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Drivers: Age 25 and older
Drivers Acknowledgement and Authorization
Sign and mail to: People Building People
P.O. Box 1083
West Chester, OH 45071-1083

DRIVER ACKNOWLEDGMENT / AUTHORIZATION
AND
DISCLOSURE UNDER FAIR CREDIT REPORTING ACT
AND
CONSENT TO PROCUREMENT OF CONSUMER REPORT


The undersigned hereby authorizes People Building People Non-Profit Organization or its insurance agency, Bauer Insurance Agency, Inc., or its/their assigns, to obtain copies of consumer reports, including motor vehicle driving report, pertaining to me. And, for use in insurance rating and/or underwriting insurance decisions for which the above-named organizationsí insurance policy may apply, and any renewal or rewrite of coverageís thereof. I understand that in obtaining such consumer reports, a consumer reporting agency may be used, and I do hereby authorize such use. I also understand that any adverse information may create a problem in my being covered on the above-named organizationís insurance policy.

By volunteering to be a driver/operator of a vehicle for People Building People Organization, I also acknowledge and recognize with my signature below, the following:

  • That my driverís license is active and valid.
     
  • That I have no restrictions, physical or health conditions which impair my ability to safely drive/operate a vehicle.
     
  • That I will endeavor to require all passengers in the vehicle (including myself) to be properly restrained by buckled seat belts at all times.
     
  • That I will endeavor to maintain an alert and active Co-Pilot (front passenger seat) to assist me in navigation, defensive driving and to stay on alert for potential road or driving perils or hazards.
     
  • That I will obey and honor all posted speed limits and all traffic signs.
     
  • That I understand there are inherent liability risks to me personally, anytime I drive/operate any vehicle; and that these liability risks, to me personally, are accepted and understood. In order to properly protect myself I understand that I need to review my personal auto insurance policy liability limits of coverage with my personal insurance agent/advisor and upgrade those coverage limits as I deem necessary. I understand that, at minimal, it is recommended that I carry a personal umbrella insurance policy (Excess Liability Insurance) at protection limits of my choosing and selection.

Signed:___________________________________________________________
Date:_____________________________________________________________
Print Name of Signature Above:__________________________________
Social Security #:_________________ Date of Birth:________________
State Licensed:____________________ License #:____________________