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49ER FORlY-NINER SHOPS INC CALIFORNIA STATE UNlVERSlTY LO G BEACH
POLICY STATEMENT
Policy Number 10006
Date Revised 112315
Driver Safety and Vehicle Use Policy
Purpose helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip1 Policy Statement helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip1 Departments Affectedhelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip1Definitions helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip1 Regulations helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip2Appendiceshelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip4
Employer Pull Notice Program- Authorization Form helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip5 Driver Safety and Vehicle Use Acknowledgementhelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip6 Campus Traffic Directory and Map helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip8 Authorization to Use Privately Owned Vehicles helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip10 Driverrsquos Privileges Revoked helliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphelliphellip11
Purpose
The purpose of this policy is to provide Forty-Niner Shops employees with guidelines regarding the use of Forty-Niner Shops company vehicles
Policy Statement
Company vehicles may be used by Forty-Niner Shops employees for business-related purposes subject to the guidelines set forth by this policy These guidelines are intended to ensure compliance with all Forty-Niner Shops policies and regulations as well as to ensure the safety of our employees
Departments Affected
This policy applies to all Forty-Niner Shops employees
Definitions
Authorized driver- A Forty-Niner Shops employee who has been authorized to drive a company owned or operated vehicle An authorized driver has met the eligibility requirements which include current driver license on file DMV pull program clearance completion of driver and cart safety training
Company vehicle- Any vehicle that is owned or operated by the Forty-Niner Shops Company vehicles include electric carts cargo passenger vans stake-bed-flatbed truck and any other company leased vehicles
DMV Pull Program- A DMV sponsored program that provides a driverrsquos license clearance and background check into an individualrsquos DMV records
Personal vehicle- Any vehicle that is owned or operated by individual Forty-Niner Shops employees for the purpose of personal use Employees using their personal vehicles for company business must also comply with the training requirements to
1
49ER FORlY-NINER SHOPS INC CALIFORNIA STATE UNlVERSlTY LO G BEACH
POLICY STATEMENT
Policy Number 10006
Date Revised 112315
operate company vehicles Must submit a copy of your personal insurance stating the minimum liability requirements
Regulations
10 Eligibility 101 Valid US Driverrsquos License
All drivers of Forty-Niner Shops vehicles must be 18 years or older and hold a valid US Driverrsquos license Once an employee has been identified as a potential driver the department manager must submit a request via email to Human Resources
102 DMV Pull Program Clearance For the safety of our employees all individuals who have been identified as potential drivers will be required to participate in the DMV Pull Program Once Human Resources is notified of potential drivers they will be contacted to complete a DMV EPN Authorization form along with a copy of a valid driverrsquos license This is to authorize the Forty-Niner Shops to review their personal records driverrsquos license validity and any activity on record Please note that the Forty-Niner Shops reserve the right to deny suspend or revoke driving privileges based on the initial or subsequent review of the motor vehicle record for any employee requesting driving privileges per the eligibility criteria below
Employees or volunteers driving on auxiliary organization business will have no more than 3 (three) VIOLATION POINTS in a 12 (twelve) month period or no more than 5 (five) points in an 18 (eighteen) month period Employees or volunteers accumulating 4 (four) VIOLATION POINTS within an 18 (eighteen) month period will be excluded from the automobile liability coverage within the AORMA LIABILITY COVERAGE PROGRAM These provisions apply regardless of whether or not the driving that resulted in acquiring the VIOLATION POINTS was or was not in the course of employment
Anyone with the following violations within the last three years on their motor vehicle record will become ineligible to drive a Forty-Niner Shops vehicle
Driving under the influence
Negligent homicide
Operating with a suspended license
Using a motor vehicle for commission of a felony
Aggravated assault with a motor vehicle
Operating a motor vehicle without the ownerrsquos consent Permitting an unlicensed driver to drive
Reckless andor careless andor negligent driving
2
49ER FORlY-NINER SHOPS INC CALIFORNIA STATE UNlVERSlTY LONG BEACH
POLICY STATEMENT
Policy Number 10006
Date Revised 112315
Hit and Run or leaving the scene of an accident with injury or death resulting or property damage in excess of $1000
Exceeding the maximum amount of violation points within a 12-18 month period
In addition individuals who have been cited for unsafe driving on campus or who are in violation of Forty-Niner Shops driver safety policies will be ineligible to drive company vehicles or personal vehicles for business purposes
Drivers with violations will be reported to the CSURMA AORMA PROGRAM ADMINISTRATOR within 15 calendar days of DMV notification
20 Driver Safety and Cart Training 201 Upon DMV clearance identified employees will be required to participate
in an online driver safety and cart training The material discussed provides an overview of driver safety practices and reviews the basic level of understanding needed for operating electric carts Upon completion employees will receive certificates of completion which must be submitted to Human Resources Human Resources will then contact the employeersquos manager to notify of completion Driverrsquos Safety and Cart Training will be required every year This training will be monitored by the immediate manager and the office of Human Resources
30 Vehicle Access 301 Keys for all vehicles are stored by the Warehouse Manager in the
Warehouse Department All drivers must check out keys clarify their department indicate where they are going how long they will be and which vehicle is needed Human Resources will forward periodic clearance reports of all approved drivers to the Warehouse Manager This will be used to make sure only employees on this list are eligible to drive
40 InsuranceIndemnification 401 The Forty-Niner Shops will provide its employees with insurance
coverage while driving company vehicles Any employees with claims or actions brought against himher and resulting from authorized use of Forty-Niner Shops owned or operated vehicles will be indemnified only to the extent that insurance coverage applies and only as long as the employee follows the driver safety requirements noted in this policy
402 All traffic violations including parking tickets and speeding tickets will be the responsibility of the driver The Forty-Niner Shops shall not be held responsible
50 Use of Personal Vehicles for Company Business 501 Forty-Niner Shops employees who require the use of their personal
vehicles for company business must also comply with the Driver Safety and Cart Training as well as all requirements to operate company vehicles
502 Forty-Niner Shops employees who require the use of their personal vehicles for company business must also comply with California State Law by having the minimum liability insurance as required by the State of California
3
49ER FORlY-NINER SHOPS INC CALIFORNIA STATE UNlVERSlTY LO G BEACH
POLICY STATEMENT
Policy Number 10006
Date Revised 112315
5021 Minimum liability insurance requirements for private passenger vehicles (California Insurance Code sect115801b)
$15000 for injurydeath to one person
$30000 for injurydeath to more than one person
$5000 for damage to property 503 In the event of an accident while driving a personal vehicle for company
business the employeesrsquo insurance is the primary carrier and all claims and settlements should go through that carrier first In case of an accident where the employee is ldquonot at faultrdquo any out of pocket expenses incurred by the employee will be covered by the Forty-Niner Shops 5031 In the event of an accident an accident report must be submitted
to your manager the Human Resources office and if necessary local police
5032 All traffic violations including parking tickets and speeding tickets will be the responsibility of the driver
Appendices
1 FORM Employer Pull Notice Program- Authorization For Release of Driver Record Information
2 FORM Forty-Niner Shops Driver Safety and Vehicle Use Acknowledgement
3 NOTICE CSULB Campus Traffic Directory and Map
4 FORM Authorization to Use Privately Owned Vehicles on Forty-Niner Shops Business
5 NOTICE Driverrsquos Privileges Revoked
4
FORlY-NINER SHOPS INC 49ER CALIFORNIA STATE UNlVERSlTY LONG BEACH
EMPLOYER PULL NOTICE PROGRAM
AUTHORIZATION FOR RELEASE OF DRIVER RECORD INFORMATION
I ________________ __Ca lifornia Driver LiceJISe Number __________ __
hereby authorize the Ca lifornia Department o f Motor Vehicles (DMV) to disclose or otherwise make available my driving record tomyemployer_ ______________________________ _
COIPWIE
I understand that my employer may enroll me in the Employer Pull Notice (EPN) program to receive a d river record report at least once every twelve (12) months or when any subsequent conviction failure to appear accident drivers license suspension revocation o r any other action is taken against my driving privilege during my employment
I am not driving in a capacity that requ ires mandatory e nro llment in the EPN program pursuant to California Vehicle Code (CVC) Section 18081(1lt) I understand that enrollment in the EPN program is in a n effort to promotedriver safety and that my drive r license report wi ll be released to ITT employer to determ ine my e ligibil ity as a licensed driver for my employment
EXECUlED AI UTY SWE
DA1E
l ______ _=======----- middotof _______ ---=====----------AUTHCfUZEo RiPRESEfiaTNE COGl8( N1HE
do hereby certify under penalty of perj ury under the laws in the State ofCalifomia that I aman authorized representative of this company that the information entered on this document is true and correct to the best o f my knowledge and that I am requesting driver record information on the above individual to verify the information as provided by said individual This record is to be used by this employer in the normal course of business and asa legitimate business need to verify information re lat ing to a driving position not mandated pursuant to CVC Section 18081 The information received wi ll not be used for any unlawful purpose I understand that if I have provided fa lse information I may be subject to prosecution for perjury (Penal Code Section 118) and fa lse representation (CVC Section 180845) T hese are punishable by a fine not exceeding five thousand do llars ($5000) or by imprisonment in the county jail not exceeding one year o r both fine and imprisonment I understand and acknowledge that any failure to maintain confidentia lity is both civilly and cri minally punishable pursuant to eve Sections 180845 and 180846
EXE CUTED Al CITY SWE
DA1E
To obtain a d river record on a prospective employee you may submitan l NF 1119form To add thisdriver to the EPNProgram you must submit the applicable forms INF 1100 INF 1102 I NF 1103 INF 11030form You may obtain forms at our website at wwwdmvcagovfotherservices orby calling 916-657-6346
THIS FORM MUST BE COMPLETED AND RETAINED AT THE EMPLOYERS PRINCIPAL PLACE OF BUSINESS AND MADE AVAJ LABLE UPON REQUEST TO DMV STAFF
DO NOT RETURN THIS FORM TO DMV
POLICY STATEMENT
Policy Number 10006
Date Revised 112315
5
49ER FORlY-NINER SHOPS INC CALIFORNIA STATE UNlVERSlTY LO G BEACH
POLICY STATEMENT
Policy Number 10006
Date Revised 112315
Forty-Niner Shops Inc
Driver Safety and Vehicle Use Acknowledgement
I Driving Risks and Responsibilities
Driving safely on and around campus is essential With the increased congestion in both vehicular and pedestrian traffic safety and caution are absolutely critical When driving on campus whether in a vehicle or cart please follow these guidelines as well as the established access and routes
Avoid driving on inner campus during class breaks (ten minutes to the hour) Only access campus interiors for specific service-related needs ie unloading or emergency response
Never exceed posted speed limits and use discretion when a slower speed may be more appropriate due to congestion
Use caution at pedestrian crossing ie intersections crosswalks and other marked or unmarked areas where frequent crossing occurs REMEMBER the pedestrian always has the right of way
Always park vehicles as not to block traffic crosswalks disabled access building entrances fire hydrants and walkways
Vehicles access in the areas prohibited as specified on the established access and routes map shall be adhered to
All vehicular traffic is prohibited on the elevated pedestrian walkway located between the Student ServicesAdministration building and the North Campus Library
All vehicular traffic is prohibited on all brick surfaces as specified on the established access and routes maps
Driving on lawns and landscaped areas is prohibited Alternate routes are to be used to eliminate unnecessary ruts in landscaped areas and repairs to underground utility systems Cutting corners through landscaped areas will be considered damaging University property Drivers will be held accountable
When attending any on-campus event (Staff Day on-campus seminars etc) use designated parking spaces This includes all vehicles and carts
II Driver and Passenger Safety Requirements
1 Driver must be at least 18 years old and in possession of a valid US driverrsquos license at all times when operating a vehicle as a Forty-Niner Shops employee
6
49ER FORlY-NINER SHOPS INC CALIFORNIA STATE UNlVERSlTY LONG BEACH
POLICY STATEMENT
Policy Number 10006
Date Revised 112315
2 Driver shall observe all rules and regulations for safe driving as defined by the State of California Motor Vehicles Department
3 Drinking possession of intoxicating liquor illegal drugs in vehicles or driving while under the influence of alcohol or drugs is prohibited
4 Avoid conditions that lead to loss of control- driving while sleepy or inattentive or driving too fast for road conditions
5 Drivers must adhere to all California DMV laws
6 In an event of an accident all incidents must be reported on an accident report and must be submitted to your manager the Human Resources office and if necessary local police
Employee Name _________________________________________ Department __________
Employee Signature _______________________________________ Date ______________
7
49ER FORlYmiddotNINER SHOPS INC CALIFORNIA STATE UNlVERSlTY LO G BEACH
CALIFORNIA STATE UNIVERSITY LONG BEACH 1250 BELLFLOWER BOULEVARD LONG BEACH CA 90840
49er Pool (POgtL) F4 4 9er Softball Com plex (SC) G3 Acadam ic Services (AS) ES
Anatol Cente r Karl WE Barren Athlatic Administration Center ltBMCgt Nei l amp Phyllis E2
Pyramid Annex Conferenca Center (2nd Floor o f MC) Special Event s (2nd Floor)
Beach Circle The BC) E4 Brotmin Ha ll (BH ) E5
Kil li ngsworth Plaza Edward A Maxson Plaza Robert C
C arpenter Performing Arts Cente r (CPAC) G 1 Central Plant (C P) F6 Cent rltgtI Q uad (COSOUTH) Fa Colle9a of Bus inass AdminislJition (CBA) 04 Child Development Center Iaibel Patte rson (CDC) B1 Corporation Ya rd (CORP) H4 Dance Center (DC) F 1
Martha B Knoebel Daneamp Theatec-Design (DESN) H5 Education 1 (ED1) bull - E9 Education 2 (ED2) - E9 Enginamparing 2 EN2 ) _ G4 Engine-aring 3 (EN3) G4 Engineering 4 (EN4) G4 Eng inaering amp Compute r Sciencas (ECS) _ H4 Engine-aring Technology (ET) H4 Facilit ies Management (FM) 14 Friendship Wltgtlk (FWCENTRAL) F5 Faculty Offic-e 2 (F02) F7 Faculty Office 3 (F03) bull F7
Multicu ltural Campntec-Faculty Office 4 (F04) bullbullbull - G7 Faculty Office 5 (F05) - G7
SAS Center bull Junes L JanGen Family amp Consumer Sciencss (FCS) 05 Fine Arts 1 amp Art Annex (FA1) (ANNEX) FS Fine Arts 2 (FA2) G8 Fine Arts 3 (FA3) bull G8 Fine Arts 4 FA4) FS Fo und at ion (Foundation) G6
College of Continuing and Profeasional Educat ion H ill of Science (HS) F7 H eilth amp Human Services 1 HHS1) F5 H ealth amp Human Services 2 (HH S2) F5 Hom Cente r Stev e amp Nini (HC) F4 H ousing amp Resident ial Life (H RL) B1 H uman Services and Design (H SD) H5
Osher Lifelong Leaming Inst itute Japanese Garden Earl B u rns Milla r (JG ) 83 KKJZFM (KKJZ) E8 L anguage Arts Building (LAB) GS
Hauth Center Luster E amp Audrey Nichol L aciure Halls 150151 (LH) Fa LiberltgtI A rts 1 middot Instructional Madia (LA1) E8 LiberltgtI Arts 2 middot H istory (LA2) ES
Liberal Arts 3 LA3) - E8 Liberal Arts 4 middot Geography (LA4) E7 Liberal A rts 5 bull Liberal Arts (LA5) E7 Librn ry (LIB) E8 MDil Services (MS) H4 McIntosh Human ities Bldg (MHB) F8 Mi crobiology MIC) G7 Molecular amp Life Sciences Canter (MLSC) G6 MultimiddotM adii Cent er (MMC) E9 Nursing (N UR) C5 Outdoor Beach Cour89 lbx Offenberg (OUTBAC) G2 Outpost Food Se-vice (O P) H5 Paiking Tranportation and Event Services PTES) _ D3 Paterson Hill 1 (PH 1) F7 Paterson Hill 2 (PH2) - F7 Physical Ed ucation (PE) - E4
Gold Mine We-st Gym East Gym
Psychology (PSY) E7 Pyr am id Mike amp A rline Wilta r (P YR) E1
The Pointe PYR yellow entranca) Ukle je Room (PYR green enlJince)
