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HomeMy WebLinkAboutCDL 3rd Party Tester Agreement AGREEMENT between the FLORIDA DEPARTMENT OF HIGHWAY SAFETY AND MOTOR VEHICLES and a COMMERCIAL DRIVER LICENSE THIRD PARTY TESTER THIS AGREEMENT is made effective this BY AND BETWEEN the day of _ FLORIDA DEPARTMENT OF HIGHWAY SAFETY AND MOTOR VEHICLES DIVISION OF DRIVER LICENSES (hereinafter the Department) CITY OF SEBASTIAN located at 1225 Main Street. Sebastian, Florida 32958 This agreement authorizes the named Third Party tester to administer Commercial Driver License skills tests on behalf of the Department. NOW THEREFORE, the Department and the Third Part~ Tester, in consideration of the duties and responsibilities set forth herein, mutually agree as follows: I. THE DEPARTMENT AGREES TO TESTING: Permit the Third Party Tester to administer commercial driver license skills tests pursuant to the terms of this agreement and applicable provisions of State and Federal Law. ADMINISTRATION AND ENFORCEMENT: Administer and enforce the provisions of the commercial Driver License Third Party Testing Program. ON-SITE INSPECTIONS: Conduct an on-site inspection of Y1aird Party Tester facilities, books, and records at least once annually. REPORTS: Prepare a written report of the results of each inspection and audit, and provide a copy of the report to the Third Party Tester. II. THE THIRD PARTY TESTER AGREES TO LEGAL COMPLIANCE: Comply with all applicable statutes and administrative rules of the State of Florida, with all applicable laws and regulations of the Federal Highway Administration (FHWA), and with all applicable local ordinances. Bo PLACE OF BUSINESS: Continuously maintain a place of business which includes at least one (1) permanent, regularly occupied slrueture located within the State of Florida. C. MAILING ADDRESS: Have a permanent mailing address. Do OPERATIONS RESPONSIBILITY: Designate an individual employee who will be responsible for the Third Party Tester's operations under this agreement, and inform the Department in writing of that designation. THIRD PARTY EXAMINER: Employ at least one qualified and approved third party eXaminer and permit only those persons who have been approved by the Department as eXaminers to administer corranereial driver license skills tests to payroll employees, ?-. .... "-':- u 1 M. N. O. THIRD PARTY EXAMINER RECORD CONTENTS: Maintain on forms provided by the Department, at each approved testing location, a record of each third party examiner in the employ of the Third Party Tester at that location. Each record shall contain a photo copy of the valid "exarrfiner identification ear& issued by the Department. Each record shall also include the name, residential address and social seeurlty number plus a copy of the third party examiner's current driving record, which must be updated semi-annually; and evidence that the third party examiner is a payroll employee of the Third Party Tester. THIRD PARTY EXAMINER RECORD MAINTENANCE: Retain all third party exaImner records for at least three (3) years a~er the third party examiner leaves the employ' oftbe Third Party Tester. SAFETY RATING: If subject to Federal Motor Carrier Safety Regulations promulgated by the U.S. Depar~ent of Transportation, maintain a DOT Safety Rating of "Satisfactory". CLrRRICULUM: ifa private school or other educational institution, utilize a training curriculum which has been certified by the Department. SKILLS TEST CONDUCT: Ensure that skills tests are conducted strictly in accordance with the test specifications and procedures prescribed in the EXAMINERS MANUAL FOR COMMERCIAL DRIVER'S LICENSE TEST (Febraa~ 24, 1989, Essex Corporation), including the requirement that tests be conducted in a vehicle which is representative of the class and type of vehicle for which the commercial driver license applicant seeks hcansure and for which the th/rd party examiner is qualified to test, and the additional requirements of using "Department approved test content, forms and scoring procedures and having skills testa administered on Florida roads and highways. DRIVER RECORDS MAINTENANCE: Maint/m on forms provided by the Deparmaent, at each approved third party testing location, for a minimum of three (3) years, all records of each driver for whom the Third Party Tester conducts a skills test, whether or not the driver passes or fails the test. PROOF OF RESULTS: Provide documented proof of results to each ckiver applicant who takes and passes the required skills tests, using a form provided by the Department. CERTIFICATES: Prominently display Third Party Tester and Examiner Certificates in its place of business. SAMPLE TESTS: Allow the Department to test a sample of drivers who were examined by the third Party Tester in order to compare pass/fail results at the Third Party Test site. RANDOM EXAMINATIONS/INSPECTIONS/AUDITS: Allow the FHWA, its representatives, and/or the Department to conduct random exanunations, inspections, and audits of its operations, facilities, mad records as they relate to its Third Party Testing Program, without prior notice. ON-SITE INSPECTIONS: Upon notification, allow the Department to conduct annual on-site inspections of its operations, facilities, and records. MISCELLANEOUS NOTIFICATIONS: 1. Notify the Department in writing thirty 00) days prior to any change in the Third Party Tester's name or address. 