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1、Driver Certification for Business Use of Vehicle(s)See Instructions on page 3.Return To:Human Resources & Risk ManagementSDSU Research Foundation5250 Campanile DriveSan Diego, CA 92182-1945Project:Supervisor:Phone:I hereby certify that, whenever I drive an SDSU Research Foundation (SDSURF) owned veh
2、icle or a privately owned vehicle on SDSURF business:1. I will have a valid driver s 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 regi
3、stration 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 we
4、ar 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 th
5、e 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 a
6、 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 completeSection C)? I will drive l
7、ess 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 proo
8、f of ClassB 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:Driver s 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:DateSection D: Authorization for release of information:Employer Pull Notice Program Authorization for Release of Driver Rec
10、ord 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) Progr
11、am to receive a driver record report at least once every twelve (12) months or when any subsequent conviction, failure to appear, accident, driver s license suspension, revocation, or any other actionis 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 m
13、y 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 Resear
14、ch Foundation 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 requ
15、ired 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 re
16、quirement 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 includes
17、whether driving anSDSU Research Foundation owned vehicle or a privately owned vehicle on SDSURF business. DMV Employee Pull Notice ProgramThe DMV-EPN Program allows SDSURF to monitor the driver license records of employees who drive on behalf of SDSURF. The EPN Program generates a driver record 1) u
18、pon enrollment in EPN program, 2) from the date of enrollment on an annual basis or 12 months from the last action/activity printout, and/or3) whenever a driver has any of the following actions/activitiesadded to his/her driver record:1. Convictions,2. Failures to appear,3. Accidents,4. Driver licen
19、se suspensions or revocations or,5. Any other actions taken against the driving privilege.Driving Standards as a Condition of EmploymentDrivers on SDSURF business will have no more than three (3) driving record points for moving violations (speeding, failure to stop, etc.), no major violations in th
20、e previous three (3) years (reckless driving, etc.), or must not have been convicted of any alcohol-related or drug-related driving offense during the past three (3) years. These provisions apply even if the driving which result in acquiring the violation points was not in the course of employment.P
21、lease be aware that should your driving record change and a major violation (i.e., driving with a suspended license, driving while intoxicated, reckless driving, etc.) occurs you may be classified as an unacceptable driver and may not be allowed to drive on SDSURF business. If driving is a job requi
22、rement, you must immediately inform your supervisor and the Director of Human Resources & Risk Management. Failure to report a serious change in your motor vehicle record may result in disciplinary action, up to and including termination of your employment.Out of State DriversIf another state report
23、s action/activity to California on out-of-state licensed drivers or California licensed drivers, it will be stored on the driver record and reported to SDSU Research Foundation. Required DocumentationEmployees classified as occasional drivers (less than 2 times per week), must present the documentat
24、ion listed below:A valid California drivers license or equivalent to legally operate the celhaiscsleo(sf )vtheyoperate in their employment.? If permitted to use a personal vehicle in the course and scope of employment, proof of personal automobile liability coverage that meets California minsimum re
25、quirements. If not accessible, the individual will have 3 business days to provide such proof.An employee who is driving more than once a week on SDSURF business or whose primary duty is driving related is classified as a non-occasional driver and will be required to present an acceptable Motor Vehi
26、cle Record (MVR) prior to employment.Additionally, any individual driving a vehicle designed, used, or maintained for carrying more than 10 persons, including the driver for the purpose of transporting passengers on SDSURF business must possess a class B drivers license with a passenger endorsement,