Receiving (REC ) H4 Recycl ing Center (RC) C 1 Residence Housing
International House (IH _ __ 15 Los A limitos HJI (LAH) C4 Los Cerritos Hall ( LCH) 85 Rasidanca Commons and Ho using (RH) 84 P3Ikside Commons and Ho using (PC H) 82
Socia l Sciences P ub lic Adm in (SSPA) G5 Soroptomist Ho us e (SOR) D5 Speakec-middots Platform I East Lawn (SP) E5 Student Haalth Sarvicas (SH S) 05 Studant Recreation amp Wellnass Center (SRWC) H3 Tenni s Cantltgtr Ten y L Rhodes (Tennis Courts) F3 Thetar Arts (TA) F9
Players ThaatecshyStudi o Theat re Universt iy Theat er middot The Williim Link Theater
Track and Fie ld Jack Rose StDdium E3 University Art Museum (UAM) E4 University Booksto re (B KS) E7 University Din ing Plaza (UDP) E5 University Musi c Center (UMC) - F2
Gerald Dan ial Reci t al Hall University Pol ice Department (UP) H3 University Print Shop (UPS) G3 University Student Union (U S U) - F6
Ballr ooms A-C (USU bull 2nd F loor) Beach Audit o rium (USU bull 1st Floor) South west Terrance (USU middot 3rd Floor)
University Telecommunications (UTC) G9 Visitor Information Center (VIC) 05 Viviin Engineer ing Center (VEC) H4
POLICY STATEMENT
Policy Number 10006
Date Revised 112315
Campus Traffic Directory
8
49ER FORlY-NINER SHOPS INC CALIFORNIA STATE UNlVERSlTY LO G BEACH
POLICY STATEMENT
Policy Number 10006
Date Revised 112315
Campus Traffic Map
9
49ER FORlY-NINER SHOPS INC CALIFORNIA STATE UNlVERSlTY LONG BEACH
POLICY STATEMENT
Policy Number 10006
Date Revised 112315
Authorization to Use Privately Owned Vehicles on Forty-Niner Shops Business Approval is required to use privately owned vehicles to conduct official Forty-Niner Shops business
This form must be approved annually
Certification I hereby certify that whenever I drive a privately owned vehicle on Forty-Niner Shops business I will have a valid driverrsquos license and proof of liability insurance in my possession I will follow Forty-Niner Shops Driver Safety Policies as well as all applicable laws as required by the State of California
Additionally I will abide by the following
All motorists must carry evidence of current automobile liability insurance in their vehicle
The vehicle shall always be covered by liability insurance for the minimum amount prescribed by State Law
o $15000 for personal injury to or death of one person o $30000 for injury to death of two or more persons in one accident o $5000 property damage
All persons in the vehicle will wear safety belts Vehicle will be adequate for the work to be performed Vehicle will be equipped with safety belts in operating condition To the best of my knowledge in safe mechanical condition as required by law
I understand that the mileage rate I claim is full reimbursement for the cost of operating the privately owned vehicle including fuel maintenance repairs and both liability and comprehensive insurance
I further certify that while using a private owned vehicle on official Forty-Niner Shops business all accidents will be reported as soon as possible after the accident not to exceed 48 hours to my immediate supervisor and the Human Resources Department I understand that the insurance policy covering the privately owned vehicle will respond to the accident- the Forty-Niner Shops will NOT provide primary insurance coverage
I understand that permission to drive a privately owned vehicle on State business is a privilege which may be suspended or revoked at any time
Request Date of Request ____________ Insurance Carrier amp Policy Number ____________________________
Driverrsquos License Number ___________________ State ___________ Expiration Date __________
Employee Name ___________________________ Employee Signature _________________________
Approval DirectorManagerrsquos Signature __________________________________________ Date ____________
HR Representative Signature __________________________________________ Date ___________
10
49ER FORlY-NINER SHOPS INC CALIFORNIA STATE UNlVERSlTY LO G BEACH
Driver Privileges Revoked
It is the policy of the Forty -Niner Shops Inc to enro ll all employees in the OMV Pull Program that will be driv ing company vehicl es as well as any employee that would need to drive their own personal vehicles for the purpose o f Forty-Niner Shops business The Cali fornia Moto r Vehicl e Records (MVRs) will be used as the source fo rv eri fying driver history MVRs will be obtained init ially when the driver is enrolled in the program and annually thereafter as well as any time a driv er receives a negative infraction on their driv ing record
Driving p riv ileges may be revoked or suspended from any authorized driv er not meeting the elig ibility criteri a li sted below In add ition appropriate discipl inary action may be taken up to and including termination of employment
bull Driv ing under the influence bull Negligent homicide bull Operating with an ex pired or a suspended li cense bull Using a motor vehicle for commiss ion of a felony bull Aggrav ated assault with a motorvehicle bull Operat ing a motor vehicle without the owners consent bull Permitting an unlicensed driv er to driv e bull Reckless andor careless andor negligent driv ing bull Hit and Run or leaving the scene o f an accident with injury or death resulting or property
damage in exce ss of $1000 bull Indiv iduals who have been cited for unsafe driving on campus or who are in v iolation of
Forty-Niner Shops driver safety policies will be ineligib le to drive company vehicles or personal vehicl es for business purposes
bull Exceeding the maximum amount o f v iolation points within a 12-18 month period
Due to the current changes on your MVR which are li sted below as of today-----~ the Forty-N iner Shops is revoking your priv ilege to drive all company v ehicles as well as your own personal vehicl e for business purposes I
Employee Printed Name Date
Employee Signature HR Representative Signature
If the violation or suspension is removed by the 01-IV and you would like to regain the privilege to drive obtain a print-outfrom the OMV showing the violation or suspension has been cleared and bring it to HR A review process will take place to determine if driving privileges will be reinstated to the employee Created 1242013
POLICY STATEMENT
Policy Number 10006
Date Revised 112315
Last Revised
Policy Version
Date Author Description (If applicable) Approved Distribution
10 112315 R Hernandez Created new policy for company vehicle use
11
49ER FORlY-NINER SHOPS INC CALIFORNIA STATE UNlVERSlTY LO G BEACH
POLICY STATEMENT
Policy Number 10006
Date Revised 112315
12
49ER FORlY-NINER SHOPS INC CALIFORNIA STATE UNlVERSlTY LO G BEACH
POLICY STATEMENT
Policy Number 10006
Date Revised 112315
operate company vehicles Must submit a copy of your personal insurance stating the minimum liability requirements
Regulations
10 Eligibility 101 Valid US Driverrsquos License
All drivers of Forty-Niner Shops vehicles must be 18 years or older and hold a valid US Driverrsquos license Once an employee has been identified as a potential driver the department manager must submit a request via email to Human Resources
102 DMV Pull Program Clearance For the safety of our employees all individuals who have been identified as potential drivers will be required to participate in the DMV Pull Program Once Human Resources is notified of potential drivers they will be contacted to complete a DMV EPN Authorization form along with a copy of a valid driverrsquos license This is to authorize the Forty-Niner Shops to review their personal records driverrsquos license validity and any activity on record Please note that the Forty-Niner Shops reserve the right to deny suspend or revoke driving privileges based on the initial or subsequent review of the motor vehicle record for any employee requesting driving privileges per the eligibility criteria below
Employees or volunteers driving on auxiliary organization business will have no more than 3 (three) VIOLATION POINTS in a 12 (twelve) month period or no more than 5 (five) points in an 18 (eighteen) month period Employees or volunteers accumulating 4 (four) VIOLATION POINTS within an 18 (eighteen) month period will be excluded from the automobile liability coverage within the AORMA LIABILITY COVERAGE PROGRAM These provisions apply regardless of whether or not the driving that resulted in acquiring the VIOLATION POINTS was or was not in the course of employment
Anyone with the following violations within the last three years on their motor vehicle record will become ineligible to drive a Forty-Niner Shops vehicle
Driving under the influence
Negligent homicide
Operating with a suspended license
Using a motor vehicle for commission of a felony
Aggravated assault with a motor vehicle
Operating a motor vehicle without the ownerrsquos consent Permitting an unlicensed driver to drive
Reckless andor careless andor negligent driving
2
49ER FORlY-NINER SHOPS INC CALIFORNIA STATE UNlVERSlTY LONG BEACH
POLICY STATEMENT
Policy Number 10006
Date Revised 112315
Hit and Run or leaving the scene of an accident with injury or death resulting or property damage in excess of $1000
Exceeding the maximum amount of violation points within a 12-18 month period
In addition individuals who have been cited for unsafe driving on campus or who are in violation of Forty-Niner Shops driver safety policies will be ineligible to drive company vehicles or personal vehicles for business purposes
Drivers with violations will be reported to the CSURMA AORMA PROGRAM ADMINISTRATOR within 15 calendar days of DMV notification
20 Driver Safety and Cart Training 201 Upon DMV clearance identified employees will be required to participate
in an online driver safety and cart training The material discussed provides an overview of driver safety practices and reviews the basic level of understanding needed for operating electric carts Upon completion employees will receive certificates of completion which must be submitted to Human Resources Human Resources will then contact the employeersquos manager to notify of completion Driverrsquos Safety and Cart Training will be required every year This training will be monitored by the immediate manager and the office of Human Resources
30 Vehicle Access 301 Keys for all vehicles are stored by the Warehouse Manager in the
Warehouse Department All drivers must check out keys clarify their department indicate where they are going how long they will be and which vehicle is needed Human Resources will forward periodic clearance reports of all approved drivers to the Warehouse Manager This will be used to make sure only employees on this list are eligible to drive
40 InsuranceIndemnification 401 The Forty-Niner Shops will provide its employees with insurance
coverage while driving company vehicles Any employees with claims or actions brought against himher and resulting from authorized use of Forty-Niner Shops owned or operated vehicles will be indemnified only to the extent that insurance coverage applies and only as long as the employee follows the driver safety requirements noted in this policy
402 All traffic violations including parking tickets and speeding tickets will be the responsibility of the driver The Forty-Niner Shops shall not be held responsible
50 Use of Personal Vehicles for Company Business 501 Forty-Niner Shops employees who require the use of their personal
vehicles for company business must also comply with the Driver Safety and Cart Training as well as all requirements to operate company vehicles
502 Forty-Niner Shops employees who require the use of their personal vehicles for company business must also comply with California State Law by having the minimum liability insurance as required by the State of California
3
49ER FORlY-NINER SHOPS INC CALIFORNIA STATE UNlVERSlTY LO G BEACH
POLICY STATEMENT
Policy Number 10006
Date Revised 112315
5021 Minimum liability insurance requirements for private passenger vehicles (California Insurance Code sect115801b)
$15000 for injurydeath to one person
$30000 for injurydeath to more than one person
$5000 for damage to property 503 In the event of an accident while driving a personal vehicle for company
business the employeesrsquo insurance is the primary carrier and all claims and settlements should go through that carrier first In case of an accident where the employee is ldquonot at faultrdquo any out of pocket expenses incurred by the employee will be covered by the Forty-Niner Shops 5031 In the event of an accident an accident report must be submitted
to your manager the Human Resources office and if necessary local police
5032 All traffic violations including parking tickets and speeding tickets will be the responsibility of the driver
Appendices
1 FORM Employer Pull Notice Program- Authorization For Release of Driver Record Information
2 FORM Forty-Niner Shops Driver Safety and Vehicle Use Acknowledgement
3 NOTICE CSULB Campus Traffic Directory and Map
4 FORM Authorization to Use Privately Owned Vehicles on Forty-Niner Shops Business
5 NOTICE Driverrsquos Privileges Revoked
4
FORlY-NINER SHOPS INC 49ER CALIFORNIA STATE UNlVERSlTY LONG BEACH
EMPLOYER PULL NOTICE PROGRAM
AUTHORIZATION FOR RELEASE OF DRIVER RECORD INFORMATION
I ________________ __Ca lifornia Driver LiceJISe Number __________ __
hereby authorize the Ca lifornia Department o f Motor Vehicles (DMV) to disclose or otherwise make available my driving record tomyemployer_ ______________________________ _
COIPWIE
I understand that my employer may enroll me in the Employer Pull Notice (EPN) program to receive a d river record report at least once every twelve (12) months or when any subsequent conviction failure to appear accident drivers license suspension revocation o r any other action is taken against my driving privilege during my employment
I am not driving in a capacity that requ ires mandatory e nro llment in the EPN program pursuant to California Vehicle Code (CVC) Section 18081(1lt) I understand that enrollment in the EPN program is in a n effort to promotedriver safety and that my drive r license report wi ll be released to ITT employer to determ ine my e ligibil ity as a licensed driver for my employment
EXECUlED AI UTY SWE
DA1E
l ______ _=======----- middotof _______ ---=====----------AUTHCfUZEo RiPRESEfiaTNE COGl8( N1HE
do hereby certify under penalty of perj ury under the laws in the State ofCalifomia that I aman authorized representative of this company that the information entered on this document is true and correct to the best o f my knowledge and that I am requesting driver record information on the above individual to verify the information as provided by said individual This record is to be used by this employer in the normal course of business and asa legitimate business need to verify information re lat ing to a driving position not mandated pursuant to CVC Section 18081 The information received wi ll not be used for any unlawful purpose I understand that if I have provided fa lse information I may be subject to prosecution for perjury (Penal Code Section 118) and fa lse representation (CVC Section 180845) T hese are punishable by a fine not exceeding five thousand do llars ($5000) or by imprisonment in the county jail not exceeding one year o r both fine and imprisonment I understand and acknowledge that any failure to maintain confidentia lity is both civilly and cri minally punishable pursuant to eve Sections 180845 and 180846
EXE CUTED Al CITY SWE
DA1E
To obtain a d river record on a prospective employee you may submitan l NF 1119form To add thisdriver to the EPNProgram you must submit the applicable forms INF 1100 INF 1102 I NF 1103 INF 11030form You may obtain forms at our website at wwwdmvcagovfotherservices orby calling 916-657-6346
THIS FORM MUST BE COMPLETED AND RETAINED AT THE EMPLOYERS PRINCIPAL PLACE OF BUSINESS AND MADE AVAJ LABLE UPON REQUEST TO DMV STAFF
DO NOT RETURN THIS FORM TO DMV
POLICY STATEMENT
Policy Number 10006
Date Revised 112315
5
49ER FORlY-NINER SHOPS INC CALIFORNIA STATE UNlVERSlTY LO G BEACH
POLICY STATEMENT
Policy Number 10006
Date Revised 112315
Forty-Niner Shops Inc
Driver Safety and Vehicle Use Acknowledgement
I Driving Risks and Responsibilities
Driving safely on and around campus is essential With the increased congestion in both vehicular and pedestrian traffic safety and caution are absolutely critical When driving on campus whether in a vehicle or cart please follow these guidelines as well as the established access and routes
Avoid driving on inner campus during class breaks (ten minutes to the hour) Only access campus interiors for specific service-related needs ie unloading or emergency response
Never exceed posted speed limits and use discretion when a slower speed may be more appropriate due to congestion
Use caution at pedestrian crossing ie intersections crosswalks and other marked or unmarked areas where frequent crossing occurs REMEMBER the pedestrian always has the right of way
Always park vehicles as not to block traffic crosswalks disabled access building entrances fire hydrants and walkways
Vehicles access in the areas prohibited as specified on the established access and routes map shall be adhered to
All vehicular traffic is prohibited on the elevated pedestrian walkway located between the Student ServicesAdministration building and the North Campus Library
All vehicular traffic is prohibited on all brick surfaces as specified on the established access and routes maps
Driving on lawns and landscaped areas is prohibited Alternate routes are to be used to eliminate unnecessary ruts in landscaped areas and repairs to underground utility systems Cutting corners through landscaped areas will be considered damaging University property Drivers will be held accountable