2. Notify the Department in ,,wiring within ten (10) days: IH. 2. Notify the Department in writing within ten (10) days: a. Of changes in third party examiners who are employed by the Third Party Tester. b. Of any change in ttfird party examiner driver license status. c. Whenever the Third Party Tester ceases business operations in Florida. 3. Submit a copy of the records described in Section II K to the Department for the months' testing by the 15th of each month, or any time the Third Party Tester ceases business operations in Florida to the ad&ess below. INDEMNIFICATION: Indernmfy and hold harmless the State of Florida, the Florida Department of Highway Safety and Motor Vehicles, and all of their officers, employees, and agents from and against any and all claims, losses, damages, costs and other proceedings made, sustained, brought or prosecuted in any manner based upon, occasioned by or attributable to any injury, infringement or damage arising from any act or omission of the Third Party Tester or the Third Party Tester's agents, examiners or other employees in the performance of this agreement COMMUNICATIONS The Third Party Tester and the Department designate the following to receive the written notices and communications which are desired or required under this agreement: TI~X) PARTY TESTER Name: Terrence R. Moore City of Sebastian Title: City Manaqer Addmss~225 Ma~n Street City/State: Selm~s~an, FL 32958 Telephone: (561) 388-8203 Fax#: (561) 581-0149 DEPARTMENT Title:Senior Highway Safety Sr peeialist C,ty,State ', ' Wo,,,%-Ft. Telephone: PROFESSIONAL CONDUCT PROHIBITED HIRING PRACTICES: The Third Party Tester agrees not to engage the services of any employee of the Department as an examiner, agent or employee. APPLICANT ASSISTANCE: The Third Party Tester agrees that no examiner, employee, or agent of the Third Party Tester will be permitted to assist any commercial driver license applicant during a skills test driver examination. SOLICITATION: The Third Party Tester agrees that no examiner, employee, or agent of the 22in'd Party Tester will be permitted to solicit any individual on premises ~nted, leased, or owned by the Department for the purpose of enrolling that individual in any Third Party Testing Program. V. ADVERTISING VI. GUARANTEES: The Third Party Tester further agrecs that no advertising shall ~nalcate in any way that the Third Party Tester can issue or guarantee the issuance of a commercial driver license or imply that the Third Party Tester can in any way influence the Department in the issuance of a commercial driver license's or imply that preferential or advantageous treatment from the Department can be obtained. ENDORSEMENTS: The Third Party Tester agrees to refrain fi~om indicating that its program is approved, sanctioned, or in any other way endorsed by the Department, except to say that it is "certified". pROGRAM NAME: The Third Party Tester agrees not to use any name in its advertising besides the name on xts apphcetmn for cemficet~on and not to use the word state m any part its name. INSURANCE SECURITY REQUIREMENTS: The Third Par~y Tester agrees to maintain security which meets the requirements of section 207.029 (Florida Statutes), as amended, on motor vehicles owned or registered by the Third Party Tester while used to administer skills tests in this state as pi'ovided in this agreement. BODILY INJURY AND PROPERTY DAMAGE COVERAGE: The Third'Party Tester further agrees to maintain bodily injury and property damage liability insurance coverage on motor vehicles owned or registered by the Third Party Tester while used to administer skills tests in this state as provided in this agreement, and the amom~t of insurance coverage shall not be less than minimum coverage prescribed by state or federal statute. NON-EXCLUSIONS: The Third Party Tester agrees that the insurance coverage required to be maintained under this agreement shall not exclude from coverage any person while taking skills tests administered by the