27、 and will be subject to random drug testing in accordance with the Omnibus Transportation Act of 1991 and must comply with additional State and Federal regulations.Automobile InsuranceYou must carry liability insurance on your personal automobile at least in the minimum amounts required by Californi
28、a State law. If you are involved in an accident while on SDSURF business, your own personal automobile insurance will be primary in the event of a loss. SDSURF s insurance coverage is only applicable if the liability exceeds your personal liability insurance coverage. It is suggested you also carry
29、automobile physical damage comprehension and collision insurance sufficient to cover the reasonable value of the vehicle, less a standard deductible. SDSURF s insurance does not cover loss or damage to your vehicle, nor your deductible.It is the normal practice of insurance carriers to allow occasio
30、nal use of privately owned vehicles on business trips without an increase in premium rates. Please check your vehicle insurance policy for specific coverage provided. If your vehicle is used consistently on SDSURF business, you should contact your insurance carrier who may require a change in the ri
31、sk class upon which your premium is calculated and this may result in a premium increase.Driver Requirements/Use of Vehicles While on SDSU Research Foundation Business? You must have a valid driver s license in your possession in accordance with California Statelaw.? You must be covered by liability
32、 insurance for at least the minimum amount prescribed by State law. You must have a current vehicle registration and proof of insurance in the vehicle at all times while driving. Vehicle Code Section 16020 (effective July 1, 1985) requires all motorists to carry in the vehicle evidence of financial
33、responsibility in effect for the vehicle.? While on SDSURF business, you should carry only passengers in the vehicle who are also on business with you. No friends, relatives or children should be in the vehicle while you are driving on SDSURF business. No exceptions!? Vehicle should be adequate for
34、the work performed and must be in safe mechanical condition as required by law.? Vehicle must be equipped with safety belts in good operating condition and all persons in the vehicle must be required to wear them.? If you are in an accident while on SDSURF business, you must complete a Vehicle Accid
35、ent Report and report the accident within 24 hours to the SDSURF Risk Management office at (619) 594-0858.Travel into Mexico on SDSURF Business Requires Additional Proof of Insurance Before driving your personal vehicle, or an SDSURF vehicle, into Mexico on SDSURF business, all employees are require
36、d to purchase Mexican Auto Physical Damage and Liability Insurance, for the duration of their travel, from a reputable insurance company.SDSURF employees mustalso keep copies of the policy, and a receipt for purchase of the insurance while in Mexico and be able to submit copies to SDSURF Risk Manage
37、ment upon request.IMPORTANTAll SDSURF employees are required to sign the ” Driver Certification for Business Use of Vehicle(s) ” form in order to meet the requirements of CSURMA policies and procedures. We will continue to ask you to provide us with updated information on an annual basis and appreci
38、ate your cooperation in doing so. If you currently do not own a car or drive your own car or a rental car on SDSURF business, please indicate that on the form. Please be aware that driving your own personal vehicle on SDSURF business without meeting the requirements as stated above is considered a v
39、iolation of SDSURF policy and may be grounds for disciplinary action, up to and including termination of your employment.(Driver Certification for Business Use of Vehicle(s) form begins on page 1.)Driver Certification for Business Use of Vehicle(s) 驅(qū)動程序認(rèn)證業(yè)務(wù)的車輛( s 使用) See Instructions on page 3. 見第 3
40、 頁說明。Return To: 返回到:Human Resources & Risk Management 人力資源及風(fēng)險(xiǎn)管理SDSU Research Foundation SDSU 研究基金會5250 Campanile Drive 5250 鐘樓驅(qū)動器San Diego, CA 92182-1945 加利福尼亞州圣迭戈 92182-1945Project: 項(xiàng)目:Supervisor: 主管:Phone: 電話:I hereby certify that, whenever I drive an SDSU Research Foundation (SDSURF) owned vehicl
41、e or a privately owned vehicle on SDSURF business: 我在此證明,當(dāng)我駕車一 SDSU 研究基金 會( SDSURF )自備車輛 , 或?qū)?SDSURF 民營汽車企業(yè):I will have a valid drivers license in my possession in accordance with California State law, 我將 在我在美國加利福尼亞州依法擁有有效的駕駛執(zhí)照,The vehicle will be covered by liability insurance for at least the mini
42、mum amount prescribed by California law. I will have a current vehicle registration and proof of insurance in the vehicle at all times while driving, as required by Vehicle Code Section 16020. 這款車將責(zé)任保險(xiǎn)覆蓋至少 受加利福尼亞州法律規(guī)定的最低數(shù)額。 我將在車輛的駕駛時(shí), 如車輛需要法第 16020 次 , 目 前所有車輛登記和保險(xiǎn)證明。I will carry only passengers who