When attending any on-campus event (Staff Day on-campus seminars etc) use designated parking spaces This includes all vehicles and carts
II Driver and Passenger Safety Requirements
1 Driver must be at least 18 years old and in possession of a valid US driverrsquos license at all times when operating a vehicle as a Forty-Niner Shops employee
6
49ER FORlY-NINER SHOPS INC CALIFORNIA STATE UNlVERSlTY LONG BEACH
POLICY STATEMENT
Policy Number 10006
Date Revised 112315
2 Driver shall observe all rules and regulations for safe driving as defined by the State of California Motor Vehicles Department
3 Drinking possession of intoxicating liquor illegal drugs in vehicles or driving while under the influence of alcohol or drugs is prohibited
4 Avoid conditions that lead to loss of control- driving while sleepy or inattentive or driving too fast for road conditions
5 Drivers must adhere to all California DMV laws
6 In an event of an accident all incidents must be reported on an accident report and must be submitted to your manager the Human Resources office and if necessary local police
Employee Name _________________________________________ Department __________
Employee Signature _______________________________________ Date ______________
7
49ER FORlYmiddotNINER SHOPS INC CALIFORNIA STATE UNlVERSlTY LO G BEACH
CALIFORNIA STATE UNIVERSITY LONG BEACH 1250 BELLFLOWER BOULEVARD LONG BEACH CA 90840
49er Pool (POgtL) F4 4 9er Softball Com plex (SC) G3 Acadam ic Services (AS) ES
Anatol Cente r Karl WE Barren Athlatic Administration Center ltBMCgt Nei l amp Phyllis E2
Pyramid Annex Conferenca Center (2nd Floor o f MC) Special Event s (2nd Floor)
Beach Circle The BC) E4 Brotmin Ha ll (BH ) E5
Kil li ngsworth Plaza Edward A Maxson Plaza Robert C
C arpenter Performing Arts Cente r (CPAC) G 1 Central Plant (C P) F6 Cent rltgtI Q uad (COSOUTH) Fa Colle9a of Bus inass AdminislJition (CBA) 04 Child Development Center Iaibel Patte rson (CDC) B1 Corporation Ya rd (CORP) H4 Dance Center (DC) F 1
Martha B Knoebel Daneamp Theatec-Design (DESN) H5 Education 1 (ED1) bull - E9 Education 2 (ED2) - E9 Enginamparing 2 EN2 ) _ G4 Engine-aring 3 (EN3) G4 Engineering 4 (EN4) G4 Eng inaering amp Compute r Sciencas (ECS) _ H4 Engine-aring Technology (ET) H4 Facilit ies Management (FM) 14 Friendship Wltgtlk (FWCENTRAL) F5 Faculty Offic-e 2 (F02) F7 Faculty Office 3 (F03) bull F7
Multicu ltural Campntec-Faculty Office 4 (F04) bullbullbull - G7 Faculty Office 5 (F05) - G7
SAS Center bull Junes L JanGen Family amp Consumer Sciencss (FCS) 05 Fine Arts 1 amp Art Annex (FA1) (ANNEX) FS Fine Arts 2 (FA2) G8 Fine Arts 3 (FA3) bull G8 Fine Arts 4 FA4) FS Fo und at ion (Foundation) G6
College of Continuing and Profeasional Educat ion H ill of Science (HS) F7 H eilth amp Human Services 1 HHS1) F5 H ealth amp Human Services 2 (HH S2) F5 Hom Cente r Stev e amp Nini (HC) F4 H ousing amp Resident ial Life (H RL) B1 H uman Services and Design (H SD) H5
Osher Lifelong Leaming Inst itute Japanese Garden Earl B u rns Milla r (JG ) 83 KKJZFM (KKJZ) E8 L anguage Arts Building (LAB) GS
Hauth Center Luster E amp Audrey Nichol L aciure Halls 150151 (LH) Fa LiberltgtI A rts 1 middot Instructional Madia (LA1) E8 LiberltgtI Arts 2 middot H istory (LA2) ES
Liberal Arts 3 LA3) - E8 Liberal Arts 4 middot Geography (LA4) E7 Liberal A rts 5 bull Liberal Arts (LA5) E7 Librn ry (LIB) E8 MDil Services (MS) H4 McIntosh Human ities Bldg (MHB) F8 Mi crobiology MIC) G7 Molecular amp Life Sciences Canter (MLSC) G6 MultimiddotM adii Cent er (MMC) E9 Nursing (N UR) C5 Outdoor Beach Cour89 lbx Offenberg (OUTBAC) G2 Outpost Food Se-vice (O P) H5 Paiking Tranportation and Event Services PTES) _ D3 Paterson Hill 1 (PH 1) F7 Paterson Hill 2 (PH2) - F7 Physical Ed ucation (PE) - E4
Gold Mine We-st Gym East Gym
Psychology (PSY) E7 Pyr am id Mike amp A rline Wilta r (P YR) E1
The Pointe PYR yellow entranca) Ukle je Room (PYR green enlJince)
Receiving (REC ) H4 Recycl ing Center (RC) C 1 Residence Housing
International House (IH _ __ 15 Los A limitos HJI (LAH) C4 Los Cerritos Hall ( LCH) 85 Rasidanca Commons and Ho using (RH) 84 P3Ikside Commons and Ho using (PC H) 82
Socia l Sciences P ub lic Adm in (SSPA) G5 Soroptomist Ho us e (SOR) D5 Speakec-middots Platform I East Lawn (SP) E5 Student Haalth Sarvicas (SH S) 05 Studant Recreation amp Wellnass Center (SRWC) H3 Tenni s Cantltgtr Ten y L Rhodes (Tennis Courts) F3 Thetar Arts (TA) F9
Players ThaatecshyStudi o Theat re Universt iy Theat er middot The Williim Link Theater
Track and Fie ld Jack Rose StDdium E3 University Art Museum (UAM) E4 University Booksto re (B KS) E7 University Din ing Plaza (UDP) E5 University Musi c Center (UMC) - F2
Gerald Dan ial Reci t al Hall University Pol ice Department (UP) H3 University Print Shop (UPS) G3 University Student Union (U S U) - F6
Ballr ooms A-C (USU bull 2nd F loor) Beach Audit o rium (USU bull 1st Floor) South west Terrance (USU middot 3rd Floor)
University Telecommunications (UTC) G9 Visitor Information Center (VIC) 05 Viviin Engineer ing Center (VEC) H4
POLICY STATEMENT
Policy Number 10006
Date Revised 112315
Campus Traffic Directory
8
49ER FORlY-NINER SHOPS INC CALIFORNIA STATE UNlVERSlTY LO G BEACH
POLICY STATEMENT
Policy Number 10006
Date Revised 112315
Campus Traffic Map
9
49ER FORlY-NINER SHOPS INC CALIFORNIA STATE UNlVERSlTY LONG BEACH
POLICY STATEMENT
Policy Number 10006
Date Revised 112315
Authorization to Use Privately Owned Vehicles on Forty-Niner Shops Business Approval is required to use privately owned vehicles to conduct official Forty-Niner Shops business
This form must be approved annually
Certification I hereby certify that whenever I drive a privately owned vehicle on Forty-Niner Shops business I will have a valid driverrsquos license and proof of liability insurance in my possession I will follow Forty-Niner Shops Driver Safety Policies as well as all applicable laws as required by the State of California
Additionally I will abide by the following
All motorists must carry evidence of current automobile liability insurance in their vehicle
The vehicle shall always be covered by liability insurance for the minimum amount prescribed by State Law
o $15000 for personal injury to or death of one person o $30000 for injury to death of two or more persons in one accident o $5000 property damage
All persons in the vehicle will wear safety belts Vehicle will be adequate for the work to be performed Vehicle will be equipped with safety belts in operating condition To the best of my knowledge in safe mechanical condition as required by law
I understand that the mileage rate I claim is full reimbursement for the cost of operating the privately owned vehicle including fuel maintenance repairs and both liability and comprehensive insurance
I further certify that while using a private owned vehicle on official Forty-Niner Shops business all accidents will be reported as soon as possible after the accident not to exceed 48 hours to my immediate supervisor and the Human Resources Department I understand that the insurance policy covering the privately owned vehicle will respond to the accident- the Forty-Niner Shops will NOT provide primary insurance coverage
I understand that permission to drive a privately owned vehicle on State business is a privilege which may be suspended or revoked at any time
Request Date of Request ____________ Insurance Carrier amp Policy Number ____________________________
Driverrsquos License Number ___________________ State ___________ Expiration Date __________
Employee Name ___________________________ Employee Signature _________________________
Approval DirectorManagerrsquos Signature __________________________________________ Date ____________
HR Representative Signature __________________________________________ Date ___________
10
49ER FORlY-NINER SHOPS INC CALIFORNIA STATE UNlVERSlTY LO G BEACH
Driver Privileges Revoked
It is the policy of the Forty -Niner Shops Inc to enro ll all employees in the OMV Pull Program that will be driv ing company vehicl es as well as any employee that would need to drive their own personal vehicles for the purpose o f Forty-Niner Shops business The Cali fornia Moto r Vehicl e Records (MVRs) will be used as the source fo rv eri fying driver history MVRs will be obtained init ially when the driver is enrolled in the program and annually thereafter as well as any time a driv er receives a negative infraction on their driv ing record
Driving p riv ileges may be revoked or suspended from any authorized driv er not meeting the elig ibility criteri a li sted below In add ition appropriate discipl inary action may be taken up to and including termination of employment
bull Driv ing under the influence bull Negligent homicide bull Operating with an ex pired or a suspended li cense bull Using a motor vehicle for commiss ion of a felony bull Aggrav ated assault with a motorvehicle bull Operat ing a motor vehicle without the owners consent bull Permitting an unlicensed driv er to driv e bull Reckless andor careless andor negligent driv ing bull Hit and Run or leaving the scene o f an accident with injury or death resulting or property
damage in exce ss of $1000 bull Indiv iduals who have been cited for unsafe driving on campus or who are in v iolation of
Forty-Niner Shops driver safety policies will be ineligib le to drive company vehicles or personal vehicl es for business purposes
bull Exceeding the maximum amount o f v iolation points within a 12-18 month period
Due to the current changes on your MVR which are li sted below as of today-----~ the Forty-N iner Shops is revoking your priv ilege to drive all company v ehicles as well as your own personal vehicl e for business purposes I
Employee Printed Name Date
Employee Signature HR Representative Signature
If the violation or suspension is removed by the 01-IV and you would like to regain the privilege to drive obtain a print-outfrom the OMV showing the violation or suspension has been cleared and bring it to HR A review process will take place to determine if driving privileges will be reinstated to the employee Created 1242013
POLICY STATEMENT
Policy Number 10006
Date Revised 112315
Last Revised
Policy Version
Date Author Description (If applicable) Approved Distribution
10 112315 R Hernandez Created new policy for company vehicle use
11
49ER FORlY-NINER SHOPS INC CALIFORNIA STATE UNlVERSlTY LO G BEACH
POLICY STATEMENT
Policy Number 10006
Date Revised 112315
12
49ER FORlY-NINER SHOPS INC CALIFORNIA STATE UNlVERSlTY LONG BEACH
POLICY STATEMENT
Policy Number 10006
Date Revised 112315
Hit and Run or leaving the scene of an accident with injury or death resulting or property damage in excess of $1000
Exceeding the maximum amount of violation points within a 12-18 month period
In addition individuals who have been cited for unsafe driving on campus or who are in violation of Forty-Niner Shops driver safety policies will be ineligible to drive company vehicles or personal vehicles for business purposes
Drivers with violations will be reported to the CSURMA AORMA PROGRAM ADMINISTRATOR within 15 calendar days of DMV notification
20 Driver Safety and Cart Training 201 Upon DMV clearance identified employees will be required to participate
in an online driver safety and cart training The material discussed provides an overview of driver safety practices and reviews the basic level of understanding needed for operating electric carts Upon completion employees will receive certificates of completion which must be submitted to Human Resources Human Resources will then contact the employeersquos manager to notify of completion Driverrsquos Safety and Cart Training will be required every year This training will be monitored by the immediate manager and the office of Human Resources
30 Vehicle Access 301 Keys for all vehicles are stored by the Warehouse Manager in the
Warehouse Department All drivers must check out keys clarify their department indicate where they are going how long they will be and which vehicle is needed Human Resources will forward periodic clearance reports of all approved drivers to the Warehouse Manager This will be used to make sure only employees on this list are eligible to drive
40 InsuranceIndemnification 401 The Forty-Niner Shops will provide its employees with insurance
coverage while driving company vehicles Any employees with claims or actions brought against himher and resulting from authorized use of Forty-Niner Shops owned or operated vehicles will be indemnified only to the extent that insurance coverage applies and only as long as the employee follows the driver safety requirements noted in this policy
402 All traffic violations including parking tickets and speeding tickets will be the responsibility of the driver The Forty-Niner Shops shall not be held responsible
50 Use of Personal Vehicles for Company Business 501 Forty-Niner Shops employees who require the use of their personal
vehicles for company business must also comply with the Driver Safety and Cart Training as well as all requirements to operate company vehicles
502 Forty-Niner Shops employees who require the use of their personal vehicles for company business must also comply with California State Law by having the minimum liability insurance as required by the State of California
3
49ER FORlY-NINER SHOPS INC CALIFORNIA STATE UNlVERSlTY LO G BEACH
POLICY STATEMENT
Policy Number 10006
Date Revised 112315
5021 Minimum liability insurance requirements for private passenger vehicles (California Insurance Code sect115801b)
$15000 for injurydeath to one person
$30000 for injurydeath to more than one person
$5000 for damage to property 503 In the event of an accident while driving a personal vehicle for company
business the employeesrsquo insurance is the primary carrier and all claims and settlements should go through that carrier first In case of an accident where the employee is ldquonot at faultrdquo any out of pocket expenses incurred by the employee will be covered by the Forty-Niner Shops 5031 In the event of an accident an accident report must be submitted
to your manager the Human Resources office and if necessary local police
5032 All traffic violations including parking tickets and speeding tickets will be the responsibility of the driver
Appendices
1 FORM Employer Pull Notice Program- Authorization For Release of Driver Record Information
2 FORM Forty-Niner Shops Driver Safety and Vehicle Use Acknowledgement
3 NOTICE CSULB Campus Traffic Directory and Map
4 FORM Authorization to Use Privately Owned Vehicles on Forty-Niner Shops Business
5 NOTICE Driverrsquos Privileges Revoked
4
FORlY-NINER SHOPS INC 49ER CALIFORNIA STATE UNlVERSlTY LONG BEACH
EMPLOYER PULL NOTICE PROGRAM
AUTHORIZATION FOR RELEASE OF DRIVER RECORD INFORMATION
I ________________ __Ca lifornia Driver LiceJISe Number __________ __
hereby authorize the Ca lifornia Department o f Motor Vehicles (DMV) to disclose or otherwise make available my driving record tomyemployer_ ______________________________ _
COIPWIE
I understand that my employer may enroll me in the Employer Pull Notice (EPN) program to receive a d river record report at least once every twelve (12) months or when any subsequent conviction failure to appear accident drivers license suspension revocation o r any other action is taken against my driving privilege during my employment
I am not driving in a capacity that requ ires mandatory e nro llment in the EPN program pursuant to California Vehicle Code (CVC) Section 18081(1lt) I understand that enrollment in the EPN program is in a n effort to promotedriver safety and that my drive r license report wi ll be released to ITT employer to determ ine my e ligibil ity as a licensed driver for my employment
EXECUlED AI UTY SWE
DA1E
l ______ _=======----- middotof _______ ---=====----------AUTHCfUZEo RiPRESEfiaTNE COGl8( N1HE
do hereby certify under penalty of perj ury under the laws in the State ofCalifomia that I aman authorized representative of this company that the information entered on this document is true and correct to the best o f my knowledge and that I am requesting driver record information on the above individual to verify the information as provided by said individual This record is to be used by this employer in the normal course of business and asa legitimate business need to verify information re lat ing to a driving position not mandated pursuant to CVC Section 18081 The information received wi ll not be used for any unlawful purpose I understand that if I have provided fa lse information I may be subject to prosecution for perjury (Penal Code Section 118) and fa lse representation (CVC Section 180845) T hese are punishable by a fine not exceeding five thousand do llars ($5000) or by imprisonment in the county jail not exceeding one year o r both fine and imprisonment I understand and acknowledge that any failure to maintain confidentia lity is both civilly and cri minally punishable pursuant to eve Sections 180845 and 180846
EXE CUTED Al CITY SWE
DA1E
To obtain a d river record on a prospective employee you may submitan l NF 1119form To add thisdriver to the EPNProgram you must submit the applicable forms INF 1100 INF 1102 I NF 1103 INF 11030form You may obtain forms at our website at wwwdmvcagovfotherservices orby calling 916-657-6346
THIS FORM MUST BE COMPLETED AND RETAINED AT THE EMPLOYERS PRINCIPAL PLACE OF BUSINESS AND MADE AVAJ LABLE UPON REQUEST TO DMV STAFF
DO NOT RETURN THIS FORM TO DMV
POLICY STATEMENT
Policy Number 10006
Date Revised 112315
5
49ER FORlY-NINER SHOPS INC CALIFORNIA STATE UNlVERSlTY LO G BEACH
POLICY STATEMENT
Policy Number 10006
Date Revised 112315
Forty-Niner Shops Inc
Driver Safety and Vehicle Use Acknowledgement
