am driving in a capacity that requires
12、 enrollment in the EPN Program pursuant to California State University Risk Management Authority (CSURMA) Policy and Procedure 1-AOC. I understand that enrollment in the EPN program is an effort to promote driver safety, and that my driver license report will be released to my employer to determine
13、my eligibility as a licensed driver for my employment. Executed at City:County:State:Date:Employee Signature:For HR Use Only:Proof of insurance verified:?Yes?NoDMV Report Requested:?Yes?NoDate Requested: DMV Employee Pull Notice Program/Automobile Insurance and the Use of Vehicles on SDSU Research F
14、oundation BusinessCalifornia State University Risk Management Authority (CSURMA) policies and procedures require SDSU Research Foundation (SDSURF) to provide them with documentation that all employees who drive vehicles on SDSU Research Foundation business hold a valid drivers license. Also required
15、 is documentation that individuals who use their own vehicles maintain current primary automobile coverage on that vehicle. This requirement applies whether the individual is driving their own vehicle only occasionally on SDSU Research Foundation business or whether driving their vehicle is a requirement of their SDSU Research Foundation employment.Additionally, CSURMA policy requires SDSURF to enroll employees who drive on SDSURF business more than once a week or whose primary duty is driving-related in the Department of Motor Vehicles Employee Pull Notice Program (DMV-EPN). This in