Third Party Tester, any person suffering bodily injury or property damage as a result of skills tests administered by the Third Party Tester, or any person employed by the Th/rd Party Tester to administer skills tests. EVIDENCE OF COVERAGE: As evidence of insurance coverage required under this agreement, the Third Party Tester agrees to file with the Department either a certificate of insurance issued by an insurance company haensed to do business in this state or a certification of self-insurance stating that there is in effect a contract of insurance providing the coverage required under this agreement, which certificate shall stipulate that the insurance shall not be canceled except upon thirty (30) days' prior written notice to the Department, or a certificate of self-insurance indicating a net worth as prescribed by state or federal statute. A certificate of insurance or self-insurance shall include the make, model, year and vehicle identification number &every vehicle which will be used by the Taird Party Tester to administer skills tests as provided in this agreement. NON-USE AGREEMENT - TESTER VEHICLES: The Third Party Tester agrees that a motor vehicle owned or registered by the ~fird Party Tester shall not be used to administer skills tests as provided in this agreement unless evidence of insurance coverage for the vehicle as required by this agreement has been filed with the Deparmaant. NON-USE AGREEMENT - OTHER VEHICLES: The Third Party Tester agrees that no motor vehicle will be used to administer skills tests as provided in this agreement unless the owner or registrant of the vehicle produces a certificate of insurance for the vehicle issued by and insurance company which states that security which meets the requirements of'sections (Florida Statute), as amended, is in force, or unless the owner or registrant produces a certificate of self- insurance issued by the Department. 4 GENERAL LIABILITY COVERAGE: The Third Pa~y Tester further agrees io'rnaintain general liability insurance coverage to provide coverage in the amount of one million dollars per occurrence, for any and all claims, losses, damages, costs, and other proceedings made, sustained, brought, or prosecuted in any manner based upon, oeeasioned by or attributable to any injury, infringement, or damage arising from any act or omission of the Third Party Tester or the Ttfird party Taster's agents, examiners, or other employees in he performance of this agreement. VII.. EXPIRATION This agreement shall remain in effect until canceled or terminated as set forth in Section VIII of this agreement. VIIL. TERMINATION, CANCELLATION, AND REINSTATEMENT TERMINATION: Either party to this agreement may terminate this agreement for any reason by providing sixty (60) days written notice of termination to the other party. CANCELLATION: The Department reserves the right to cancel this agxeement immediately upon determining that the Th/rd Party Tester, or third party examiner employed by the 2lfia-d Party Tester, has done one or more of the following: Has failed to comply with or satisfy any of the provisions of this agreement or the Department's instructions relating to this agreement. 2. Has falsified any record or information relating to the 12fird Party Testing Program. 3. Has committed an act wkich compromises the integrity of the Third Party Testing Program. Employs a third party eXarmner who does not have a valid driver license, whose driver license is under suspension, revocation, cancellation or disqualification, whose examiner card has been canceled, or whose application for a driver's liconse has been denied. Has failed to file a certificate ofinsumxtce ur self-insurance or has failed to maintain insurance coverage. Has refused to allow public access to all documents, papers, letters, or other material subject to the provisions of Chapter 119, Florida Statutes, and made or received by the contractor in conjuetion with the contract. Cancellation of this agreement shall be effected by furnishing the Third Party Tester with whtten notice of cancellation, which shall be effective mediately upon receipt. The notice shall include a short and plain statement of the facts necessitating the cancellation. If the Department determines that grotmda for eancollatiun exist and relate to a failure to comply with or satisfy and provision of the agreement, the Deparlment may postpone cancellation and allow the Third Party Tester thirty (30) days to correct the deficiency. REINSTATEMENT: Ifa notice of cancellation is issued and the Th/rd Party Tester disagrees with the notice, the Third Party Tester may, within fourteen (14) calendar days alter receipt of the notice, request a Depar~ent hearing to determine whether this agreement should be reinstated. Ifa request for hearing is made, the matter shall be scheduled for hearing to be eunvened not more than thirty 00) days from the receipt of*he request. The Department shall render its decision within fourteen (14) calendar days following the conclusion of the hearing. The Department's decision is final. 