I Driving Risks and Responsibilities
Driving safely on and around campus is essential With the increased congestion in both vehicular and pedestrian traffic safety and caution are absolutely critical When driving on campus whether in a vehicle or cart please follow these guidelines as well as the established access and routes
Avoid driving on inner campus during class breaks (ten minutes to the hour) Only access campus interiors for specific service-related needs ie unloading or emergency response
Never exceed posted speed limits and use discretion when a slower speed may be more appropriate due to congestion
Use caution at pedestrian crossing ie intersections crosswalks and other marked or unmarked areas where frequent crossing occurs REMEMBER the pedestrian always has the right of way
Always park vehicles as not to block traffic crosswalks disabled access building entrances fire hydrants and walkways
Vehicles access in the areas prohibited as specified on the established access and routes map shall be adhered to
All vehicular traffic is prohibited on the elevated pedestrian walkway located between the Student ServicesAdministration building and the North Campus Library
All vehicular traffic is prohibited on all brick surfaces as specified on the established access and routes maps
Driving on lawns and landscaped areas is prohibited Alternate routes are to be used to eliminate unnecessary ruts in landscaped areas and repairs to underground utility systems Cutting corners through landscaped areas will be considered damaging University property Drivers will be held accountable
When attending any on-campus event (Staff Day on-campus seminars etc) use designated parking spaces This includes all vehicles and carts
II Driver and Passenger Safety Requirements
1 Driver must be at least 18 years old and in possession of a valid US driverrsquos license at all times when operating a vehicle as a Forty-Niner Shops employee
6
49ER FORlY-NINER SHOPS INC CALIFORNIA STATE UNlVERSlTY LONG BEACH
POLICY STATEMENT
Policy Number 10006
Date Revised 112315
2 Driver shall observe all rules and regulations for safe driving as defined by the State of California Motor Vehicles Department
3 Drinking possession of intoxicating liquor illegal drugs in vehicles or driving while under the influence of alcohol or drugs is prohibited
4 Avoid conditions that lead to loss of control- driving while sleepy or inattentive or driving too fast for road conditions
5 Drivers must adhere to all California DMV laws
6 In an event of an accident all incidents must be reported on an accident report and must be submitted to your manager the Human Resources office and if necessary local police
Employee Name _________________________________________ Department __________
Employee Signature _______________________________________ Date ______________
7
49ER FORlYmiddotNINER SHOPS INC CALIFORNIA STATE UNlVERSlTY LO G BEACH
CALIFORNIA STATE UNIVERSITY LONG BEACH 1250 BELLFLOWER BOULEVARD LONG BEACH CA 90840
49er Pool (POgtL) F4 4 9er Softball Com plex (SC) G3 Acadam ic Services (AS) ES
Anatol Cente r Karl WE Barren Athlatic Administration Center ltBMCgt Nei l amp Phyllis E2
Pyramid Annex Conferenca Center (2nd Floor o f MC) Special Event s (2nd Floor)
Beach Circle The BC) E4 Brotmin Ha ll (BH ) E5
Kil li ngsworth Plaza Edward A Maxson Plaza Robert C
C arpenter Performing Arts Cente r (CPAC) G 1 Central Plant (C P) F6 Cent rltgtI Q uad (COSOUTH) Fa Colle9a of Bus inass AdminislJition (CBA) 04 Child Development Center Iaibel Patte rson (CDC) B1 Corporation Ya rd (CORP) H4 Dance Center (DC) F 1
Martha B Knoebel Daneamp Theatec-Design (DESN) H5 Education 1 (ED1) bull - E9 Education 2 (ED2) - E9 Enginamparing 2 EN2 ) _ G4 Engine-aring 3 (EN3) G4 Engineering 4 (EN4) G4 Eng inaering amp Compute r Sciencas (ECS) _ H4 Engine-aring Technology (ET) H4 Facilit ies Management (FM) 14 Friendship Wltgtlk (FWCENTRAL) F5 Faculty Offic-e 2 (F02) F7 Faculty Office 3 (F03) bull F7
Multicu ltural Campntec-Faculty Office 4 (F04) bullbullbull - G7 Faculty Office 5 (F05) - G7
SAS Center bull Junes L JanGen Family amp Consumer Sciencss (FCS) 05 Fine Arts 1 amp Art Annex (FA1) (ANNEX) FS Fine Arts 2 (FA2) G8 Fine Arts 3 (FA3) bull G8 Fine Arts 4 FA4) FS Fo und at ion (Foundation) G6
College of Continuing and Profeasional Educat ion H ill of Science (HS) F7 H eilth amp Human Services 1 HHS1) F5 H ealth amp Human Services 2 (HH S2) F5 Hom Cente r Stev e amp Nini (HC) F4 H ousing amp Resident ial Life (H RL) B1 H uman Services and Design (H SD) H5
Osher Lifelong Leaming Inst itute Japanese Garden Earl B u rns Milla r (JG ) 83 KKJZFM (KKJZ) E8 L anguage Arts Building (LAB) GS
Hauth Center Luster E amp Audrey Nichol L aciure Halls 150151 (LH) Fa LiberltgtI A rts 1 middot Instructional Madia (LA1) E8 LiberltgtI Arts 2 middot H istory (LA2) ES
Liberal Arts 3 LA3) - E8 Liberal Arts 4 middot Geography (LA4) E7 Liberal A rts 5 bull Liberal Arts (LA5) E7 Librn ry (LIB) E8 MDil Services (MS) H4 McIntosh Human ities Bldg (MHB) F8 Mi crobiology MIC) G7 Molecular amp Life Sciences Canter (MLSC) G6 MultimiddotM adii Cent er (MMC) E9 Nursing (N UR) C5 Outdoor Beach Cour89 lbx Offenberg (OUTBAC) G2 Outpost Food Se-vice (O P) H5 Paiking Tranportation and Event Services PTES) _ D3 Paterson Hill 1 (PH 1) F7 Paterson Hill 2 (PH2) - F7 Physical Ed ucation (PE) - E4
Gold Mine We-st Gym East Gym
Psychology (PSY) E7 Pyr am id Mike amp A rline Wilta r (P YR) E1
The Pointe PYR yellow entranca) Ukle je Room (PYR green enlJince)
Receiving (REC ) H4 Recycl ing Center (RC) C 1 Residence Housing
International House (IH _ __ 15 Los A limitos HJI (LAH) C4 Los Cerritos Hall ( LCH) 85 Rasidanca Commons and Ho using (RH) 84 P3Ikside Commons and Ho using (PC H) 82
Socia l Sciences P ub lic Adm in (SSPA) G5 Soroptomist Ho us e (SOR) D5 Speakec-middots Platform I East Lawn (SP) E5 Student Haalth Sarvicas (SH S) 05 Studant Recreation amp Wellnass Center (SRWC) H3 Tenni s Cantltgtr Ten y L Rhodes (Tennis Courts) F3 Thetar Arts (TA) F9
Players ThaatecshyStudi o Theat re Universt iy Theat er middot The Williim Link Theater
Track and Fie ld Jack Rose StDdium E3 University Art Museum (UAM) E4 University Booksto re (B KS) E7 University Din ing Plaza (UDP) E5 University Musi c Center (UMC) - F2
Gerald Dan ial Reci t al Hall University Pol ice Department (UP) H3 University Print Shop (UPS) G3 University Student Union (U S U) - F6
Ballr ooms A-C (USU bull 2nd F loor) Beach Audit o rium (USU bull 1st Floor) South west Terrance (USU middot 3rd Floor)
University Telecommunications (UTC) G9 Visitor Information Center (VIC) 05 Viviin Engineer ing Center (VEC) H4
POLICY STATEMENT
Policy Number 10006
Date Revised 112315
Campus Traffic Directory
8
49ER FORlY-NINER SHOPS INC CALIFORNIA STATE UNlVERSlTY LO G BEACH
POLICY STATEMENT
Policy Number 10006
Date Revised 112315
Campus Traffic Map
9
49ER FORlY-NINER SHOPS INC CALIFORNIA STATE UNlVERSlTY LONG BEACH
POLICY STATEMENT
Policy Number 10006
Date Revised 112315
Authorization to Use Privately Owned Vehicles on Forty-Niner Shops Business Approval is required to use privately owned vehicles to conduct official Forty-Niner Shops business
This form must be approved annually
Certification I hereby certify that whenever I drive a privately owned vehicle on Forty-Niner Shops business I will have a valid driverrsquos license and proof of liability insurance in my possession I will follow Forty-Niner Shops Driver Safety Policies as well as all applicable laws as required by the State of California
Additionally I will abide by the following
All motorists must carry evidence of current automobile liability insurance in their vehicle
The vehicle shall always be covered by liability insurance for the minimum amount prescribed by State Law
o $15000 for personal injury to or death of one person o $30000 for injury to death of two or more persons in one accident o $5000 property damage
All persons in the vehicle will wear safety belts Vehicle will be adequate for the work to be performed Vehicle will be equipped with safety belts in operating condition To the best of my knowledge in safe mechanical condition as required by law
I understand that the mileage rate I claim is full reimbursement for the cost of operating the privately owned vehicle including fuel maintenance repairs and both liability and comprehensive insurance
I further certify that while using a private owned vehicle on official Forty-Niner Shops business all accidents will be reported as soon as possible after the accident not to exceed 48 hours to my immediate supervisor and the Human Resources Department I understand that the insurance policy covering the privately owned vehicle will respond to the accident- the Forty-Niner Shops will NOT provide primary insurance coverage
I understand that permission to drive a privately owned vehicle on State business is a privilege which may be suspended or revoked at any time
Request Date of Request ____________ Insurance Carrier amp Policy Number ____________________________
Driverrsquos License Number ___________________ State ___________ Expiration Date __________
Employee Name ___________________________ Employee Signature _________________________
Approval DirectorManagerrsquos Signature __________________________________________ Date ____________
HR Representative Signature __________________________________________ Date ___________
10
49ER FORlY-NINER SHOPS INC CALIFORNIA STATE UNlVERSlTY LO G BEACH
Driver Privileges Revoked
It is the policy of the Forty -Niner Shops Inc to enro ll all employees in the OMV Pull Program that will be driv ing company vehicl es as well as any employee that would need to drive their own personal vehicles for the purpose o f Forty-Niner Shops business The Cali fornia Moto r Vehicl e Records (MVRs) will be used as the source fo rv eri fying driver history MVRs will be obtained init ially when the driver is enrolled in the program and annually thereafter as well as any time a driv er receives a negative infraction on their driv ing record
Driving p riv ileges may be revoked or suspended from any authorized driv er not meeting the elig ibility criteri a li sted below In add ition appropriate discipl inary action may be taken up to and including termination of employment
bull Driv ing under the influence bull Negligent homicide bull Operating with an ex pired or a suspended li cense bull Using a motor vehicle for commiss ion of a felony bull Aggrav ated assault with a motorvehicle bull Operat ing a motor vehicle without the owners consent bull Permitting an unlicensed driv er to driv e bull Reckless andor careless andor negligent driv ing bull Hit and Run or leaving the scene o f an accident with injury or death resulting or property
damage in exce ss of $1000 bull Indiv iduals who have been cited for unsafe driving on campus or who are in v iolation of
Forty-Niner Shops driver safety policies will be ineligib le to drive company vehicles or personal vehicl es for business purposes
bull Exceeding the maximum amount o f v iolation points within a 12-18 month period
Due to the current changes on your MVR which are li sted below as of today-----~ the Forty-N iner Shops is revoking your priv ilege to drive all company v ehicles as well as your own personal vehicl e for business purposes I
Employee Printed Name Date
Employee Signature HR Representative Signature
If the violation or suspension is removed by the 01-IV and you would like to regain the privilege to drive obtain a print-outfrom the OMV showing the violation or suspension has been cleared and bring it to HR A review process will take place to determine if driving privileges will be reinstated to the employee Created 1242013
POLICY STATEMENT
Policy Number 10006
Date Revised 112315
Last Revised
Policy Version
Date Author Description (If applicable) Approved Distribution
10 112315 R Hernandez Created new policy for company vehicle use
11
49ER FORlY-NINER SHOPS INC CALIFORNIA STATE UNlVERSlTY LO G BEACH
POLICY STATEMENT
Policy Number 10006
Date Revised 112315
12
49ER FORlY-NINER SHOPS INC CALIFORNIA STATE UNlVERSlTY LO G BEACH
POLICY STATEMENT
Policy Number 10006
Date Revised 112315
5021 Minimum liability insurance requirements for private passenger vehicles (California Insurance Code sect115801b)
$15000 for injurydeath to one person
$30000 for injurydeath to more than one person
$5000 for damage to property 503 In the event of an accident while driving a personal vehicle for company
business the employeesrsquo insurance is the primary carrier and all claims and settlements should go through that carrier first In case of an accident where the employee is ldquonot at faultrdquo any out of pocket expenses incurred by the employee will be covered by the Forty-Niner Shops 5031 In the event of an accident an accident report must be submitted
to your manager the Human Resources office and if necessary local police
5032 All traffic violations including parking tickets and speeding tickets will be the responsibility of the driver
Appendices
1 FORM Employer Pull Notice Program- Authorization For Release of Driver Record Information
2 FORM Forty-Niner Shops Driver Safety and Vehicle Use Acknowledgement
3 NOTICE CSULB Campus Traffic Directory and Map
4 FORM Authorization to Use Privately Owned Vehicles on Forty-Niner Shops Business
5 NOTICE Driverrsquos Privileges Revoked
4
FORlY-NINER SHOPS INC 49ER CALIFORNIA STATE UNlVERSlTY LONG BEACH
EMPLOYER PULL NOTICE PROGRAM
AUTHORIZATION FOR RELEASE OF DRIVER RECORD INFORMATION
I ________________ __Ca lifornia Driver LiceJISe Number __________ __
hereby authorize the Ca lifornia Department o f Motor Vehicles (DMV) to disclose or otherwise make available my driving record tomyemployer_ ______________________________ _
COIPWIE
I understand that my employer may enroll me in the Employer Pull Notice (EPN) program to receive a d river record report at least once every twelve (12) months or when any subsequent conviction failure to appear accident drivers license suspension revocation o r any other action is taken against my driving privilege during my employment
I am not driving in a capacity that requ ires mandatory e nro llment in the EPN program pursuant to California Vehicle Code (CVC) Section 18081(1lt) I understand that enrollment in the EPN program is in a n effort to promotedriver safety and that my drive r license report wi ll be released to ITT employer to determ ine my e ligibil ity as a licensed driver for my employment
EXECUlED AI UTY SWE
DA1E
l ______ _=======----- middotof _______ ---=====----------AUTHCfUZEo RiPRESEfiaTNE COGl8( N1HE
do hereby certify under penalty of perj ury under the laws in the State ofCalifomia that I aman authorized representative of this company that the information entered on this document is true and correct to the best o f my knowledge and that I am requesting driver record information on the above individual to verify the information as provided by said individual This record is to be used by this employer in the normal course of business and asa legitimate business need to verify information re lat ing to a driving position not mandated pursuant to CVC Section 18081 The information received wi ll not be used for any unlawful purpose I understand that if I have provided fa lse information I may be subject to prosecution for perjury (Penal Code Section 118) and fa lse representation (CVC Section 180845) T hese are punishable by a fine not exceeding five thousand do llars ($5000) or by imprisonment in the county jail not exceeding one year o r both fine and imprisonment I understand and acknowledge that any failure to maintain confidentia lity is both civilly and cri minally punishable pursuant to eve Sections 180845 and 180846
EXE CUTED Al CITY SWE
DA1E
To obtain a d river record on a prospective employee you may submitan l NF 1119form To add thisdriver to the EPNProgram you must submit the applicable forms INF 1100 INF 1102 I NF 1103 INF 11030form You may obtain forms at our website at wwwdmvcagovfotherservices orby calling 916-657-6346
THIS FORM MUST BE COMPLETED AND RETAINED AT THE EMPLOYERS PRINCIPAL PLACE OF BUSINESS AND MADE AVAJ LABLE UPON REQUEST TO DMV STAFF
DO NOT RETURN THIS FORM TO DMV
POLICY STATEMENT
Policy Number 10006
Date Revised 112315
5
49ER FORlY-NINER SHOPS INC CALIFORNIA STATE UNlVERSlTY LO G BEACH
POLICY STATEMENT
Policy Number 10006
Date Revised 112315
Forty-Niner Shops Inc
Driver Safety and Vehicle Use Acknowledgement
I Driving Risks and Responsibilities
Driving safely on and around campus is essential With the increased congestion in both vehicular and pedestrian traffic safety and caution are absolutely critical When driving on campus whether in a vehicle or cart please follow these guidelines as well as the established access and routes
Avoid driving on inner campus during class breaks (ten minutes to the hour) Only access campus interiors for specific service-related needs ie unloading or emergency response
Never exceed posted speed limits and use discretion when a slower speed may be more appropriate due to congestion
Use caution at pedestrian crossing ie intersections crosswalks and other marked or unmarked areas where frequent crossing occurs REMEMBER the pedestrian always has the right of way
Always park vehicles as not to block traffic crosswalks disabled access building entrances fire hydrants and walkways
Vehicles access in the areas prohibited as specified on the established access and routes map shall be adhered to
All vehicular traffic is prohibited on the elevated pedestrian walkway located between the Student ServicesAdministration building and the North Campus Library
