CHICAGO PARK SCHOOL DRIVER CERTIFICATION FORM
CHICAGO PARK DISTRICT DRIVER CERTIFICATION FORM
Student: Grade:
DRIVER (must be at least 21 years of age) (circle one) Parent Employee Volunteer
Name:
Address:
No. & Street City Zip
Home Phone #: Work #: Cell #:
Drivers License #: Expiration Date:
VEHICLE
Name of Registered Owner:
Address:
Year : Make & Model: Color:
License Plate #: Registration Expires: No. Seat Belts :
(Other than driver)
Passenger air bag(s)? ________
INSURANCE INFORMATION
Insurance Company: Policy #: Expiration Date:
Liability Limits of Policy
(per person) (per accident) (property damage)
|According to Board Policy 3541.1, drivers are required to possess a valid California driver's license or a valid driver’s license from his/her state of |
|residence if he/she is a non-resident on active military duty in California. A driver shall be required to have a good driving record and at least the |
|District required minimum liability insurance per occurrence, which is $100,000 per person, $300,000 per accident/bodily injury and $50,000 property damage. |
|The driver also ensures that manufacturer’s recommendations for his/her vehicle are followed regarding the seating of children in seats equipped with |
|airbags. All drivers shall wear seat belts in accordance with the law. In addition, drivers shall ensure that a child who is under age 8, be secured in a car|
|or booster, unless exempted by law and, all other passengers wear seat belts. Whenever said vehicle is used for student transportation, the driver will |
|maintain it in a safe operating condition; drive in a safe and courteous manner; and, follow prescribed routes and timelines to the best of his/her ability. |
Name of Agent: Phone #:
I certify that the information given above is true and correct. I understand that if an accident occurs, as the registered owner, my insurance coverage and I shall bear primary responsibility for any losses or claims for damages. I have read and understand the information provided in the attached Driver Instruction Form and will keep this form in my car when transporting students. I agree to provide a copy of my driver’s license, insurance policy showing my liability limits, and my DMV driving record. You can obtain your driving record at
Signature: Date:
PLEASE RETURN COMPLETED FORM WITH COPIES OF YOUR DMV DRIVING RECORD, INSURANCE POLICY SHOWING LIABILITY LIMITS AND YOUR DRIVER’S LICENSE.
................
................
In order to avoid copyright disputes, this page is only a partial summary.
To fulfill the demand for quickly locating and searching documents.
It is intelligent file search solution for home and business.
Related download
Related searches
- fedloan employment certification form pslf
- pslf employment certification form pdf
- galena park school taxes
- prometric renewal certification form arkansas
- medical certification form fmla
- pslf employer certification form 2020
- pslf employment certification form 2020
- employment certification form pslf fedloan
- fmla medical certification form 2020
- teach grant certification form download
- pslf employment certification form 2019
- employment certification form public service