5 IX. AMeNDMeNTS NECESSARY AMENDMENTS: The Tkird Party Tester a~ees to accept any amendment to any provision of this agreement, if the amendment is set forth in writing, is necessitated by a change in state or federal law and is requested by the Department. The Thh'd Party Tester shall execute such an amendment upon request. OTHER AMENDMENTS: Except as otherwise provided, this agreement may be amended only by the mutual consent of the parties which is expressed in writing and is signed by a duly authorized representative of each party. No verbal representation, interpretation, or comment by any officer, agent, representative, or employee of either party, either before or after the execution of this agreement, shall affect or modify any cf the provisions in the agreement, unless the representatives' interpretation, commitment, or representation is expressly stated in a written amendment to this agreemem, signed by a duly authorized representative of each party. X. NON-ASSIGNABILITY This agreement and the Third Party Tester's certification are not assignable by the Third Party Tester, either in whole or in part. XI. WAIVERS AND UNENFORCEABILITY A waiver by either party of any provision of this agreement shall not act as a waiver of any other provision of this agreement, ffany provision of tkis agreement is for any reason declared invalid, illegal or unenforceable, that declaration shall not affect the ~mainder of the provisions of this agreement. XII. REQUIREMENTS The parties to this agreement hereby agree that the Third party Testin~ Requirements (Attachment A to this agreement) shall be the requa'ements for persons other than employees of the Florida Department of Highway Safety and Motor Vehicles to conduct commercial driver license skill testa as provided for under Florida law. IN WITNESS WHEREOF, the parties hereto have executed this agreement as of the date first written above. BY: City of Seb~se~an Terrenge R. Moore NAME: BY: Florld~p~r~ont o~wa, Safe~ ~d Motor Vehicles SIGNAT~': 6 FLORIDA DEPARTMENT OF HIGHWAY SAFETY AND MOTOR VEHICLES. _ DMSION OF DRIVER LICENSES COMMERCIAL DRIVER LICENSE THIRD PARTY TESTING REQUIREMENTS PURPOSE The purpose of this document is to explain the requirements for persons other than employees of the Florida Department of Highway Safety and Motor vehicles to conduct Commercial Driver License skills tests as provided for under Florida law. Authority to administer skills tests will be granted only to third party testers who enter into an agreement with the Depam-nent and utilize third party examiners deemed qualified by the Department. IH. DEFINITIONS The following words and terms, when used in this document, shall have the following meanings: DEPARTMENT - The Florida Department of Highway Safety and Motor Vehicles, Division of Driver Licenses. B. CDL - Commercial Driver License C. FHWA - Federal Highway Adminis~a'ation FMCSR - The Federal Motor Carder Safety Regulations promulgated hy the U.S. Department of Transportation. APPROVED TESTING PROGRAM - The skills tests which are required by the Department and are administered by Third Party Testers. CERTIFICATE - That document which is issued to a third party tester verifying that the tester is authorized to administer an approved testing program on behalf of the Department. THII~D PARTY TESTER - A government entity, an association, an educational institution or a business entity engaged in the use of commercial motor vehicles and ceaified by the Department as authorized to administer an approved testing program for CDL applicants in accordance with the requirements described herein. H. DIRECTOR - The Director of Division of Driver Licenses. EXAMINER IDENTIFICATION CARD - A card issued by the Department to indicate that an individual has been approved by the Department as a qualified examiner, and evidencing authorization to conduct the skills tests required for a CDL. THIRD PARTY EXAMINER - An individual who is a payroll employee cfa Third Party Tester and for whom un examiner identification card has been issued evidencing authorization to conduct the skills tests required for a CDL to those employees or pmpariy enrolled students of said Third Party Tester. REQUIREMENTS FOR THIRD PARTY TESTERS A. To be certified, a lltird Party Tester must: Make application to and enter into an agreement