DRIVER ACKNOWLEDGMENT / AUTHORIZATION
DISCLOSURE UNDER FAIR CREDIT REPORTING ACT
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.
Print Name of Signature
Social Security #:_________________ Date of
State Licensed:____________________ License