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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) 驱动程序认证业务的车辆( s 使用) See Instructions on page 3. 见第 3

40、 页说明。Return To: 返回到:Human Resources & Risk Management 人力资源及风险管理SDSU Research Foundation SDSU 研究基金会5250 Campanile Drive 5250 钟楼驱动器San Diego, CA 92182-1945 加利福尼亚州圣迭戈 92182-1945Project: 项目:Supervisor: 主管:Phone: 电话:I hereby certify that, whenever I drive an SDSU Research Foundation (SDSURF) owned vehicl

41、e or a privately owned vehicle on SDSURF business: 我在此证明,当我驾车一 SDSU 研究基金 会( SDSURF )自备车辆 , 或对 SDSURF 民营汽车企业:I will have a valid drivers license in my possession in accordance with California State law, 我将 在我在美国加利福尼亚州依法拥有有效的驾驶执照,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. 这款车将责任保险覆盖至少 受加利福尼亚州法律规定的最低数额。 我将在车辆的驾驶时, 如车辆需要法第 16020 次 , 目 前所有车辆登记和保险证明。I will carry only passengers who

43、 are also on SDSURF business, 我会继续谁上 SDSURF 业务也 只乘客,The vehicle will be equipped with safety belts in good operating condition and all passengers will be required to wear them, 这款车将配备安全带的良好运作状态, 所有乘客必须穿,The vehicle will be appropriate for the work performed, and 这款车将适当完成的工作,和 To the best of my knowl

44、edge, the vehicle will be in safe mechanical condition as required by law. 据我所知,将在汽车安全机械状况所要求的法律。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.我还证明,虽然使用任何官方 SDSURF 商务车,所有的事故报告将在24 小时内( 619) 594-0858向 SDSURF 风险管理办公室。据我所知 , 允许驾驶的车辆上 SDSURF 业务是一种特权, 这可能会被暂停或撤销在任何时间, 而驾驶 SDSURF 业务不作为上述会议被认为是 SDSURF一辆私人汽车。违反政策 , 并可能采取纪律行动的理由,直至并包括终止雇用的要求Section A - Choose the applicable driving option from the follow

47、ing: A节 -选择从以下适用的驱动选项:I will never drive any vehicle on SDSURF business. (If checked, proceed to and complete SectionC) 我绝对不会推动任何 SDSURF 商务车。(如果选中,开始并完成 C 节)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) 我将驾驶少于每

48、周 2 次 , 并同意提供保险证明。 (如果选中,开始并完成第 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) 我将驾驶 SDSURF 业务 , 作为我工作的一部分 , 至少每星期 2 次 , 并同意 提供保险证明,否则我将驾驶10, 12 或 15 个客运车,可以提供 B 级许可证明,并同意提供保险证明。(如果选中,开始并完成第 B, C和D)Section B: License and insurance information: B 节:执照和保险资料:Drivers License Number:State: Expiration Date: 驾驶执照号码:国家:截止日期:Insurance Carrier Name:P

50、olicy Expiration: 保险运营商的名称:政策到期日:Policy Number:Policy Period: 保单号码:政策时期:Section C. Employee acknowledgment: C 节员工承认:Acknowledgment - If requested I agree to provide my current Motor Vehicle Record to SDSURF within 3 working days. 确认 -如果要求我同意提供 3 个工作日内我目前的机动车记录的 SDSURF 。Employee Signature:Date: 员工签名:

51、日期:Print Name and Red ID:Date 打印名称和红色编号:日期Section D: Authorization for release of information: D 节:为信息发布授权:Employer Pull Notice Program Authorization for Release of Driver Record Information 雇主拉的 驱动程序授权发布公告记录信息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). 本人授权的汽车( DMV )的加州披露或以其他方式提供,我的驾驶 记录,我的雇主,圣地亚哥州立大学研究基金会( 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. 据我所知 , 我的雇主将参加在雇 主拉公告( EPN 公司)计划 , 以获得驱动程序记录报告一次 , 至少 12(12)个月或我 再犯时,未能出现意外,驾驶

54、执照吊销,撤销,或任何其他采取行动 , 对我的驾驶在我工 作的特权。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. 我驾驶的能力 , 需要注册参与 EPN 公司计划根据加州州立大学 风险管理委员会( CSURMA )政策和程序 1 抗氧化能力。据我所知 , 在 EPN 公司注册程 序 , 是为了促进车手的安全, 而我驾驶执照的报告将发表在我的雇主 , 以确定作为我的 就业许可的驱动程序我的资格。Executed at City: County: Stat

56、e: 执行在城市:县:国家:Date: Employee Signature: 日期:员工签字:For HR Use Only: 对于仅使用人力资源:Proof of insurance verified: 保险证明验证:Yes 是No 否DMV Report Requested: 机动车管理局要求的报告: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 机

57、动车管理局员工拉公告程序 /汽车保险和车辆 SDSU 研究基金 会使用 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. 加州州立大学风险管理委员会 ( CSURMA )的政 策和程序要求SDSU研究基金会(SDSURF),以向他们提供证件,所有的员工谁驾驶 SDSU研究基金会的业务车辆持有有效的驾驶执照。 文件还规定 , 个人是谁使用的自己的车辆保 持目前的车辆主要是汽车覆盖。 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. 这项规定适用于个人 是否是驾驶自己的车辆 , 偶尔在 SDSU 研究基金会的业务或驾驶的车辆是否是他们 SDSU 研究基金会的就业要求

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