with the Department as~d_eseribed in Section V 1.B. of this document. Ensure that its place of business is safe and meets ali requirements of state and federal law and local ordinances. Ensure that skills tests are conducted in accordance with all legal requirements and with test specifications and prccedures prescribed in the EXAMINER'S MANUAL FOR COMMERCIAL DRIVER'S LICENSE TEST (February 24, 1989, Essex Corporation). Provide documented proof, using a form provided by the Department, to each ckiver- applicant who takes and passes the required skills test. The driver-applicant in turn will present the form to the Department as evidence that he/she has successfully passed the skills tests administered by the Third Party Tester. In addition to the requirements listed above, a Third Party Tester must meet the following conditions: Be a person or firm which owns or leases five (5) or more commercial vehicles vehicles; or employs five (5) or more commercial motor vehicle operators at any one time, or more than 6 months with five (5) or more commercial motor vehicle operators at any one time. 2. Must have adequate facilities to perform the driving skills test. 3. Conduct tests for payroll employees o~~l~;~z~_~r.:z z:~2y. REQUIREMENTS FOR THIRD PARTY EXAMINERS u A. A third party examiner may conduct skills tests on behalf of only one Third Party Tester. Third Party Testers must apply for "examiner identification cards" on behalf of persons seeking to become third party examiners in their employ. Ifa third party examiner leaves the employ of the Third Par~y Tester, he/she must be approved for a new examiner identification card in order to conduct tests on behalf of another Third Party Tester. To qualify as a third party examiner, an individual must: Have an application made to and approved by the Department as provided in Section V (B) of these requirements. 2. Be a payroll employee of the third party tester submitting the application. 3. Hold a valid driver's license. Have successfully completed a Department sanctioned CDL examiner training Agree to attend all Department required advanced training courses, workshc,ps, Within the last three (3) years have had no driver license disqualification's, suspensions, revocations, or ccurt or Department ordered driver improvement actions. Il, ave at least three (3) years of experiencc as a commercial motor vehicle operator, or trainer. 8 VI* Conduct skills tests on behalf of the third party testers, in accordance with ~all legal requirements and in accordance with test specifications and procedures prescribed in the EXAMINER'S MANUAL FOR COMMERCIAL DRIVERS LICENSE TEST (February 24, 1989, Essex Corporation). CERTIFICATES AND IDENTIFICATION CARDS A. General Requirements: A certificate will be issued to qualified entities evidencing the thkd party tester's entry into an agreement to operate an approved testing program to give driving tests to applicants for a CDL. The certificate issued by the Department to operate a third party testing program must be prominently displayed in the place of business of the Third Party Tester. A copy of the examiner's certificate must be prominently displayed in the appropriate office of the Third Party Tester. An "examiner identification card" and an examiner certificate will be issued to qualified employees of the Third Party Tester. ~he examiner must surrender the identification card and certificate to the Department when the examiner becomes inactive or when the card or certificate has been canceled or expired. Agreement to admin/ster Third Party Testing Programs, certificates to operate Third Party Testing Programs, examiner's identification cards, and certificates are non-assignable. Each certificate and identification card shall be effective on the date of issuance and shall remain valid until canceled by the Department or voluntarily relinquished by the Third Party Tester or examiner. B. Application for Agreements/Certification: Before an agreement or certificate is issued, an application shall be made in writing to the Department on a form prepared end furnished by the Department. C. Application for "lb./rd Party Examiner Identification Card: Application for an examiner identification card must be made by the Third Party Tester in writing to the Department on a form supplied by the Department, on behalf of the prospective examiner. EVALUATION OF APPLICANTS BY THE DEPARTMENT The Deparmaent will evaluate the application subrdtted by the ~hird Party Tester and if satisfactory, the Depar~xnent will sehadule and on-site inspection and audit of the applicant's Third Party Testing Program to complete the evaluation. The Department will evaluate the application