Authorization to Use Private Vehicle Club Sports Club Sports participants who will operate motorized vehicles on Club Sports business are required to be safe drivers and operate vehicles in a safe manner. This is your request to operate vehicles on Club Sports business only. You must have Club Sports Management’s permission to operate any vehicle on Club Sports business. You must understand that your continued participation as a driver for Club Sports is contingent upon satisfying each of the following. Before operating a vehicle on Club Sports business, you must first provide evidence of, and certify and maintain, the following: 1. You possess and maintain a valid State driver’s license (foreign licenses are not permitted). The driver’s license must be appropriate for the job and vehicle(s) to be operated (e.g., class A, B, C). 2. You have not received one or more DUI or reckless driving violation(s), or more than three moving violations and/or accidents, or combination thereof, in the past twelve-month period. 3. You have and maintain a good and safe driving record. AGREEMENT, CERTIFICATION, RELEASE, AND ACKNOWLEDGEMENT I understand and agree that I must possess and maintain a valid State driver’s license in order to operate vehicles on Club Sports business. I am in possession of a valid state driver’s license, and I understand that my continued participation as a driver for Club Sports is contingent upon maintaining a valid driver’s license. If at any time my driver’s license becomes suspended or revoked, I will notify the Club Sports Coordinator.

Club Sports Participant Signature: ______________________________________________ Date: __________

I. CERTIFICATION I hereby certify that, whenever I drive a privately owned vehicle on Club Sports business, I will have a valid driver's license and proof of liability insurance in my possession, all persons in the vehicle will wear safety belts and the vehicle shall always be: 1. Covered by liability insurance for the minimum amount prescribed by State Law ($15,000 for personal injury to, or death of one person; $30,000 for injury to, or death of, two or more persons in one accident; $5,000 property damage). Vehicle Code Section 16020 (effective July 1, 1985) requires all motorists to carry evidence of current automobile liability insurance in their vehicle. 2. My vehicle is equipped with safety belts in good operating condition. 3. To the best of my knowledge, my vehicle is in safe mechanical condition as required by law. I understand that permission to drive a privately owned vehicle on Club Sports business is a privilege, which may be suspended or revoked at any time. And that I must maintain updated copies in the Club Sports office in order to maintain driver permissions. Driver’s License Number

State

Expiration Date

Club Sports Participant’s Signature

Print Name

Date Signed

II. APPROVAL Approving Authority Signature

Use of privately owned vehicle on State business is approved. Title Date Approved

SAN JOSE STATE UNIVERSITY  Student Union, Inc. Club Sports Administration Office  290 South 7th Street  San Jose, CA 95192 Phone: (408) 924-6274  Fax: (408) 924-6390  Email: [email protected]