All vehicular traffic is prohibited on all brick surfaces as specified on the established access and routes maps
Driving on lawns and landscaped areas is prohibited Alternate routes are to be used to eliminate unnecessary ruts in landscaped areas and repairs to underground utility systems Cutting corners through landscaped areas will be considered damaging University property Drivers will be held accountable
When attending any on-campus event (Staff Day on-campus seminars etc) use designated parking spaces This includes all vehicles and carts
II Driver and Passenger Safety Requirements
1 Driver must be at least 18 years old and in possession of a valid US driverrsquos license at all times when operating a vehicle as a Forty-Niner Shops employee
6
49ER FORlY-NINER SHOPS INC CALIFORNIA STATE UNlVERSlTY LONG BEACH
POLICY STATEMENT
Policy Number 10006
Date Revised 112315
2 Driver shall observe all rules and regulations for safe driving as defined by the State of California Motor Vehicles Department
3 Drinking possession of intoxicating liquor illegal drugs in vehicles or driving while under the influence of alcohol or drugs is prohibited
4 Avoid conditions that lead to loss of control- driving while sleepy or inattentive or driving too fast for road conditions
5 Drivers must adhere to all California DMV laws
6 In an event of an accident all incidents must be reported on an accident report and must be submitted to your manager the Human Resources office and if necessary local police
Employee Name _________________________________________ Department __________
Employee Signature _______________________________________ Date ______________
7
49ER FORlYmiddotNINER SHOPS INC CALIFORNIA STATE UNlVERSlTY LO G BEACH
CALIFORNIA STATE UNIVERSITY LONG BEACH 1250 BELLFLOWER BOULEVARD LONG BEACH CA 90840
49er Pool (POgtL) F4 4 9er Softball Com plex (SC) G3 Acadam ic Services (AS) ES
Anatol Cente r Karl WE Barren Athlatic Administration Center ltBMCgt Nei l amp Phyllis E2
Pyramid Annex Conferenca Center (2nd Floor o f MC) Special Event s (2nd Floor)
Beach Circle The BC) E4 Brotmin Ha ll (BH ) E5
Kil li ngsworth Plaza Edward A Maxson Plaza Robert C
C arpenter Performing Arts Cente r (CPAC) G 1 Central Plant (C P) F6 Cent rltgtI Q uad (COSOUTH) Fa Colle9a of Bus inass AdminislJition (CBA) 04 Child Development Center Iaibel Patte rson (CDC) B1 Corporation Ya rd (CORP) H4 Dance Center (DC) F 1
Martha B Knoebel Daneamp Theatec-Design (DESN) H5 Education 1 (ED1) bull - E9 Education 2 (ED2) - E9 Enginamparing 2 EN2 ) _ G4 Engine-aring 3 (EN3) G4 Engineering 4 (EN4) G4 Eng inaering amp Compute r Sciencas (ECS) _ H4 Engine-aring Technology (ET) H4 Facilit ies Management (FM) 14 Friendship Wltgtlk (FWCENTRAL) F5 Faculty Offic-e 2 (F02) F7 Faculty Office 3 (F03) bull F7
Multicu ltural Campntec-Faculty Office 4 (F04) bullbullbull - G7 Faculty Office 5 (F05) - G7
SAS Center bull Junes L JanGen Family amp Consumer Sciencss (FCS) 05 Fine Arts 1 amp Art Annex (FA1) (ANNEX) FS Fine Arts 2 (FA2) G8 Fine Arts 3 (FA3) bull G8 Fine Arts 4 FA4) FS Fo und at ion (Foundation) G6
College of Continuing and Profeasional Educat ion H ill of Science (HS) F7 H eilth amp Human Services 1 HHS1) F5 H ealth amp Human Services 2 (HH S2) F5 Hom Cente r Stev e amp Nini (HC) F4 H ousing amp Resident ial Life (H RL) B1 H uman Services and Design (H SD) H5
Osher Lifelong Leaming Inst itute Japanese Garden Earl B u rns Milla r (JG ) 83 KKJZFM (KKJZ) E8 L anguage Arts Building (LAB) GS
Hauth Center Luster E amp Audrey Nichol L aciure Halls 150151 (LH) Fa LiberltgtI A rts 1 middot Instructional Madia (LA1) E8 LiberltgtI Arts 2 middot H istory (LA2) ES
Liberal Arts 3 LA3) - E8 Liberal Arts 4 middot Geography (LA4) E7 Liberal A rts 5 bull Liberal Arts (LA5) E7 Librn ry (LIB) E8 MDil Services (MS) H4 McIntosh Human ities Bldg (MHB) F8 Mi crobiology MIC) G7 Molecular amp Life Sciences Canter (MLSC) G6 MultimiddotM adii Cent er (MMC) E9 Nursing (N UR) C5 Outdoor Beach Cour89 lbx Offenberg (OUTBAC) G2 Outpost Food Se-vice (O P) H5 Paiking Tranportation and Event Services PTES) _ D3 Paterson Hill 1 (PH 1) F7 Paterson Hill 2 (PH2) - F7 Physical Ed ucation (PE) - E4
Gold Mine We-st Gym East Gym
Psychology (PSY) E7 Pyr am id Mike amp A rline Wilta r (P YR) E1
The Pointe PYR yellow entranca) Ukle je Room (PYR green enlJince)
Receiving (REC ) H4 Recycl ing Center (RC) C 1 Residence Housing
International House (IH _ __ 15 Los A limitos HJI (LAH) C4 Los Cerritos Hall ( LCH) 85 Rasidanca Commons and Ho using (RH) 84 P3Ikside Commons and Ho using (PC H) 82
Socia l Sciences P ub lic Adm in (SSPA) G5 Soroptomist Ho us e (SOR) D5 Speakec-middots Platform I East Lawn (SP) E5 Student Haalth Sarvicas (SH S) 05 Studant Recreation amp Wellnass Center (SRWC) H3 Tenni s Cantltgtr Ten y L Rhodes (Tennis Courts) F3 Thetar Arts (TA) F9
Players ThaatecshyStudi o Theat re Universt iy Theat er middot The Williim Link Theater
Track and Fie ld Jack Rose StDdium E3 University Art Museum (UAM) E4 University Booksto re (B KS) E7 University Din ing Plaza (UDP) E5 University Musi c Center (UMC) - F2
Gerald Dan ial Reci t al Hall University Pol ice Department (UP) H3 University Print Shop (UPS) G3 University Student Union (U S U) - F6
Ballr ooms A-C (USU bull 2nd F loor) Beach Audit o rium (USU bull 1st Floor) South west Terrance (USU middot 3rd Floor)
University Telecommunications (UTC) G9 Visitor Information Center (VIC) 05 Viviin Engineer ing Center (VEC) H4
POLICY STATEMENT
Policy Number 10006
Date Revised 112315
Campus Traffic Directory
8
49ER FORlY-NINER SHOPS INC CALIFORNIA STATE UNlVERSlTY LO G BEACH
POLICY STATEMENT
Policy Number 10006
Date Revised 112315
Campus Traffic Map
9
49ER FORlY-NINER SHOPS INC CALIFORNIA STATE UNlVERSlTY LONG BEACH
POLICY STATEMENT
Policy Number 10006
Date Revised 112315
Authorization to Use Privately Owned Vehicles on Forty-Niner Shops Business Approval is required to use privately owned vehicles to conduct official Forty-Niner Shops business
This form must be approved annually
Certification I hereby certify that whenever I drive a privately owned vehicle on Forty-Niner Shops business I will have a valid driverrsquos license and proof of liability insurance in my possession I will follow Forty-Niner Shops Driver Safety Policies as well as all applicable laws as required by the State of California
Additionally I will abide by the following
All motorists must carry evidence of current automobile liability insurance in their vehicle
The vehicle shall always be covered by liability insurance for the minimum amount prescribed by State Law
o $15000 for personal injury to or death of one person o $30000 for injury to death of two or more persons in one accident o $5000 property damage
All persons in the vehicle will wear safety belts Vehicle will be adequate for the work to be performed Vehicle will be equipped with safety belts in operating condition To the best of my knowledge in safe mechanical condition as required by law
I understand that the mileage rate I claim is full reimbursement for the cost of operating the privately owned vehicle including fuel maintenance repairs and both liability and comprehensive insurance
I further certify that while using a private owned vehicle on official Forty-Niner Shops business all accidents will be reported as soon as possible after the accident not to exceed 48 hours to my immediate supervisor and the Human Resources Department I understand that the insurance policy covering the privately owned vehicle will respond to the accident- the Forty-Niner Shops will NOT provide primary insurance coverage
I understand that permission to drive a privately owned vehicle on State business is a privilege which may be suspended or revoked at any time
Request Date of Request ____________ Insurance Carrier amp Policy Number ____________________________
Driverrsquos License Number ___________________ State ___________ Expiration Date __________
Employee Name ___________________________ Employee Signature _________________________
Approval DirectorManagerrsquos Signature __________________________________________ Date ____________
HR Representative Signature __________________________________________ Date ___________
10
49ER FORlY-NINER SHOPS INC CALIFORNIA STATE UNlVERSlTY LO G BEACH
Driver Privileges Revoked
It is the policy of the Forty -Niner Shops Inc to enro ll all employees in the OMV Pull Program that will be driv ing company vehicl es as well as any employee that would need to drive their own personal vehicles for the purpose o f Forty-Niner Shops business The Cali fornia Moto r Vehicl e Records (MVRs) will be used as the source fo rv eri fying driver history MVRs will be obtained init ially when the driver is enrolled in the program and annually thereafter as well as any time a driv er receives a negative infraction on their driv ing record
Driving p riv ileges may be revoked or suspended from any authorized driv er not meeting the elig ibility criteri a li sted below In add ition appropriate discipl inary action may be taken up to and including termination of employment
bull Driv ing under the influence bull Negligent homicide bull Operating with an ex pired or a suspended li cense bull Using a motor vehicle for commiss ion of a felony bull Aggrav ated assault with a motorvehicle bull Operat ing a motor vehicle without the owners consent bull Permitting an unlicensed driv er to driv e bull Reckless andor careless andor negligent driv ing bull Hit and Run or leaving the scene o f an accident with injury or death resulting or property
damage in exce ss of $1000 bull Indiv iduals who have been cited for unsafe driving on campus or who are in v iolation of
Forty-Niner Shops driver safety policies will be ineligib le to drive company vehicles or personal vehicl es for business purposes
bull Exceeding the maximum amount o f v iolation points within a 12-18 month period
Due to the current changes on your MVR which are li sted below as of today-----~ the Forty-N iner Shops is revoking your priv ilege to drive all company v ehicles as well as your own personal vehicl e for business purposes I
Employee Printed Name Date
Employee Signature HR Representative Signature
If the violation or suspension is removed by the 01-IV and you would like to regain the privilege to drive obtain a print-outfrom the OMV showing the violation or suspension has been cleared and bring it to HR A review process will take place to determine if driving privileges will be reinstated to the employee Created 1242013
POLICY STATEMENT
Policy Number 10006
Date Revised 112315
Last Revised
Policy Version
Date Author Description (If applicable) Approved Distribution
10 112315 R Hernandez Created new policy for company vehicle use
11
49ER FORlY-NINER SHOPS INC CALIFORNIA STATE UNlVERSlTY LO G BEACH
POLICY STATEMENT
Policy Number 10006
Date Revised 112315
12
FORlY-NINER SHOPS INC 49ER CALIFORNIA STATE UNlVERSlTY LONG BEACH
EMPLOYER PULL NOTICE PROGRAM
AUTHORIZATION FOR RELEASE OF DRIVER RECORD INFORMATION
I ________________ __Ca lifornia Driver LiceJISe Number __________ __
hereby authorize the Ca lifornia Department o f Motor Vehicles (DMV) to disclose or otherwise make available my driving record tomyemployer_ ______________________________ _
COIPWIE
I understand that my employer may enroll me in the Employer Pull Notice (EPN) program to receive a d river record report at least once every twelve (12) months or when any subsequent conviction failure to appear accident drivers license suspension revocation o r any other action is taken against my driving privilege during my employment
I am not driving in a capacity that requ ires mandatory e nro llment in the EPN program pursuant to California Vehicle Code (CVC) Section 18081(1lt) I understand that enrollment in the EPN program is in a n effort to promotedriver safety and that my drive r license report wi ll be released to ITT employer to determ ine my e ligibil ity as a licensed driver for my employment
EXECUlED AI UTY SWE
DA1E
l ______ _=======----- middotof _______ ---=====----------AUTHCfUZEo RiPRESEfiaTNE COGl8( N1HE
do hereby certify under penalty of perj ury under the laws in the State ofCalifomia that I aman authorized representative of this company that the information entered on this document is true and correct to the best o f my knowledge and that I am requesting driver record information on the above individual to verify the information as provided by said individual This record is to be used by this employer in the normal course of business and asa legitimate business need to verify information re lat ing to a driving position not mandated pursuant to CVC Section 18081 The information received wi ll not be used for any unlawful purpose I understand that if I have provided fa lse information I may be subject to prosecution for perjury (Penal Code Section 118) and fa lse representation (CVC Section 180845) T hese are punishable by a fine not exceeding five thousand do llars ($5000) or by imprisonment in the county jail not exceeding one year o r both fine and imprisonment I understand and acknowledge that any failure to maintain confidentia lity is both civilly and cri minally punishable pursuant to eve Sections 180845 and 180846
EXE CUTED Al CITY SWE
DA1E
To obtain a d river record on a prospective employee you may submitan l NF 1119form To add thisdriver to the EPNProgram you must submit the applicable forms INF 1100 INF 1102 I NF 1103 INF 11030form You may obtain forms at our website at wwwdmvcagovfotherservices orby calling 916-657-6346
THIS FORM MUST BE COMPLETED AND RETAINED AT THE EMPLOYERS PRINCIPAL PLACE OF BUSINESS AND MADE AVAJ LABLE UPON REQUEST TO DMV STAFF
DO NOT RETURN THIS FORM TO DMV
POLICY STATEMENT
Policy Number 10006
Date Revised 112315
5
49ER FORlY-NINER SHOPS INC CALIFORNIA STATE UNlVERSlTY LO G BEACH
POLICY STATEMENT
Policy Number 10006
Date Revised 112315
Forty-Niner Shops Inc
Driver Safety and Vehicle Use Acknowledgement
I Driving Risks and Responsibilities
Driving safely on and around campus is essential With the increased congestion in both vehicular and pedestrian traffic safety and caution are absolutely critical When driving on campus whether in a vehicle or cart please follow these guidelines as well as the established access and routes
Avoid driving on inner campus during class breaks (ten minutes to the hour) Only access campus interiors for specific service-related needs ie unloading or emergency response
Never exceed posted speed limits and use discretion when a slower speed may be more appropriate due to congestion
Use caution at pedestrian crossing ie intersections crosswalks and other marked or unmarked areas where frequent crossing occurs REMEMBER the pedestrian always has the right of way
Always park vehicles as not to block traffic crosswalks disabled access building entrances fire hydrants and walkways
Vehicles access in the areas prohibited as specified on the established access and routes map shall be adhered to
All vehicular traffic is prohibited on the elevated pedestrian walkway located between the Student ServicesAdministration building and the North Campus Library
All vehicular traffic is prohibited on all brick surfaces as specified on the established access and routes maps
Driving on lawns and landscaped areas is prohibited Alternate routes are to be used to eliminate unnecessary ruts in landscaped areas and repairs to underground utility systems Cutting corners through landscaped areas will be considered damaging University property Drivers will be held accountable
When attending any on-campus event (Staff Day on-campus seminars etc) use designated parking spaces This includes all vehicles and carts
II Driver and Passenger Safety Requirements
1 Driver must be at least 18 years old and in possession of a valid US driverrsquos license at all times when operating a vehicle as a Forty-Niner Shops employee
6
49ER FORlY-NINER SHOPS INC CALIFORNIA STATE UNlVERSlTY LONG BEACH
POLICY STATEMENT
Policy Number 10006
Date Revised 112315
2 Driver shall observe all rules and regulations for safe driving as defined by the State of California Motor Vehicles Department
3 Drinking possession of intoxicating liquor illegal drugs in vehicles or driving while under the influence of alcohol or drugs is prohibited
4 Avoid conditions that lead to loss of control- driving while sleepy or inattentive or driving too fast for road conditions
5 Drivers must adhere to all California DMV laws
6 In an event of an accident all incidents must be reported on an accident report and must be submitted to your manager the Human Resources office and if necessary local police
Employee Name _________________________________________ Department __________
Employee Signature _______________________________________ Date ______________
7
49ER FORlYmiddotNINER SHOPS INC CALIFORNIA STATE UNlVERSlTY LO G BEACH
CALIFORNIA STATE UNIVERSITY LONG BEACH 1250 BELLFLOWER BOULEVARD LONG BEACH CA 90840
49er Pool (POgtL) F4 4 9er Softball Com plex (SC) G3 Acadam ic Services (AS) ES
Anatol Cente r Karl WE Barren Athlatic Administration Center ltBMCgt Nei l amp Phyllis E2
Pyramid Annex Conferenca Center (2nd Floor o f MC) Special Event s (2nd Floor)
Beach Circle The BC) E4 Brotmin Ha ll (BH ) E5
Kil li ngsworth Plaza Edward A Maxson Plaza Robert C
C arpenter Performing Arts Cente r (CPAC) G 1 Central Plant (C P) F6 Cent rltgtI Q uad (COSOUTH) Fa Colle9a of Bus inass AdminislJition (CBA) 04 Child Development Center Iaibel Patte rson (CDC) B1 Corporation Ya rd (CORP) H4 Dance Center (DC) F 1
Martha B Knoebel Daneamp Theatec-Design (DESN) H5 Education 1 (ED1) bull - E9 Education 2 (ED2) - E9 Enginamparing 2 EN2 ) _ G4 Engine-aring 3 (EN3) G4 Engineering 4 (EN4) G4 Eng inaering amp Compute r Sciencas (ECS) _ H4 Engine-aring Technology (ET) H4 Facilit ies Management (FM) 14 Friendship Wltgtlk (FWCENTRAL) F5 Faculty Offic-e 2 (F02) F7 Faculty Office 3 (F03) bull F7