submitted on behalf of the third party examiner including the individuals driving record. If satisfactory, the Department will authorize the prospective examiner to apply for third party examiner training. Training may be waived if the examiner is seeking another examiner's certificate only became he/she has changed employees. VII. CERTIFICATION BY THE DEPARTMENT Upon successful application and evaluation, by the Department, a Third Party Tes .t~r. will be issued a certificate evidencing the tester's authority to administer a Third Party Testing Program for the classes and types of vehicles listed. Upon successful application, evaluation, and training, an examiner certificate will be issued evidencing a third party examiner's authority to conduct skills tests for the classes and types of vehicles listed. Certificates, agreements, and identification cards will remain valid until canceled by he Deparmaent or voluntarily relinquished by the third party tester or examiner. VIII. ON-SITE INSPECTIONS AND AUDITS Each applicant for a Third Party Tester certificate shall permit the FHWA and the Department to inspect and audit its operations, facilities, and records as they relate to its third Party Testing Program, for the purpose of determining whether the applicant is qualified to be certified. A ltfird Party Tester who has executed an agreement and has been certified shall permit the Department or FHWA to inspect and audit its Third Party Testing Program to determine whether it remains in compliance with ail legal requirements. The Department and FHWA may perform its inspections and audits with or without prior notice to the Third Party Teeter. D. Inspections and audits will include, at a minimum, an examination off 1. Records relating to the Third Party Testing Program; 2. Evidence of compliance with the FMCSRs; 3. Skills testing procedures, practices end operations 4. Vehicles used for testing; 5. Qualifications of third party examiners; 6. Effectiveness of the skills tests program by testing a sample of drivers who have been issued skills tests certificates by the third party examiner or having Department employees take the skills tests from a third party examiner; and 7. Any other aspect of the Takd Party Tester's operation that the Department determines is necessa~ to verify that the Third Party Tester meets all applicable requirements. The Department will prepare a written report of the results of each inspection and audit. A copy of the report will be provided to the Third Party Tester. DENIAL/TERMINATION OF THIRD PARTY TESTING PROGRAM AND CERTIFICATES The Department may deny any application for a Third Party Tester agreement/certificate or examiner's identification card, if the applicant or examiner does not qualify for the certificate or card under the requirements oftha Third Party Tester Program as explained herein. Misstatements or misrepresentation may be grounds for denying an agreement, a certificate or a card. CONTRACT FOR ADMINISTRATION OF DRIVING SKILLS PORTION OF EXAMINATION FLORIDA STATUTE 322.56 10 The Department may by contract, interagency agreement, or inter local agreement, authorize a person, an entity oftha state government, or an entity of a local government to administer the ckiving skills portion of an examination for a commercial driver's license, the result of winch may be accepted in lieu of the results cfa driving skills examination given by the department. Any test given by a third party under contract with the state must be the same as the test winch the state would otherwise give. The contract or agreement between the third party and the state must at a minimum, contain the provisions that: Allow the Federal Highway Administration, or its representative, to conduct random examinations, inspections, and audits without prior notice; Allow the department, or its representative, to conduct random examinations, inspections, and audits with prior notice; Require the department to conduct on site inspections at least annually; Require that all third party examiners meet the same qualifications and education and training standards as department examiners, to the extent necessary to conduct the driving skills portion of the examination; Require that the department test, at l~st annually, a random sample of the drivers approved by the third party for licensure; and Reserve to the department the fight to take prompt and appropriate action against a third party that fails to comply with state or federal standards for a commercial driver's license examination or that fails to comply with any terms of the contract. The department shall monitor examinations administered under the authority of tins section. Such monitoring