Driver Certification for Business Use of Vehicle(s)
See Instructions on page 3.
Return To: Project: Human Resources & Risk Management
Supervisor: SDSU Research Foundation
5250 Campanile Drive Phone: San Diego, CA 92182-1945
I hereby certify that, whenever I drive an SDSU Research Foundation (SDSURF) owned vehicle 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 registration 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 wear them,
5. The vehicle will be appropriate for the work performed, and
6. 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 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 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
? 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)
? 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 to and complete Sections B, C and
Section B: License and insurance information:
Driver’s License Number: State: Expiration Date:
Insurance Carrier Name: Policy Expiration:
Policy Number: Policy Period:
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Section C. Employee 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 Record Information
I 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) Program 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 action is taken against my driving privilege during my employment.
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 that my driver license report will be released to my employer to determine 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:
DMV Report Requested:
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DMV Employee Pull Notice Program/Automobile Insurance and the Use of
Vehicles on SDSU Research Foundation Business
California 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 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 includes whether driving an SDSU Research Foundation owned vehicle or a privately owned vehicle on SDSURF business.
DMV Employee Pull Notice Program
The 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) upon enrollment in EPN program, 2) from the date of enrollment on an annual basis or 12 months from the last action/activity printout, and/or 3) whenever a driver has any of the following actions/activities added to his/her driver record:
2. Failures to appear,
4. Driver license suspensions or revocations or,
5. Any other actions taken against the driving privilege.
Driving Standards as a Condition of Employment
Drivers 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 the 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.
Please 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 requirement, 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 Drivers
If another state reports 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 Documentation
Employees classified as occasional drivers (less than 2 times per week), must present the documentation listed below:
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? A valid California driver’s license or equivalent to legally operate the class of vehicle(s) they operate
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’s minimum requirements. 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 Vehicle 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 driver's license with a passenger endorsement, 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.
You must carry liability insurance on your personal automobile at least in the minimum amounts required
by California 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 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 occasional 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 risk 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 State law.
? You must be covered by liability 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 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 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 Accident 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 required to purchase Mexican Auto Physical Damage and Liability Insurance, for the
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duration of their travel, from a reputable insurance company. SDSURF employees must also 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 Management upon request.
All 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 appreciate 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 violation 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.)
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