Multicu ltural Campntec-Faculty Office 4 (F04) bullbullbull - G7 Faculty Office 5 (F05) - G7
SAS Center bull Junes L JanGen Family amp Consumer Sciencss (FCS) 05 Fine Arts 1 amp Art Annex (FA1) (ANNEX) FS Fine Arts 2 (FA2) G8 Fine Arts 3 (FA3) bull G8 Fine Arts 4 FA4) FS Fo und at ion (Foundation) G6
College of Continuing and Profeasional Educat ion H ill of Science (HS) F7 H eilth amp Human Services 1 HHS1) F5 H ealth amp Human Services 2 (HH S2) F5 Hom Cente r Stev e amp Nini (HC) F4 H ousing amp Resident ial Life (H RL) B1 H uman Services and Design (H SD) H5
Osher Lifelong Leaming Inst itute Japanese Garden Earl B u rns Milla r (JG ) 83 KKJZFM (KKJZ) E8 L anguage Arts Building (LAB) GS
Hauth Center Luster E amp Audrey Nichol L aciure Halls 150151 (LH) Fa LiberltgtI A rts 1 middot Instructional Madia (LA1) E8 LiberltgtI Arts 2 middot H istory (LA2) ES
Liberal Arts 3 LA3) - E8 Liberal Arts 4 middot Geography (LA4) E7 Liberal A rts 5 bull Liberal Arts (LA5) E7 Librn ry (LIB) E8 MDil Services (MS) H4 McIntosh Human ities Bldg (MHB) F8 Mi crobiology MIC) G7 Molecular amp Life Sciences Canter (MLSC) G6 MultimiddotM adii Cent er (MMC) E9 Nursing (N UR) C5 Outdoor Beach Cour89 lbx Offenberg (OUTBAC) G2 Outpost Food Se-vice (O P) H5 Paiking Tranportation and Event Services PTES) _ D3 Paterson Hill 1 (PH 1) F7 Paterson Hill 2 (PH2) - F7 Physical Ed ucation (PE) - E4
Gold Mine We-st Gym East Gym
Psychology (PSY) E7 Pyr am id Mike amp A rline Wilta r (P YR) E1
The Pointe PYR yellow entranca) Ukle je Room (PYR green enlJince)
Receiving (REC ) H4 Recycl ing Center (RC) C 1 Residence Housing
International House (IH _ __ 15 Los A limitos HJI (LAH) C4 Los Cerritos Hall ( LCH) 85 Rasidanca Commons and Ho using (RH) 84 P3Ikside Commons and Ho using (PC H) 82
Socia l Sciences P ub lic Adm in (SSPA) G5 Soroptomist Ho us e (SOR) D5 Speakec-middots Platform I East Lawn (SP) E5 Student Haalth Sarvicas (SH S) 05 Studant Recreation amp Wellnass Center (SRWC) H3 Tenni s Cantltgtr Ten y L Rhodes (Tennis Courts) F3 Thetar Arts (TA) F9
Players ThaatecshyStudi o Theat re Universt iy Theat er middot The Williim Link Theater
Track and Fie ld Jack Rose StDdium E3 University Art Museum (UAM) E4 University Booksto re (B KS) E7 University Din ing Plaza (UDP) E5 University Musi c Center (UMC) - F2
Gerald Dan ial Reci t al Hall University Pol ice Department (UP) H3 University Print Shop (UPS) G3 University Student Union (U S U) - F6
Ballr ooms A-C (USU bull 2nd F loor) Beach Audit o rium (USU bull 1st Floor) South west Terrance (USU middot 3rd Floor)
University Telecommunications (UTC) G9 Visitor Information Center (VIC) 05 Viviin Engineer ing Center (VEC) H4
POLICY STATEMENT
Policy Number 10006
Date Revised 112315
Campus Traffic Directory
8
49ER FORlY-NINER SHOPS INC CALIFORNIA STATE UNlVERSlTY LO G BEACH
POLICY STATEMENT
Policy Number 10006
Date Revised 112315
Campus Traffic Map
9
49ER FORlY-NINER SHOPS INC CALIFORNIA STATE UNlVERSlTY LONG BEACH
POLICY STATEMENT
Policy Number 10006
Date Revised 112315
Authorization to Use Privately Owned Vehicles on Forty-Niner Shops Business Approval is required to use privately owned vehicles to conduct official Forty-Niner Shops business
This form must be approved annually
Certification I hereby certify that whenever I drive a privately owned vehicle on Forty-Niner Shops business I will have a valid driverrsquos license and proof of liability insurance in my possession I will follow Forty-Niner Shops Driver Safety Policies as well as all applicable laws as required by the State of California
Additionally I will abide by the following
All motorists must carry evidence of current automobile liability insurance in their vehicle
The vehicle shall always be covered by liability insurance for the minimum amount prescribed by State Law
o $15000 for personal injury to or death of one person o $30000 for injury to death of two or more persons in one accident o $5000 property damage
All persons in the vehicle will wear safety belts Vehicle will be adequate for the work to be performed Vehicle will be equipped with safety belts in operating condition To the best of my knowledge in safe mechanical condition as required by law
I understand that the mileage rate I claim is full reimbursement for the cost of operating the privately owned vehicle including fuel maintenance repairs and both liability and comprehensive insurance
I further certify that while using a private owned vehicle on official Forty-Niner Shops business all accidents will be reported as soon as possible after the accident not to exceed 48 hours to my immediate supervisor and the Human Resources Department I understand that the insurance policy covering the privately owned vehicle will respond to the accident- the Forty-Niner Shops will NOT provide primary insurance coverage
I understand that permission to drive a privately owned vehicle on State business is a privilege which may be suspended or revoked at any time
Request Date of Request ____________ Insurance Carrier amp Policy Number ____________________________
Driverrsquos License Number ___________________ State ___________ Expiration Date __________
Employee Name ___________________________ Employee Signature _________________________
Approval DirectorManagerrsquos Signature __________________________________________ Date ____________
HR Representative Signature __________________________________________ Date ___________
10
49ER FORlY-NINER SHOPS INC CALIFORNIA STATE UNlVERSlTY LO G BEACH
Driver Privileges Revoked
It is the policy of the Forty -Niner Shops Inc to enro ll all employees in the OMV Pull Program that will be driv ing company vehicl es as well as any employee that would need to drive their own personal vehicles for the purpose o f Forty-Niner Shops business The Cali fornia Moto r Vehicl e Records (MVRs) will be used as the source fo rv eri fying driver history MVRs will be obtained init ially when the driver is enrolled in the program and annually thereafter as well as any time a driv er receives a negative infraction on their driv ing record
Driving p riv ileges may be revoked or suspended from any authorized driv er not meeting the elig ibility criteri a li sted below In add ition appropriate discipl inary action may be taken up to and including termination of employment
bull Driv ing under the influence bull Negligent homicide bull Operating with an ex pired or a suspended li cense bull Using a motor vehicle for commiss ion of a felony bull Aggrav ated assault with a motorvehicle bull Operat ing a motor vehicle without the owners consent bull Permitting an unlicensed driv er to driv e bull Reckless andor careless andor negligent driv ing bull Hit and Run or leaving the scene o f an accident with injury or death resulting or property
damage in exce ss of $1000 bull Indiv iduals who have been cited for unsafe driving on campus or who are in v iolation of
Forty-Niner Shops driver safety policies will be ineligib le to drive company vehicles or personal vehicl es for business purposes
bull Exceeding the maximum amount o f v iolation points within a 12-18 month period
Due to the current changes on your MVR which are li sted below as of today-----~ the Forty-N iner Shops is revoking your priv ilege to drive all company v ehicles as well as your own personal vehicl e for business purposes I
Employee Printed Name Date
Employee Signature HR Representative Signature
If the violation or suspension is removed by the 01-IV and you would like to regain the privilege to drive obtain a print-outfrom the OMV showing the violation or suspension has been cleared and bring it to HR A review process will take place to determine if driving privileges will be reinstated to the employee Created 1242013
POLICY STATEMENT
Policy Number 10006
Date Revised 112315
Last Revised
Policy Version
Date Author Description (If applicable) Approved Distribution
10 112315 R Hernandez Created new policy for company vehicle use
11
49ER FORlY-NINER SHOPS INC CALIFORNIA STATE UNlVERSlTY LO G BEACH
POLICY STATEMENT
Policy Number 10006
Date Revised 112315
12
49ER FORlY-NINER SHOPS INC CALIFORNIA STATE UNlVERSlTY LO G BEACH
POLICY STATEMENT
Policy Number 10006
Date Revised 112315
Forty-Niner Shops Inc
Driver Safety and Vehicle Use Acknowledgement
I Driving Risks and Responsibilities
Driving safely on and around campus is essential With the increased congestion in both vehicular and pedestrian traffic safety and caution are absolutely critical When driving on campus whether in a vehicle or cart please follow these guidelines as well as the established access and routes
Avoid driving on inner campus during class breaks (ten minutes to the hour) Only access campus interiors for specific service-related needs ie unloading or emergency response
Never exceed posted speed limits and use discretion when a slower speed may be more appropriate due to congestion
Use caution at pedestrian crossing ie intersections crosswalks and other marked or unmarked areas where frequent crossing occurs REMEMBER the pedestrian always has the right of way
Always park vehicles as not to block traffic crosswalks disabled access building entrances fire hydrants and walkways
Vehicles access in the areas prohibited as specified on the established access and routes map shall be adhered to
All vehicular traffic is prohibited on the elevated pedestrian walkway located between the Student ServicesAdministration building and the North Campus Library
All vehicular traffic is prohibited on all brick surfaces as specified on the established access and routes maps
Driving on lawns and landscaped areas is prohibited Alternate routes are to be used to eliminate unnecessary ruts in landscaped areas and repairs to underground utility systems Cutting corners through landscaped areas will be considered damaging University property Drivers will be held accountable
When attending any on-campus event (Staff Day on-campus seminars etc) use designated parking spaces This includes all vehicles and carts
II Driver and Passenger Safety Requirements
1 Driver must be at least 18 years old and in possession of a valid US driverrsquos license at all times when operating a vehicle as a Forty-Niner Shops employee
6
49ER FORlY-NINER SHOPS INC CALIFORNIA STATE UNlVERSlTY LONG BEACH
POLICY STATEMENT
Policy Number 10006
Date Revised 112315
2 Driver shall observe all rules and regulations for safe driving as defined by the State of California Motor Vehicles Department
3 Drinking possession of intoxicating liquor illegal drugs in vehicles or driving while under the influence of alcohol or drugs is prohibited
4 Avoid conditions that lead to loss of control- driving while sleepy or inattentive or driving too fast for road conditions
5 Drivers must adhere to all California DMV laws
6 In an event of an accident all incidents must be reported on an accident report and must be submitted to your manager the Human Resources office and if necessary local police
Employee Name _________________________________________ Department __________
Employee Signature _______________________________________ Date ______________
7
49ER FORlYmiddotNINER SHOPS INC CALIFORNIA STATE UNlVERSlTY LO G BEACH
CALIFORNIA STATE UNIVERSITY LONG BEACH 1250 BELLFLOWER BOULEVARD LONG BEACH CA 90840
49er Pool (POgtL) F4 4 9er Softball Com plex (SC) G3 Acadam ic Services (AS) ES
Anatol Cente r Karl WE Barren Athlatic Administration Center ltBMCgt Nei l amp Phyllis E2
Pyramid Annex Conferenca Center (2nd Floor o f MC) Special Event s (2nd Floor)
Beach Circle The BC) E4 Brotmin Ha ll (BH ) E5
Kil li ngsworth Plaza Edward A Maxson Plaza Robert C
C arpenter Performing Arts Cente r (CPAC) G 1 Central Plant (C P) F6 Cent rltgtI Q uad (COSOUTH) Fa Colle9a of Bus inass AdminislJition (CBA) 04 Child Development Center Iaibel Patte rson (CDC) B1 Corporation Ya rd (CORP) H4 Dance Center (DC) F 1
Martha B Knoebel Daneamp Theatec-Design (DESN) H5 Education 1 (ED1) bull - E9 Education 2 (ED2) - E9 Enginamparing 2 EN2 ) _ G4 Engine-aring 3 (EN3) G4 Engineering 4 (EN4) G4 Eng inaering amp Compute r Sciencas (ECS) _ H4 Engine-aring Technology (ET) H4 Facilit ies Management (FM) 14 Friendship Wltgtlk (FWCENTRAL) F5 Faculty Offic-e 2 (F02) F7 Faculty Office 3 (F03) bull F7
Multicu ltural Campntec-Faculty Office 4 (F04) bullbullbull - G7 Faculty Office 5 (F05) - G7
SAS Center bull Junes L JanGen Family amp Consumer Sciencss (FCS) 05 Fine Arts 1 amp Art Annex (FA1) (ANNEX) FS Fine Arts 2 (FA2) G8 Fine Arts 3 (FA3) bull G8 Fine Arts 4 FA4) FS Fo und at ion (Foundation) G6
College of Continuing and Profeasional Educat ion H ill of Science (HS) F7 H eilth amp Human Services 1 HHS1) F5 H ealth amp Human Services 2 (HH S2) F5 Hom Cente r Stev e amp Nini (HC) F4 H ousing amp Resident ial Life (H RL) B1 H uman Services and Design (H SD) H5
Osher Lifelong Leaming Inst itute Japanese Garden Earl B u rns Milla r (JG ) 83 KKJZFM (KKJZ) E8 L anguage Arts Building (LAB) GS
Hauth Center Luster E amp Audrey Nichol L aciure Halls 150151 (LH) Fa LiberltgtI A rts 1 middot Instructional Madia (LA1) E8 LiberltgtI Arts 2 middot H istory (LA2) ES
Liberal Arts 3 LA3) - E8 Liberal Arts 4 middot Geography (LA4) E7 Liberal A rts 5 bull Liberal Arts (LA5) E7 Librn ry (LIB) E8 MDil Services (MS) H4 McIntosh Human ities Bldg (MHB) F8 Mi crobiology MIC) G7 Molecular amp Life Sciences Canter (MLSC) G6 MultimiddotM adii Cent er (MMC) E9 Nursing (N UR) C5 Outdoor Beach Cour89 lbx Offenberg (OUTBAC) G2 Outpost Food Se-vice (O P) H5 Paiking Tranportation and Event Services PTES) _ D3 Paterson Hill 1 (PH 1) F7 Paterson Hill 2 (PH2) - F7 Physical Ed ucation (PE) - E4
Gold Mine We-st Gym East Gym
Psychology (PSY) E7 Pyr am id Mike amp A rline Wilta r (P YR) E1
The Pointe PYR yellow entranca) Ukle je Room (PYR green enlJince)
Receiving (REC ) H4 Recycl ing Center (RC) C 1 Residence Housing
International House (IH _ __ 15 Los A limitos HJI (LAH) C4 Los Cerritos Hall ( LCH) 85 Rasidanca Commons and Ho using (RH) 84 P3Ikside Commons and Ho using (PC H) 82
Socia l Sciences P ub lic Adm in (SSPA) G5 Soroptomist Ho us e (SOR) D5 Speakec-middots Platform I East Lawn (SP) E5 Student Haalth Sarvicas (SH S) 05 Studant Recreation amp Wellnass Center (SRWC) H3 Tenni s Cantltgtr Ten y L Rhodes (Tennis Courts) F3 Thetar Arts (TA) F9
Players ThaatecshyStudi o Theat re Universt iy Theat er middot The Williim Link Theater
Track and Fie ld Jack Rose StDdium E3 University Art Museum (UAM) E4 University Booksto re (B KS) E7 University Din ing Plaza (UDP) E5 University Musi c Center (UMC) - F2
Gerald Dan ial Reci t al Hall University Pol ice Department (UP) H3 University Print Shop (UPS) G3 University Student Union (U S U) - F6
Ballr ooms A-C (USU bull 2nd F loor) Beach Audit o rium (USU bull 1st Floor) South west Terrance (USU middot 3rd Floor)
University Telecommunications (UTC) G9 Visitor Information Center (VIC) 05 Viviin Engineer ing Center (VEC) H4
POLICY STATEMENT
Policy Number 10006
Date Revised 112315
Campus Traffic Directory
8
49ER FORlY-NINER SHOPS INC CALIFORNIA STATE UNlVERSlTY LO G BEACH
POLICY STATEMENT
Policy Number 10006
Date Revised 112315
Campus Traffic Map
9
49ER FORlY-NINER SHOPS INC CALIFORNIA STATE UNlVERSlTY LONG BEACH
POLICY STATEMENT
Policy Number 10006
Date Revised 112315
Authorization to Use Privately Owned Vehicles on Forty-Niner Shops Business Approval is required to use privately owned vehicles to conduct official Forty-Niner Shops business
This form must be approved annually
Certification I hereby certify that whenever I drive a privately owned vehicle on Forty-Niner Shops business I will have a valid driverrsquos license and proof of liability insurance in my possession I will follow Forty-Niner Shops Driver Safety Policies as well as all applicable laws as required by the State of California
Additionally I will abide by the following
All motorists must carry evidence of current automobile liability insurance in their vehicle
The vehicle shall always be covered by liability insurance for the minimum amount prescribed by State Law
o $15000 for personal injury to or death of one person o $30000 for injury to death of two or more persons in one accident o $5000 property damage
All persons in the vehicle will wear safety belts Vehicle will be adequate for the work to be performed Vehicle will be equipped with safety belts in operating condition To the best of my knowledge in safe mechanical condition as required by law
I understand that the mileage rate I claim is full reimbursement for the cost of operating the privately owned vehicle including fuel maintenance repairs and both liability and comprehensive insurance
I further certify that while using a private owned vehicle on official Forty-Niner Shops business all accidents will be reported as soon as possible after the accident not to exceed 48 hours to my immediate supervisor and the Human Resources Department I understand that the insurance policy covering the privately owned vehicle will respond to the accident- the Forty-Niner Shops will NOT provide primary insurance coverage
I understand that permission to drive a privately owned vehicle on State business is a privilege which may be suspended or revoked at any time
Request Date of Request ____________ Insurance Carrier amp Policy Number ____________________________
Driverrsquos License Number ___________________ State ___________ Expiration Date __________
Employee Name ___________________________ Employee Signature _________________________
Approval DirectorManagerrsquos Signature __________________________________________ Date ____________
