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Use of Personal Vehicle Policy

Several staff positions at Donate Life Northwest require the use of/access to reliable and insured transportation, whether that be a personal vehicle, Zipcar, or other such vehicle service.  Before being permitted to drive a personal vehicle on behalf of Donate Life Northwest, Employees are required to read and sign the agreement below and must meet the following requirements:

  1. Have a valid Driver’s License, and be at least 21 years of age.
  2. Not have received more than one moving violation in the past 12 months, or more than two in the last 36 months.
  3. Not have received any DUI violations (driving under the influence of alcohol or drugs) within the last 5 years.
  4. No felony convictions involving the use of a motor vehicle.
  5. Have insurance coverage with a minimum of:
    • $100,000 per person/$300,000 per occurrence for bodily injury
      ($500,000 for vehicles with more than 5 passengers).
    • $50,000 property damage per occurrence
    • $5,000 per person for medical payment
  6. Drive a safe, well-maintained vehicle.

Whenever you are driving on behalf of the organization, either in your own vehicle or a rental vehicle, the following rules apply:

  1. Maintain your vehicle’s interior and exterior for safety measures.
  2. The driver and all passengers must wear seat belts.
  3. Obey all traffic laws, including wearing seatbelts, following posted speed limits, and maintaining proper distance between cars. Do not under any circumstances attempt to keep a specific time of arrival promise by breaking traffic laws, or by driving in an unsafe manner. If following posted limits will make you late, stop somewhere and phone the people you need to meet, or call the office and have someone there call them.
  4. Drive defensively.
  5. Do not pick up hitchhikers or allow an unauthorized person to be a passenger in or to drive your own vehicle while being used on organization business.
  6. Maintain automobile liability coverage equal to or greater than the limits outlined above.
  7. Provide Donate Life Northwest with a copy of the declarations page of your automobile insurance policy upon hire and promise to maintain required minimum coverage limits throughout the duration of employment at Donate Life Northwest.

This agreement has been made by and between Donate Life Northwest (hereinafter referred to as the Organization) and the Employee (or Volunteer) identified in this form. This agreement is as follows:

  1. The Organization hereby authorizes the Employee/Volunteer to use his or her personally owned vehicle on behalf of the Organization.
  2. The Employee understands that the Organization places a great emphasis on the safe operation of all vehicles. Given this, the Employee understands and agrees that they:
    1. Will not allow any other person to be a passenger in the Employee-owned vehicle while it is being used on behalf of the Organization unless such person is another Employee, a volunteer, or another authorized person;
    2. Will allow no other person to operate the Employee’s vehicle while it is being used on behalf of the Organization unless that other person is another Employee and is at least 18 years of age and possesses a valid driver’s license;
    3. Will not operate the vehicle, nor allow it to be operated by someone else, while the Employee or that other person is under the influence of alcohol or drugs; and,
    4. Will not use or permit the use of the vehicle in a negligent or improper manner or in violation of any law or of this agreement.
    5. Will report to the Organization any accidents if there are personal injuries to anyone involved in the accident or if property is damaged, other than the driver’s vehicle.
  3. The Employee understands that the Organization does not furnish any insurance for the protection of the Employee if any claim or suit is made against the Employee arising out of his or her operation of a personally owned vehicle unless otherwise stated in this agreement; nor is any insurance provided by the Organization to repair damage that may occur to the Employee’s personally owned vehicle.
  4. The Employee, at all times, will maintain automobile coverage as required by the Organization and is responsible for the personal auto insurance deductible(s).
  5. The Employee agrees to indemnify the Organization against all claims, losses, damages and expenses, including legal fees, which the Organization may incur as the result of the use of the Employee’s vehicle on behalf of the Organization.

Contact Information
Diver Safety History
Have you received more than one moving violation in the past 12 months, or more than two in the last 36 months?
Have you received any DUI violations (driving under the influence of alcohol or drugs) within the last 5 years?
Do you have a felony conviction involving the use of a motor vehicle?
Employee Owned Vehicle Information
Do you drive a safe, well-maintained vehicle?*
*Required insurance coverage will have a minimum of:
  • $100,000 per person/$300,000 per occurrence for bodily injury
    ($500,000 for vehicles with more than 5 passengers).
  • $50,000 property damage per occurrence
  • $5,000 per person for medical payment
Proof of Insurance & Driver License: File Upload
One file only.
60 MB limit.
Allowed types: gif jpg jpeg png bmp eps tif pict psd txt rtf html odf pdf doc docx ppt pptx xls xlsx xml avi mov mp3 mp4 ogg wav bz2 dmg gz jar rar sit svg tar zip.
One file only.
60 MB limit.
Allowed types: gif jpg jpeg png bmp eps tif pict psd txt rtf html odf pdf doc docx ppt pptx xls xlsx xml avi mov mp3 mp4 ogg wav bz2 dmg gz jar rar sit svg tar zip.
Only needed is coverage dates are not included on the uploaded Insurance Declaration Page
One file only.
60 MB limit.
Allowed types: gif jpg jpeg png bmp eps tif pict psd txt rtf html odf pdf doc docx ppt pptx xls xlsx xml avi mov mp3 mp4 ogg wav bz2 dmg gz jar rar sit svg tar zip.
Cardholder's Signature (above)