shall, at a minimum, satisfy the reqUn'ements of paragraphs (b), (c), (d), and (e) of subsection (3). An applicant who successfully completes a driving skills examination admimstered by an authorized third party shall provide evidence of such fact to the department prior to licensure. A person or entity must own or lease 5 or more commercial motor vehicles, or employ 5 or more commemial motor vehicle operators at any one time, or contract, for a period of more than 6 months, with 5 or more commercial motor vehicle operators at any one time to qualify as a third party examiner and must have adequate facilities to perform the driving skills test. Nothing in this section exempts a person fxom the requirement that he successfully complete a test of his knowledge administered by the depamuent or any othar test required for lieensure under the provisions of this chapter. (Added by L. 1989, chap. 282(8), eft 7/5/89.) 11 DIVISION OF DRIVER LICENSES THIRD PARTY TESTER APPLICATION Submit to: E.J. Kelley Senior Highway S~ety Specialist 703 Waterview Drive Palm Springs, Florida 33461 Name COMPANY/SCHOOL/ORGANIZATION I~FORMATION (please print or type) City of Sel~s~n Address 1225 M~n Street, Sel~as~an, FL 32958 County I,nd~ au River Telephone number 561-388-8203 Designated Third Party Representative Robert.J. ~ell Name Mailing Address (if different from business address). bl~ir~z, ue W~d~r III ( 56]~ 388-8203 Title Phone No. Current DOT Safety Rating (if applicable) Type of Company Number of Drivers Employed Type of CDL Skills Tests You Plan to Administer a. __ School (Commemial) a. Full time b. __ School (Non-Commercial) b. Part-time c. __ Government Entity (State) c. Total d. __ Government Entity (County) f.e' -~- OtherG°vemment Entity (Local) a. X CDL "A" Combination Veh b. 'XCDL "B" Straight Trucks c. CDL "B" School Buses d. CDL "B" Transit Buses e. CDL "B" Coach Buses f. __ CDL "C" Small Vehicles If you check F, please explain who you represent and how you represent them. I certify under the penalty of perju~ that the above stated facts are tree and accurate to the best of my knowledge, information and belief. m~uthoriz~ Coff[pany Agent Date FOR DEPARTMENT USE ONLY Date Inititials Received ~9 ~/(,1-,~'0/ Initial Audit 01/96 IVISION OF DRIVER LICENSES THIRD PARTY EXAMINER APPLICATION (ple~e print or type) Name/r~o/,JC/~ 7'- J7 /~/~/l//(~4/~(}&L Title Ci~.~ ~y ~, Zip C~e ~; ~o~ Home Phone No. ~ ~ ~ f'- ~/,~/ Date of Bi~ Submit to: E. J. Kelley .. Sr. Highway Safety Specialist 703 Waterview Drive Palm Springs, Florida 33461 County Driver License No. ,/~2 ,)-2 / - 2 fftY'. ~.~--~/O-O Social Security No./~ - Three years precedin~g the date of this application have you: Yes ( No (t/) a. Been issued more than one commercial driver license? Yes ( No (~/) b. Had any license suspended, revoked, cancelled or subject to driver improvement action? Yes ( No (,~) c. Had any convictions for any type of motor vehicle for the disqualifications contained in the CFR 383.51 ? Yes( No( ) d. If, YEStoanyoftheabeve, please explain Yes ) No ( J~ e. Are you currently or have previously been employed as a CDL third party examiner with another company. If so, please state the company. Currently Employed By Empl~er's Desi~ated T~rd Pa~ Represen~five: Name .~ i'3 c~ / & ~ Phone No (~ / ) I ce~ ~der ~e ~n~W of pc~ ~at ~e a~ve ~owledge, i~omfion ~d ~lie[ Date smt~ fa~s ~e ~e ~d accmate to ~e be~ of my Si~e ~owledge, i~oma~on ~d belief. Date FOR DEP~ USE Date apd I~s Reco~en~fion ( 01/96 THIRD PARTY EXAMINERS QUALIFICATION QUESTIONAIRE 1. WHAT IS YOUR FULL NAME? 2.. WHAT IS YOUR DATE OF BIRTH? WHAT IS THE NAME AND ADDRESS OF THE ORGANIZATION YOU WORK FOR? HOW LONG HAVE YOU WORKED FOR THE ORGANIZATION 5. ARE YOU A FULL TIME EMPLOYEE? YES ~ NO WHAT IS YOUR POSITION WH'tIIN THE ORGANIZATION? 7. BRIEFLY DESCRIBE YOUR DUTIES? 8. DO YOU P~SEN~Y HOLD A V~ D~R LICENSE? YES ~NO__IE SO, WHAT CLASS OF LICENSE (PLEASE CIRCLE) CLASS A ~ D E 9, HOW LONG HAVE BEEN A LICENSED DRIVER? 10. 11. HAVE YOU HELD A DRIVER LICENSE IN ANY OTHER STATE? YES ~'"NO__ IE SO, WHICH STATE? ,/~/~/,~ ~-~/&f e- )/ WITHIN THE LAST THREE YEARS HAVE YOU HAD ANY VIOLATIONS, SUSPENSION, REVOCATIONS, CANCELLATIONS, DISQUALIFICATIONS? 12. WHAT IS THE HIGHEST GRADE LEVEL OF EDUCATION THAT YOU COMPLETED? PLEASE CIRCLE ELEMENTARY H~IIGH SCHOOL~ COLLEGE POST GRADUATE STUDY 13. HOW MANY YEARS OF EXPERIENCE DO YOU HAVE AS A COMMERICAL MOTOR VEHICLE OPERATOR? 14. CHECK TYPE OF VEHICLE AND LENGTH OF TIME DRIVING? TRACTOR TRAILER ~-STRAIGHT TRUCKS BUSES __ OTHER (SPECIFY). 15. HOW MANY YEARS EXPERIENCE HAVE YOU HAD AS A TRAINER? 