HR Representative Signature __________________________________________ Date ___________
10
49ER FORlY-NINER SHOPS INC CALIFORNIA STATE UNlVERSlTY LO G BEACH
Driver Privileges Revoked
It is the policy of the Forty -Niner Shops Inc to enro ll all employees in the OMV Pull Program that will be driv ing company vehicl es as well as any employee that would need to drive their own personal vehicles for the purpose o f Forty-Niner Shops business The Cali fornia Moto r Vehicl e Records (MVRs) will be used as the source fo rv eri fying driver history MVRs will be obtained init ially when the driver is enrolled in the program and annually thereafter as well as any time a driv er receives a negative infraction on their driv ing record
Driving p riv ileges may be revoked or suspended from any authorized driv er not meeting the elig ibility criteri a li sted below In add ition appropriate discipl inary action may be taken up to and including termination of employment
bull Driv ing under the influence bull Negligent homicide bull Operating with an ex pired or a suspended li cense bull Using a motor vehicle for commiss ion of a felony bull Aggrav ated assault with a motorvehicle bull Operat ing a motor vehicle without the owners consent bull Permitting an unlicensed driv er to driv e bull Reckless andor careless andor negligent driv ing bull Hit and Run or leaving the scene o f an accident with injury or death resulting or property
damage in exce ss of $1000 bull Indiv iduals who have been cited for unsafe driving on campus or who are in v iolation of
Forty-Niner Shops driver safety policies will be ineligib le to drive company vehicles or personal vehicl es for business purposes
bull Exceeding the maximum amount o f v iolation points within a 12-18 month period
Due to the current changes on your MVR which are li sted below as of today-----~ the Forty-N iner Shops is revoking your priv ilege to drive all company v ehicles as well as your own personal vehicl e for business purposes I
Employee Printed Name Date
Employee Signature HR Representative Signature
If the violation or suspension is removed by the 01-IV and you would like to regain the privilege to drive obtain a print-outfrom the OMV showing the violation or suspension has been cleared and bring it to HR A review process will take place to determine if driving privileges will be reinstated to the employee Created 1242013
POLICY STATEMENT
Policy Number 10006
Date Revised 112315
Last Revised
Policy Version
Date Author Description (If applicable) Approved Distribution
10 112315 R Hernandez Created new policy for company vehicle use
11
49ER FORlY-NINER SHOPS INC CALIFORNIA STATE UNlVERSlTY LO G BEACH
POLICY STATEMENT
Policy Number 10006
Date Revised 112315
12
49ER FORlY-NINER SHOPS INC CALIFORNIA STATE UNlVERSlTY LONG BEACH
POLICY STATEMENT
Policy Number 10006
Date Revised 112315
2 Driver shall observe all rules and regulations for safe driving as defined by the State of California Motor Vehicles Department
3 Drinking possession of intoxicating liquor illegal drugs in vehicles or driving while under the influence of alcohol or drugs is prohibited
4 Avoid conditions that lead to loss of control- driving while sleepy or inattentive or driving too fast for road conditions
5 Drivers must adhere to all California DMV laws
6 In an event of an accident all incidents must be reported on an accident report and must be submitted to your manager the Human Resources office and if necessary local police
Employee Name _________________________________________ Department __________
Employee Signature _______________________________________ Date ______________
7
49ER FORlYmiddotNINER SHOPS INC CALIFORNIA STATE UNlVERSlTY LO G BEACH
CALIFORNIA STATE UNIVERSITY LONG BEACH 1250 BELLFLOWER BOULEVARD LONG BEACH CA 90840
49er Pool (POgtL) F4 4 9er Softball Com plex (SC) G3 Acadam ic Services (AS) ES
Anatol Cente r Karl WE Barren Athlatic Administration Center ltBMCgt Nei l amp Phyllis E2
Pyramid Annex Conferenca Center (2nd Floor o f MC) Special Event s (2nd Floor)
Beach Circle The BC) E4 Brotmin Ha ll (BH ) E5
Kil li ngsworth Plaza Edward A Maxson Plaza Robert C
C arpenter Performing Arts Cente r (CPAC) G 1 Central Plant (C P) F6 Cent rltgtI Q uad (COSOUTH) Fa Colle9a of Bus inass AdminislJition (CBA) 04 Child Development Center Iaibel Patte rson (CDC) B1 Corporation Ya rd (CORP) H4 Dance Center (DC) F 1
Martha B Knoebel Daneamp Theatec-Design (DESN) H5 Education 1 (ED1) bull - E9 Education 2 (ED2) - E9 Enginamparing 2 EN2 ) _ G4 Engine-aring 3 (EN3) G4 Engineering 4 (EN4) G4 Eng inaering amp Compute r Sciencas (ECS) _ H4 Engine-aring Technology (ET) H4 Facilit ies Management (FM) 14 Friendship Wltgtlk (FWCENTRAL) F5 Faculty Offic-e 2 (F02) F7 Faculty Office 3 (F03) bull F7
Multicu ltural Campntec-Faculty Office 4 (F04) bullbullbull - G7 Faculty Office 5 (F05) - G7
SAS Center bull Junes L JanGen Family amp Consumer Sciencss (FCS) 05 Fine Arts 1 amp Art Annex (FA1) (ANNEX) FS Fine Arts 2 (FA2) G8 Fine Arts 3 (FA3) bull G8 Fine Arts 4 FA4) FS Fo und at ion (Foundation) G6
College of Continuing and Profeasional Educat ion H ill of Science (HS) F7 H eilth amp Human Services 1 HHS1) F5 H ealth amp Human Services 2 (HH S2) F5 Hom Cente r Stev e amp Nini (HC) F4 H ousing amp Resident ial Life (H RL) B1 H uman Services and Design (H SD) H5
Osher Lifelong Leaming Inst itute Japanese Garden Earl B u rns Milla r (JG ) 83 KKJZFM (KKJZ) E8 L anguage Arts Building (LAB) GS
Hauth Center Luster E amp Audrey Nichol L aciure Halls 150151 (LH) Fa LiberltgtI A rts 1 middot Instructional Madia (LA1) E8 LiberltgtI Arts 2 middot H istory (LA2) ES
Liberal Arts 3 LA3) - E8 Liberal Arts 4 middot Geography (LA4) E7 Liberal A rts 5 bull Liberal Arts (LA5) E7 Librn ry (LIB) E8 MDil Services (MS) H4 McIntosh Human ities Bldg (MHB) F8 Mi crobiology MIC) G7 Molecular amp Life Sciences Canter (MLSC) G6 MultimiddotM adii Cent er (MMC) E9 Nursing (N UR) C5 Outdoor Beach Cour89 lbx Offenberg (OUTBAC) G2 Outpost Food Se-vice (O P) H5 Paiking Tranportation and Event Services PTES) _ D3 Paterson Hill 1 (PH 1) F7 Paterson Hill 2 (PH2) - F7 Physical Ed ucation (PE) - E4
Gold Mine We-st Gym East Gym
Psychology (PSY) E7 Pyr am id Mike amp A rline Wilta r (P YR) E1
The Pointe PYR yellow entranca) Ukle je Room (PYR green enlJince)
Receiving (REC ) H4 Recycl ing Center (RC) C 1 Residence Housing
International House (IH _ __ 15 Los A limitos HJI (LAH) C4 Los Cerritos Hall ( LCH) 85 Rasidanca Commons and Ho using (RH) 84 P3Ikside Commons and Ho using (PC H) 82
Socia l Sciences P ub lic Adm in (SSPA) G5 Soroptomist Ho us e (SOR) D5 Speakec-middots Platform I East Lawn (SP) E5 Student Haalth Sarvicas (SH S) 05 Studant Recreation amp Wellnass Center (SRWC) H3 Tenni s Cantltgtr Ten y L Rhodes (Tennis Courts) F3 Thetar Arts (TA) F9
Players ThaatecshyStudi o Theat re Universt iy Theat er middot The Williim Link Theater
Track and Fie ld Jack Rose StDdium E3 University Art Museum (UAM) E4 University Booksto re (B KS) E7 University Din ing Plaza (UDP) E5 University Musi c Center (UMC) - F2
Gerald Dan ial Reci t al Hall University Pol ice Department (UP) H3 University Print Shop (UPS) G3 University Student Union (U S U) - F6
Ballr ooms A-C (USU bull 2nd F loor) Beach Audit o rium (USU bull 1st Floor) South west Terrance (USU middot 3rd Floor)
University Telecommunications (UTC) G9 Visitor Information Center (VIC) 05 Viviin Engineer ing Center (VEC) H4
POLICY STATEMENT
Policy Number 10006
Date Revised 112315
Campus Traffic Directory
8
49ER FORlY-NINER SHOPS INC CALIFORNIA STATE UNlVERSlTY LO G BEACH
POLICY STATEMENT
Policy Number 10006
Date Revised 112315
Campus Traffic Map
9
49ER FORlY-NINER SHOPS INC CALIFORNIA STATE UNlVERSlTY LONG BEACH
POLICY STATEMENT
Policy Number 10006
Date Revised 112315
Authorization to Use Privately Owned Vehicles on Forty-Niner Shops Business Approval is required to use privately owned vehicles to conduct official Forty-Niner Shops business
This form must be approved annually
Certification I hereby certify that whenever I drive a privately owned vehicle on Forty-Niner Shops business I will have a valid driverrsquos license and proof of liability insurance in my possession I will follow Forty-Niner Shops Driver Safety Policies as well as all applicable laws as required by the State of California
Additionally I will abide by the following
All motorists must carry evidence of current automobile liability insurance in their vehicle
The vehicle shall always be covered by liability insurance for the minimum amount prescribed by State Law
o $15000 for personal injury to or death of one person o $30000 for injury to death of two or more persons in one accident o $5000 property damage
All persons in the vehicle will wear safety belts Vehicle will be adequate for the work to be performed Vehicle will be equipped with safety belts in operating condition To the best of my knowledge in safe mechanical condition as required by law
I understand that the mileage rate I claim is full reimbursement for the cost of operating the privately owned vehicle including fuel maintenance repairs and both liability and comprehensive insurance
I further certify that while using a private owned vehicle on official Forty-Niner Shops business all accidents will be reported as soon as possible after the accident not to exceed 48 hours to my immediate supervisor and the Human Resources Department I understand that the insurance policy covering the privately owned vehicle will respond to the accident- the Forty-Niner Shops will NOT provide primary insurance coverage
I understand that permission to drive a privately owned vehicle on State business is a privilege which may be suspended or revoked at any time
Request Date of Request ____________ Insurance Carrier amp Policy Number ____________________________
Driverrsquos License Number ___________________ State ___________ Expiration Date __________
Employee Name ___________________________ Employee Signature _________________________
Approval DirectorManagerrsquos Signature __________________________________________ Date ____________
HR Representative Signature __________________________________________ Date ___________
10
49ER FORlY-NINER SHOPS INC CALIFORNIA STATE UNlVERSlTY LO G BEACH
Driver Privileges Revoked
It is the policy of the Forty -Niner Shops Inc to enro ll all employees in the OMV Pull Program that will be driv ing company vehicl es as well as any employee that would need to drive their own personal vehicles for the purpose o f Forty-Niner Shops business The Cali fornia Moto r Vehicl e Records (MVRs) will be used as the source fo rv eri fying driver history MVRs will be obtained init ially when the driver is enrolled in the program and annually thereafter as well as any time a driv er receives a negative infraction on their driv ing record
Driving p riv ileges may be revoked or suspended from any authorized driv er not meeting the elig ibility criteri a li sted below In add ition appropriate discipl inary action may be taken up to and including termination of employment
bull Driv ing under the influence bull Negligent homicide bull Operating with an ex pired or a suspended li cense bull Using a motor vehicle for commiss ion of a felony bull Aggrav ated assault with a motorvehicle bull Operat ing a motor vehicle without the owners consent bull Permitting an unlicensed driv er to driv e bull Reckless andor careless andor negligent driv ing bull Hit and Run or leaving the scene o f an accident with injury or death resulting or property
damage in exce ss of $1000 bull Indiv iduals who have been cited for unsafe driving on campus or who are in v iolation of
Forty-Niner Shops driver safety policies will be ineligib le to drive company vehicles or personal vehicl es for business purposes
bull Exceeding the maximum amount o f v iolation points within a 12-18 month period
Due to the current changes on your MVR which are li sted below as of today-----~ the Forty-N iner Shops is revoking your priv ilege to drive all company v ehicles as well as your own personal vehicl e for business purposes I
Employee Printed Name Date
Employee Signature HR Representative Signature
If the violation or suspension is removed by the 01-IV and you would like to regain the privilege to drive obtain a print-outfrom the OMV showing the violation or suspension has been cleared and bring it to HR A review process will take place to determine if driving privileges will be reinstated to the employee Created 1242013
POLICY STATEMENT
Policy Number 10006
Date Revised 112315
Last Revised
Policy Version
Date Author Description (If applicable) Approved Distribution
10 112315 R Hernandez Created new policy for company vehicle use
11
49ER FORlY-NINER SHOPS INC CALIFORNIA STATE UNlVERSlTY LO G BEACH
POLICY STATEMENT
Policy Number 10006
Date Revised 112315
12
49ER FORlYmiddotNINER SHOPS INC CALIFORNIA STATE UNlVERSlTY LO G BEACH
CALIFORNIA STATE UNIVERSITY LONG BEACH 1250 BELLFLOWER BOULEVARD LONG BEACH CA 90840
49er Pool (POgtL) F4 4 9er Softball Com plex (SC) G3 Acadam ic Services (AS) ES
Anatol Cente r Karl WE Barren Athlatic Administration Center ltBMCgt Nei l amp Phyllis E2
Pyramid Annex Conferenca Center (2nd Floor o f MC) Special Event s (2nd Floor)
Beach Circle The BC) E4 Brotmin Ha ll (BH ) E5
Kil li ngsworth Plaza Edward A Maxson Plaza Robert C
C arpenter Performing Arts Cente r (CPAC) G 1 Central Plant (C P) F6 Cent rltgtI Q uad (COSOUTH) Fa Colle9a of Bus inass AdminislJition (CBA) 04 Child Development Center Iaibel Patte rson (CDC) B1 Corporation Ya rd (CORP) H4 Dance Center (DC) F 1
Martha B Knoebel Daneamp Theatec-Design (DESN) H5 Education 1 (ED1) bull - E9 Education 2 (ED2) - E9 Enginamparing 2 EN2 ) _ G4 Engine-aring 3 (EN3) G4 Engineering 4 (EN4) G4 Eng inaering amp Compute r Sciencas (ECS) _ H4 Engine-aring Technology (ET) H4 Facilit ies Management (FM) 14 Friendship Wltgtlk (FWCENTRAL) F5 Faculty Offic-e 2 (F02) F7 Faculty Office 3 (F03) bull F7
Multicu ltural Campntec-Faculty Office 4 (F04) bullbullbull - G7 Faculty Office 5 (F05) - G7
SAS Center bull Junes L JanGen Family amp Consumer Sciencss (FCS) 05 Fine Arts 1 amp Art Annex (FA1) (ANNEX) FS Fine Arts 2 (FA2) G8 Fine Arts 3 (FA3) bull G8 Fine Arts 4 FA4) FS Fo und at ion (Foundation) G6
College of Continuing and Profeasional Educat ion H ill of Science (HS) F7 H eilth amp Human Services 1 HHS1) F5 H ealth amp Human Services 2 (HH S2) F5 Hom Cente r Stev e amp Nini (HC) F4 H ousing amp Resident ial Life (H RL) B1 H uman Services and Design (H SD) H5
Osher Lifelong Leaming Inst itute Japanese Garden Earl B u rns Milla r (JG ) 83 KKJZFM (KKJZ) E8 L anguage Arts Building (LAB) GS
Hauth Center Luster E amp Audrey Nichol L aciure Halls 150151 (LH) Fa LiberltgtI A rts 1 middot Instructional Madia (LA1) E8 LiberltgtI Arts 2 middot H istory (LA2) ES
Liberal Arts 3 LA3) - E8 Liberal Arts 4 middot Geography (LA4) E7 Liberal A rts 5 bull Liberal Arts (LA5) E7 Librn ry (LIB) E8 MDil Services (MS) H4 McIntosh Human ities Bldg (MHB) F8 Mi crobiology MIC) G7 Molecular amp Life Sciences Canter (MLSC) G6 MultimiddotM adii Cent er (MMC) E9 Nursing (N UR) C5 Outdoor Beach Cour89 lbx Offenberg (OUTBAC) G2 Outpost Food Se-vice (O P) H5 Paiking Tranportation and Event Services PTES) _ D3 Paterson Hill 1 (PH 1) F7 Paterson Hill 2 (PH2) - F7 Physical Ed ucation (PE) - E4
Gold Mine We-st Gym East Gym
Psychology (PSY) E7 Pyr am id Mike amp A rline Wilta r (P YR) E1
The Pointe PYR yellow entranca) Ukle je Room (PYR green enlJince)
Receiving (REC ) H4 Recycl ing Center (RC) C 1 Residence Housing
International House (IH _ __ 15 Los A limitos HJI (LAH) C4 Los Cerritos Hall ( LCH) 85 Rasidanca Commons and Ho using (RH) 84 P3Ikside Commons and Ho using (PC H) 82
Socia l Sciences P ub lic Adm in (SSPA) G5 Soroptomist Ho us e (SOR) D5 Speakec-middots Platform I East Lawn (SP) E5 Student Haalth Sarvicas (SH S) 05 Studant Recreation amp Wellnass Center (SRWC) H3 Tenni s Cantltgtr Ten y L Rhodes (Tennis Courts) F3 Thetar Arts (TA) F9
Players ThaatecshyStudi o Theat re Universt iy Theat er middot The Williim Link Theater
Track and Fie ld Jack Rose StDdium E3 University Art Museum (UAM) E4 University Booksto re (B KS) E7 University Din ing Plaza (UDP) E5 University Musi c Center (UMC) - F2
Gerald Dan ial Reci t al Hall University Pol ice Department (UP) H3 University Print Shop (UPS) G3 University Student Union (U S U) - F6
Ballr ooms A-C (USU bull 2nd F loor) Beach Audit o rium (USU bull 1st Floor) South west Terrance (USU middot 3rd Floor)
University Telecommunications (UTC) G9 Visitor Information Center (VIC) 05 Viviin Engineer ing Center (VEC) H4
POLICY STATEMENT
Policy Number 10006
Date Revised 112315
Campus Traffic Directory
8
49ER FORlY-NINER SHOPS INC CALIFORNIA STATE UNlVERSlTY LO G BEACH
POLICY STATEMENT
Policy Number 10006
Date Revised 112315
Campus Traffic Map
9
49ER FORlY-NINER SHOPS INC CALIFORNIA STATE UNlVERSlTY LONG BEACH
POLICY STATEMENT
Policy Number 10006
Date Revised 112315
Authorization to Use Privately Owned Vehicles on Forty-Niner Shops Business Approval is required to use privately owned vehicles to conduct official Forty-Niner Shops business
This form must be approved annually
Certification I hereby certify that whenever I drive a privately owned vehicle on Forty-Niner Shops business I will have a valid driverrsquos license and proof of liability insurance in my possession I will follow Forty-Niner Shops Driver Safety Policies as well as all applicable laws as required by the State of California
Additionally I will abide by the following
All motorists must carry evidence of current automobile liability insurance in their vehicle
