DRIVER

Name _________________________________    Date of Birth ______________________

Address _____________________________    Social Security # _____________________

Phone # ____________________________

Drivers License #______________________    Date of Expiration ____________________

VEHICLE TO BE USED

Name of Owner _______________________    Model of Vehicle _____________________

Address of Owner ______________________    Make of Vehicle  _____________________

              ______________________________    Year of Vehicle   _____________________

License Plate # ________________________    Date of Expiration ____________________

If more than one vehicle is to be used, the aforementioned information must be provided for each vehicle.

INSURANCE INFORMATION

When using a privately-owned vehicle, the insurance coverage is the limit of the insurance policy covering that specific vehicle.

Insurance Company _________________________________________________________________________


Policy # _______________________________    Date of Expiration ___________________


Liability Limits of Policy  ____________________________________________________________________

Please note: the minimal, acceptable liability limit for privately-owned vehicles is $100,000/$300,000

CERTIFICATION

I certify that the information given on this form is true and correct to the best of my knowledge.  I understand that as a volunteer driver, I must be 21 years of age or older, possess a valid driver’s license, have the proper and current license and vehicle registration, and have the required insurance coverage in effect on any vehicle used to transport participants of the event.

___________________________________________________________________
Signature                                                                                                            Date
 
VOLUNTEER & EMPLOYEE DRIVERS

This information pertains to both volunteers and employees who use their personal vehicles on a mission for the church/school.

Automobile insurance follows the vehicle; therefore, the volunteer’s auto liability insurance is primary.  Catholic Mutual has excess liability coverage only, which would come into effect only after all other liability coverage is exhausted.

Under the No-Fault-Medical statute, if passengers are injured, the medical bills would go first to the passenger’s own automobile coverage, or if the passenger is a minor, to the parent/guardian’s auto insurance.  If the passenger has no auto coverage, then the medical bills would go to the volunteer driver’s No-Fault medical insurance.  There is no medical coverage provided for volunteer drivers or passengers through the Catholic Mutual Program.

-    Please be certain that your volunteer drivers have adequate insurance.  The minimal acceptable liability limit from privately owned vehicles in the State of Minnesota is $100,000/$300,000.
-    All drivers must be at least 21 years of age, even if they are parish/school employees.
-    Drivers must have a valid driver’s license (non-probationary).
-    Drivers must fill out a Driver Information Sheet to be kept on file in the parish/school office.

In addition, drivers should not have any physical disabilities that could in any way impair their ability to drive safely.  The volunteer’s vehicle should be in good working order and have current registration and license plates.  It is advised, but not mandatory, that the volunteer carry collision and comprehensive coverage on their vehicle as well, as the church/school cannot pay for damages to their vehicle if it is damaged in a collision or is vandalized.

If a parish employee or volunteer, driving their personal vehicle on a mission for the church, does not have the minimum amount of insurance coverage and is in an auto accident, that person will be held responsible for paying any claims made due to the accident, up to the limit of financial responsibility allowed by law in Minnesota.

Under no circumstances are 10-15 passenger vans to be used for school trips or to transport minors for parish activities.  Regardless of who owns the vehicle, how many passengers are in the vehicle, or how many seats are installed in the vehicle, use of this van style is dangerous and strictly prohibited.

For further information, please contact your service office, (651) 290-1605.

         ________________________________________________________________________