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Hope ESD  |  E  3541.1  Business and Noninstructional Operations

School-Related Trips   

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SCHOOL DRIVER CERTIFICATION FORM

DRIVER (circle one)

Employee Parent/Guardian Volunteer

Name______________________________________

Date of Birth________________________________

Address____________________________________

Driver+s License No.___________________________

Expiration Date______________________________

Telephone No. _(__)____________

VEHICLE

Name of Owner_______________________________

Year_______________________________________

Address____________________________________

Make______________________________________

License Plate No._____________________________

Registration Expires__________________________

Seating Capacity_____________________________

No. Seat Belts_______________________________

INSURANCE INFORMATION

Insurance Company___________________________

Policy No.__________________________________

Expiration Date______________________________

Liability Limits of Policy______________________

(The minimum acceptable liability limit for privately-owned vehicles is $100,000 per occurrence. If you transport students often, it is recommended that your coverage be $300,000 per occurrence.)

Name of Agent_______________________________

Telephone No. (___)__________________________

I certify that the information given above is true and correct. I understand that if an accident occurs, my insurance coverage shall bear primary responsibility for any losses or claims for damages.

Name___________________________

Date____________________________

HOPE SCHOOL DISTRICT

Santa Barbara, California