The vehicle shall always be covered by liability insurance for the minimum amount prescribed by State Law
o $15000 for personal injury to or death of one person o $30000 for injury to death of two or more persons in one accident o $5000 property damage
All persons in the vehicle will wear safety belts Vehicle will be adequate for the work to be performed Vehicle will be equipped with safety belts in operating condition To the best of my knowledge in safe mechanical condition as required by law
I understand that the mileage rate I claim is full reimbursement for the cost of operating the privately owned vehicle including fuel maintenance repairs and both liability and comprehensive insurance
I further certify that while using a private owned vehicle on official Forty-Niner Shops business all accidents will be reported as soon as possible after the accident not to exceed 48 hours to my immediate supervisor and the Human Resources Department I understand that the insurance policy covering the privately owned vehicle will respond to the accident- the Forty-Niner Shops will NOT provide primary insurance coverage
I understand that permission to drive a privately owned vehicle on State business is a privilege which may be suspended or revoked at any time
Request Date of Request ____________ Insurance Carrier amp Policy Number ____________________________
Driverrsquos License Number ___________________ State ___________ Expiration Date __________
Employee Name ___________________________ Employee Signature _________________________
Approval DirectorManagerrsquos Signature __________________________________________ Date ____________
HR Representative Signature __________________________________________ Date ___________
10
49ER FORlY-NINER SHOPS INC CALIFORNIA STATE UNlVERSlTY LO G BEACH
Driver Privileges Revoked
It is the policy of the Forty -Niner Shops Inc to enro ll all employees in the OMV Pull Program that will be driv ing company vehicl es as well as any employee that would need to drive their own personal vehicles for the purpose o f Forty-Niner Shops business The Cali fornia Moto r Vehicl e Records (MVRs) will be used as the source fo rv eri fying driver history MVRs will be obtained init ially when the driver is enrolled in the program and annually thereafter as well as any time a driv er receives a negative infraction on their driv ing record
Driving p riv ileges may be revoked or suspended from any authorized driv er not meeting the elig ibility criteri a li sted below In add ition appropriate discipl inary action may be taken up to and including termination of employment
bull Driv ing under the influence bull Negligent homicide bull Operating with an ex pired or a suspended li cense bull Using a motor vehicle for commiss ion of a felony bull Aggrav ated assault with a motorvehicle bull Operat ing a motor vehicle without the owners consent bull Permitting an unlicensed driv er to driv e bull Reckless andor careless andor negligent driv ing bull Hit and Run or leaving the scene o f an accident with injury or death resulting or property
damage in exce ss of $1000 bull Indiv iduals who have been cited for unsafe driving on campus or who are in v iolation of
Forty-Niner Shops driver safety policies will be ineligib le to drive company vehicles or personal vehicl es for business purposes
bull Exceeding the maximum amount o f v iolation points within a 12-18 month period
Due to the current changes on your MVR which are li sted below as of today-----~ the Forty-N iner Shops is revoking your priv ilege to drive all company v ehicles as well as your own personal vehicl e for business purposes I
Employee Printed Name Date
Employee Signature HR Representative Signature
If the violation or suspension is removed by the 01-IV and you would like to regain the privilege to drive obtain a print-outfrom the OMV showing the violation or suspension has been cleared and bring it to HR A review process will take place to determine if driving privileges will be reinstated to the employee Created 1242013
POLICY STATEMENT
Policy Number 10006
Date Revised 112315
Last Revised
Policy Version
Date Author Description (If applicable) Approved Distribution
10 112315 R Hernandez Created new policy for company vehicle use
11
49ER FORlY-NINER SHOPS INC CALIFORNIA STATE UNlVERSlTY LO G BEACH
POLICY STATEMENT
Policy Number 10006
Date Revised 112315
12
49ER FORlY-NINER SHOPS INC CALIFORNIA STATE UNlVERSlTY LO G BEACH
POLICY STATEMENT
Policy Number 10006
Date Revised 112315
Campus Traffic Map
9
49ER FORlY-NINER SHOPS INC CALIFORNIA STATE UNlVERSlTY LONG BEACH
POLICY STATEMENT
Policy Number 10006
Date Revised 112315
Authorization to Use Privately Owned Vehicles on Forty-Niner Shops Business Approval is required to use privately owned vehicles to conduct official Forty-Niner Shops business
This form must be approved annually
Certification I hereby certify that whenever I drive a privately owned vehicle on Forty-Niner Shops business I will have a valid driverrsquos license and proof of liability insurance in my possession I will follow Forty-Niner Shops Driver Safety Policies as well as all applicable laws as required by the State of California
Additionally I will abide by the following
All motorists must carry evidence of current automobile liability insurance in their vehicle
The vehicle shall always be covered by liability insurance for the minimum amount prescribed by State Law
o $15000 for personal injury to or death of one person o $30000 for injury to death of two or more persons in one accident o $5000 property damage
All persons in the vehicle will wear safety belts Vehicle will be adequate for the work to be performed Vehicle will be equipped with safety belts in operating condition To the best of my knowledge in safe mechanical condition as required by law
I understand that the mileage rate I claim is full reimbursement for the cost of operating the privately owned vehicle including fuel maintenance repairs and both liability and comprehensive insurance
I further certify that while using a private owned vehicle on official Forty-Niner Shops business all accidents will be reported as soon as possible after the accident not to exceed 48 hours to my immediate supervisor and the Human Resources Department I understand that the insurance policy covering the privately owned vehicle will respond to the accident- the Forty-Niner Shops will NOT provide primary insurance coverage
I understand that permission to drive a privately owned vehicle on State business is a privilege which may be suspended or revoked at any time
Request Date of Request ____________ Insurance Carrier amp Policy Number ____________________________
Driverrsquos License Number ___________________ State ___________ Expiration Date __________
Employee Name ___________________________ Employee Signature _________________________
Approval DirectorManagerrsquos Signature __________________________________________ Date ____________
HR Representative Signature __________________________________________ Date ___________
10
49ER FORlY-NINER SHOPS INC CALIFORNIA STATE UNlVERSlTY LO G BEACH
Driver Privileges Revoked
It is the policy of the Forty -Niner Shops Inc to enro ll all employees in the OMV Pull Program that will be driv ing company vehicl es as well as any employee that would need to drive their own personal vehicles for the purpose o f Forty-Niner Shops business The Cali fornia Moto r Vehicl e Records (MVRs) will be used as the source fo rv eri fying driver history MVRs will be obtained init ially when the driver is enrolled in the program and annually thereafter as well as any time a driv er receives a negative infraction on their driv ing record
Driving p riv ileges may be revoked or suspended from any authorized driv er not meeting the elig ibility criteri a li sted below In add ition appropriate discipl inary action may be taken up to and including termination of employment
bull Driv ing under the influence bull Negligent homicide bull Operating with an ex pired or a suspended li cense bull Using a motor vehicle for commiss ion of a felony bull Aggrav ated assault with a motorvehicle bull Operat ing a motor vehicle without the owners consent bull Permitting an unlicensed driv er to driv e bull Reckless andor careless andor negligent driv ing bull Hit and Run or leaving the scene o f an accident with injury or death resulting or property
damage in exce ss of $1000 bull Indiv iduals who have been cited for unsafe driving on campus or who are in v iolation of
Forty-Niner Shops driver safety policies will be ineligib le to drive company vehicles or personal vehicl es for business purposes
bull Exceeding the maximum amount o f v iolation points within a 12-18 month period
Due to the current changes on your MVR which are li sted below as of today-----~ the Forty-N iner Shops is revoking your priv ilege to drive all company v ehicles as well as your own personal vehicl e for business purposes I
Employee Printed Name Date
Employee Signature HR Representative Signature
If the violation or suspension is removed by the 01-IV and you would like to regain the privilege to drive obtain a print-outfrom the OMV showing the violation or suspension has been cleared and bring it to HR A review process will take place to determine if driving privileges will be reinstated to the employee Created 1242013
POLICY STATEMENT
Policy Number 10006
Date Revised 112315
Last Revised
Policy Version
Date Author Description (If applicable) Approved Distribution
10 112315 R Hernandez Created new policy for company vehicle use
11
49ER FORlY-NINER SHOPS INC CALIFORNIA STATE UNlVERSlTY LO G BEACH
POLICY STATEMENT
Policy Number 10006
Date Revised 112315
12
49ER FORlY-NINER SHOPS INC CALIFORNIA STATE UNlVERSlTY LONG BEACH
POLICY STATEMENT
Policy Number 10006
Date Revised 112315
Authorization to Use Privately Owned Vehicles on Forty-Niner Shops Business Approval is required to use privately owned vehicles to conduct official Forty-Niner Shops business
This form must be approved annually
Certification I hereby certify that whenever I drive a privately owned vehicle on Forty-Niner Shops business I will have a valid driverrsquos license and proof of liability insurance in my possession I will follow Forty-Niner Shops Driver Safety Policies as well as all applicable laws as required by the State of California
Additionally I will abide by the following
All motorists must carry evidence of current automobile liability insurance in their vehicle
The vehicle shall always be covered by liability insurance for the minimum amount prescribed by State Law
o $15000 for personal injury to or death of one person o $30000 for injury to death of two or more persons in one accident o $5000 property damage
All persons in the vehicle will wear safety belts Vehicle will be adequate for the work to be performed Vehicle will be equipped with safety belts in operating condition To the best of my knowledge in safe mechanical condition as required by law
I understand that the mileage rate I claim is full reimbursement for the cost of operating the privately owned vehicle including fuel maintenance repairs and both liability and comprehensive insurance
I further certify that while using a private owned vehicle on official Forty-Niner Shops business all accidents will be reported as soon as possible after the accident not to exceed 48 hours to my immediate supervisor and the Human Resources Department I understand that the insurance policy covering the privately owned vehicle will respond to the accident- the Forty-Niner Shops will NOT provide primary insurance coverage
I understand that permission to drive a privately owned vehicle on State business is a privilege which may be suspended or revoked at any time
Request Date of Request ____________ Insurance Carrier amp Policy Number ____________________________
Driverrsquos License Number ___________________ State ___________ Expiration Date __________
Employee Name ___________________________ Employee Signature _________________________
Approval DirectorManagerrsquos Signature __________________________________________ Date ____________
HR Representative Signature __________________________________________ Date ___________
10
49ER FORlY-NINER SHOPS INC CALIFORNIA STATE UNlVERSlTY LO G BEACH
Driver Privileges Revoked
It is the policy of the Forty -Niner Shops Inc to enro ll all employees in the OMV Pull Program that will be driv ing company vehicl es as well as any employee that would need to drive their own personal vehicles for the purpose o f Forty-Niner Shops business The Cali fornia Moto r Vehicl e Records (MVRs) will be used as the source fo rv eri fying driver history MVRs will be obtained init ially when the driver is enrolled in the program and annually thereafter as well as any time a driv er receives a negative infraction on their driv ing record
Driving p riv ileges may be revoked or suspended from any authorized driv er not meeting the elig ibility criteri a li sted below In add ition appropriate discipl inary action may be taken up to and including termination of employment
bull Driv ing under the influence bull Negligent homicide bull Operating with an ex pired or a suspended li cense bull Using a motor vehicle for commiss ion of a felony bull Aggrav ated assault with a motorvehicle bull Operat ing a motor vehicle without the owners consent bull Permitting an unlicensed driv er to driv e bull Reckless andor careless andor negligent driv ing bull Hit and Run or leaving the scene o f an accident with injury or death resulting or property
damage in exce ss of $1000 bull Indiv iduals who have been cited for unsafe driving on campus or who are in v iolation of
Forty-Niner Shops driver safety policies will be ineligib le to drive company vehicles or personal vehicl es for business purposes
bull Exceeding the maximum amount o f v iolation points within a 12-18 month period
Due to the current changes on your MVR which are li sted below as of today-----~ the Forty-N iner Shops is revoking your priv ilege to drive all company v ehicles as well as your own personal vehicl e for business purposes I
Employee Printed Name Date
Employee Signature HR Representative Signature
If the violation or suspension is removed by the 01-IV and you would like to regain the privilege to drive obtain a print-outfrom the OMV showing the violation or suspension has been cleared and bring it to HR A review process will take place to determine if driving privileges will be reinstated to the employee Created 1242013
POLICY STATEMENT
Policy Number 10006
Date Revised 112315
Last Revised
Policy Version
Date Author Description (If applicable) Approved Distribution
10 112315 R Hernandez Created new policy for company vehicle use
11
49ER FORlY-NINER SHOPS INC CALIFORNIA STATE UNlVERSlTY LO G BEACH
POLICY STATEMENT
Policy Number 10006
Date Revised 112315
12
49ER FORlY-NINER SHOPS INC CALIFORNIA STATE UNlVERSlTY LO G BEACH
Driver Privileges Revoked
It is the policy of the Forty -Niner Shops Inc to enro ll all employees in the OMV Pull Program that will be driv ing company vehicl es as well as any employee that would need to drive their own personal vehicles for the purpose o f Forty-Niner Shops business The Cali fornia Moto r Vehicl e Records (MVRs) will be used as the source fo rv eri fying driver history MVRs will be obtained init ially when the driver is enrolled in the program and annually thereafter as well as any time a driv er receives a negative infraction on their driv ing record
Driving p riv ileges may be revoked or suspended from any authorized driv er not meeting the elig ibility criteri a li sted below In add ition appropriate discipl inary action may be taken up to and including termination of employment
bull Driv ing under the influence bull Negligent homicide bull Operating with an ex pired or a suspended li cense bull Using a motor vehicle for commiss ion of a felony bull Aggrav ated assault with a motorvehicle bull Operat ing a motor vehicle without the owners consent bull Permitting an unlicensed driv er to driv e bull Reckless andor careless andor negligent driv ing bull Hit and Run or leaving the scene o f an accident with injury or death resulting or property
damage in exce ss of $1000 bull Indiv iduals who have been cited for unsafe driving on campus or who are in v iolation of
Forty-Niner Shops driver safety policies will be ineligib le to drive company vehicles or personal vehicl es for business purposes
bull Exceeding the maximum amount o f v iolation points within a 12-18 month period
Due to the current changes on your MVR which are li sted below as of today-----~ the Forty-N iner Shops is revoking your priv ilege to drive all company v ehicles as well as your own personal vehicl e for business purposes I
Employee Printed Name Date
Employee Signature HR Representative Signature
If the violation or suspension is removed by the 01-IV and you would like to regain the privilege to drive obtain a print-outfrom the OMV showing the violation or suspension has been cleared and bring it to HR A review process will take place to determine if driving privileges will be reinstated to the employee Created 1242013
POLICY STATEMENT
Policy Number 10006
Date Revised 112315
Last Revised
Policy Version
Date Author Description (If applicable) Approved Distribution
10 112315 R Hernandez Created new policy for company vehicle use
11
49ER FORlY-NINER SHOPS INC CALIFORNIA STATE UNlVERSlTY LO G BEACH
POLICY STATEMENT
Policy Number 10006
Date Revised 112315
12
49ER FORlY-NINER SHOPS INC CALIFORNIA STATE UNlVERSlTY LO G BEACH
POLICY STATEMENT
Policy Number 10006
Date Revised 112315
12
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