43、 are also on SDSURF business, 我會繼續(xù)誰上 SDSURF 業(yè)務(wù)也 只乘客,The vehicle will be equipped with safety belts in good operating condition and all passengers will be required to wear them, 這款車將配備安全帶的良好運(yùn)作狀態(tài), 所有乘客必須穿,The vehicle will be appropriate for the work performed, and 這款車將適當(dāng)完成的工作,和 To the best of my knowl
44、edge, the vehicle will be in safe mechanical condition as required by law. 據(jù)我所知,將在汽車安全機(jī)械狀況所要求的法律。I further certify that, while using any vehicle for official SDSURF business, all accidents will be reported within 24 hours to the SDSURF Risk Management Office at (619) 594-0858. I understand that perm
45、ission 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 a violation of SDSURF policy and may be grounds for disciplinary action, u
46、p to and including termination of employment.我還證明,雖然使用任何官方 SDSURF 商務(wù)車,所有的事故報(bào)告將在24 小時(shí)內(nèi)( 619) 594-0858向 SDSURF 風(fēng)險(xiǎn)管理辦公室。據(jù)我所知 , 允許駕駛的車輛上 SDSURF 業(yè)務(wù)是一種特權(quán), 這可能會被暫?;虺蜂N在任何時(shí)間, 而駕駛 SDSURF 業(yè)務(wù)不作為上述會議被認(rèn)為是 SDSURF一輛私人汽車。違反政策 , 并可能采取紀(jì)律行動的理由,直至并包括終止雇用的要求Section A - Choose the applicable driving option from the follow
47、ing: A節(jié) -選擇從以下適用的驅(qū)動選項(xiàng):I will never drive any vehicle on SDSURF business. (If checked, proceed to and complete SectionC) 我絕對不會推動任何 SDSURF 商務(wù)車。(如果選中,開始并完成 C 節(jié))I will drive less than 2 times per week and agree to provide proof of insurance. (If checked, proceed to and complete Sections B and C) 我將駕駛少于每
48、周 2 次 , 并同意提供保險(xiǎn)證明。 (如果選中,開始并完成第 B 和 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 proof of Class B license, and agree to provide proof of insurance. (If checked, proceed
49、 to and complete Sections B, C and D) 我將駕駛 SDSURF 業(yè)務(wù) , 作為我工作的一部分 , 至少每星期 2 次 , 并同意 提供保險(xiǎn)證明,否則我將駕駛10, 12 或 15 個(gè)客運(yùn)車,可以提供 B 級許可證明,并同意提供保險(xiǎn)證明。(如果選中,開始并完成第 B, C和D)Section B: License and insurance information: B 節(jié):執(zhí)照和保險(xiǎn)資料:Drivers License Number:State: Expiration Date: 駕駛執(zhí)照號碼:國家:截止日期:Insurance Carrier Name:P
50、olicy Expiration: 保險(xiǎn)運(yùn)營商的名稱:政策到期日:Policy Number:Policy Period: 保單號碼:政策時(shí)期:Section C. Employee acknowledgment: C 節(jié)員工承認(rèn):Acknowledgment - If requested I agree to provide my current Motor Vehicle Record to SDSURF within 3 working days. 確認(rèn) -如果要求我同意提供 3 個(gè)工作日內(nèi)我目前的機(jī)動車記錄的 SDSURF 。Employee Signature:Date: 員工簽名:
51、日期:Print Name and Red ID:Date 打印名稱和紅色編號:日期Section D: Authorization for release of information: D 節(jié):為信息發(fā)布授權(quán):Employer Pull Notice Program Authorization for Release of Driver Record Information 雇主拉的 驅(qū)動程序授權(quán)發(fā)布公告記錄信息I hereby authorize the California Department of Motor Vehicles (DMV) to disclose or otherw
52、ise make available, my driving record, to my employer, San Diego State University Research Foundation (SDSURF). 本人授權(quán)的汽車( DMV )的加州披露或以其他方式提供,我的駕駛 記錄,我的雇主,圣地亞哥州立大學(xué)研究基金會( SDSURF ) 。I understand that my employer will enroll me in the Employer Pull Notice (EPN) Program to receive a driver record report a
53、t 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. 據(jù)我所知 , 我的雇主將參加在雇 主拉公告( EPN 公司)計(jì)劃 , 以獲得驅(qū)動程序記錄報(bào)告一次 , 至少 12(12)個(gè)月或我 再犯時(shí),未能出現(xiàn)意外,駕駛
54、執(zhí)照吊銷,撤銷,或任何其他采取行動 , 對我的駕駛在我工 作的特權(quán)。I am driving in a capacity that requires 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 t
55、hat my driver license report will be released to my employer to determine my eligibility as a licensed driver for my employment. 我駕駛的能力 , 需要注冊參與 EPN 公司計(jì)劃根據(jù)加州州立大學(xué) 風(fēng)險(xiǎn)管理委員會( CSURMA )政策和程序 1 抗氧化能力。據(jù)我所知 , 在 EPN 公司注冊程 序 , 是為了促進(jìn)車手的安全, 而我駕駛執(zhí)照的報(bào)告將發(fā)表在我的雇主 , 以確定作為我的 就業(yè)許可的驅(qū)動程序我的資格。Executed at City: County: Stat
56、e: 執(zhí)行在城市:縣:國家:Date: Employee Signature: 日期:員工簽字:For HR Use Only: 對于僅使用人力資源:Proof of insurance verified: 保險(xiǎn)證明驗(yàn)證:Yes 是No 否DMV Report Requested: 機(jī)動車管理局要求的報(bào)告:Yes 是No 否Date Requested: 日期要求:DMV Employee Pull Notice Program/Automobile Insurance and the Use of Vehicles on SDSU Research Foundation Business 機(jī)
57、動車管理局員工拉公告程序 /汽車保險(xiǎn)和車輛 SDSU 研究基金 會使用 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 driv
58、ers license. Also required is documentation that individuals who use their own vehicles maintain current primary automobile coverage on that vehicle. 加州州立大學(xué)風(fēng)險(xiǎn)管理委員會 ( CSURMA )的政 策和程序要求SDSU研究基金會(SDSURF),以向他們提供證件,所有的員工誰駕駛 SDSU研究基金會的業(yè)務(wù)車輛持有有效的駕駛執(zhí)照。 文件還規(guī)定 , 個(gè)人是誰使用的自己的車輛保 持目前的車輛主要是汽車覆蓋。 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. 這項(xiàng)規(guī)定適用于個(gè)人 是否是駕駛自己的車輛 , 偶爾在 SDSU 研究基金會的業(yè)務(wù)或駕駛的車輛是否是他們 SDSU 研究基金會的就業(yè)要求
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