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