16. LIST ANY COURSES WHICH ACCOUNT FOR TRAINING, ANY IN-SERVICE WORK EXPERIENCE RELATED TO: A. THE PRINCIPLES AND PRACTICES OF SAFE OPERATION OF A COMMERCIAL MOTOR VEHICLES. Bo LAWS AN REGULATIONS COVERING COMMERCIAL MOTOR VEHICLE OPERATIONS. INSTRUCTING INDIVIDUALS ON DRIVING COMMERCIAL MOTOR VEHICLES. 17. BRIEFLY EXPLAIN WHY YOU WISH TO BE A CDL THIRD PARTY EXAMINER? _ACORD. CERTIFICATE OF LIABILITY INSURANCE j BATEIM .D 03/21/2001 PRODUCER (954)723-0939 (954)723-0942 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION -Risk Management Associates 8220 State Road #84 Suite 300 Ft. Lauderda]e, FL 33324 ~NSURED Sebastian, City of c/o Gehring Group '0~ ~ 1645 Palm Beach Lakes By #480 West Pa]m Beach, FL 3340[ 1 COVERAGES P[q ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. INSURERS AFFC~R'DING COVERAGE INSURERA: Coregis Insurance Company INSURER O: INSURER E: THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED, NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. LT~R TYPE OF INSURANCE POLICY NUMBER ~ ~ ~ ~ LIMITS GENERAL LIABILITY 551-011248 10/01/2000 10/01/2001 EACH OCCURRENCE $ 1.000.00r ~- COMMERCIAL GENERAL LIABILIT~ I CL^tMS MADE [] OCCUR fIRE O^MAGE (Any one,r~ $ 50.00~; A X Emp'loyee benefits MEDEXP(Anyonepe~son) $ 5,00~ PERSONAL & ADV INJURY $ 1 ~ 000,00~ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 3 j 000 ~ 00~ PRO- I PO,~c¥ ~ JECT [~ LOC PRODUCTS-COME,Dp A~G $ 3,000,00~ AUTO~OB,LEUABlUTV 651-011248 10/01/2000 10/01/2001 COMBINED SINGLE LIMIT X ANYAUTO (Ea accident) $ ALL OWNED AUTOS 1,000,00~ A , SCHEDULED AUTOS SODILY INJURY -- (Per person) HIRED AUTOS NON-OWNED AUTOS BODILY INJURY (Per acCident) $ GARAGE LIABILITY ANY AUTO AUTO ONLY. EA ACCIDENT $ OTHER THAN EAACC $ AUTO ONLY: EXCESS LIABILITY AGG $ I OCCUR [] C~A'MS MADE ~AC" OCCURRENCE $ AGGREGATE $ DEDUCTIBLE RETENTION $ $ WORKERS COMPENSATION AND $ E.L EACH ACCIDENT E.L. DISEASE - EA EMPLOYEE A P°UT~[~:C OFFICIALS LTAB. :~0D100089 10/01/2000 10/01/2001 L'r/,11-I': $1,000,000 ABOVE LTM~-rs ARE TNCLUS[VE OF A $1OO,0OO PERSON/$200,O00 OCCURRENCE COVERAGE PER F.S.768.28. EXCESS COVERAGE APPLICABLE TO "CLAIMS BILLS", OUT-OF-STATE AND FEDERAL 3URISDICTION CLAIMS ONLY AS RESPECTS £DL ITCENSES, INCLUDING THIRTY DAYS PRIOR WR~I-rEN NOTIFTCATION OF CANCELLATION TO FLOR~A DEPARTMENT ~F TRANSPORTATION. Florida Department of Transportation E.3. Kelly 605 Suwanee Street Tallahassee, FL 32399-0450 ~7/97) CELLATION SHOULD ANY OF THE ABOVE DESCRIBED PoucrEs BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF~ THE ISSUING COMPANY WILL ENDEAVOR TO MAIL DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE COMPANY, ITS AGENTS OR REPRESENTA~*'ES. 'AUTHORIZED REP ©ACORD CORPORATION 1988 . CORD,. CERTIFICATE OF PROPERTY INSURANCE :' 0ATE,""I ' 03/21/2001 RODUCER (954)723-0939 Risk Management Associates 8220 State Road #84 Suite 300 Ft. Lauderdale, FL 33324 Todd Higley INSURED Sebastian, City of c/o Gehring Group 1645 Palm Beach Lakes Bv #480 West Palm Beach, FL 33401 FAx (954)723-0942 THIS CERTIFICATE IS ISSUED AS A MAI ~ bR OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. COMPANY Ext A COMPANY B COMPANY C COMPANY D COMPANIES AFFORDING COVERAGE Coregis Insurance Company COVERAGES THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED, NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID ~LAIMS CO LTR TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION DATE 'MM/D D/YY) DATE (MM/DD/YY] COVERED PROPERTY LIMITS X PROPERTM 651-011248 10/01/2000 10/01/2001 BUILDING $ CAUSES OF LOSS PERSONAL PROPERTY $ BASIC BUSINESS INCOME $ BROAD X BLANKET E]LDG & pp $ 5,636,682 INLAND MARINE TYPE OF POLICY $ $ CAUSES OF LOSS $ NAMED PERILS $ OTHER CRIME TYPE OF POLICY $ S BOILER & MACHINERY $ OTHER PROPERTY ALL INSURED LOC~TIONS. SPECIAL CONDITIONS/OTHER COVERAGES ~S RESPECTS CIl~ TO ACT AS A THIRD PARTY EXAMINER FOR CDL LICENSES. 3UBJECT TO POLICY TERMS, CONDITIONS, EXCLUSIONS AND ENDORSEMENTS. Florida Department of Transportation E.]. Kelly 605 Suwannee Street Tallahassee, FL 32399-0450 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT. BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANy KIND UPON THE COMPANY, ITS AGENTS OR REPRESENTATIVES. IMPORTANT ~,CORD 25-S (7197) If the certificate holder is an ADDITIONAL INSURED, the policy(les) must be endorsed. A statement on this certificate does not confer dghts to the certificate holder in lieu of such endorsement(s), If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). DISCLAIMER The Certificate of Insurance on the reverse side of this form does not constitute a contract between the issuing insurer(s), authorized representative or producer, and the certificate holder, nor does it affirmatively or negatively amend, extend or alter the coverage afforded by the policies listed thereon.