Request to Operate OARDC Vehicles - Non-OSU Employee Permission

Name                                                                    Department                                    

Driver license no.                                                    Insurance carrier                              

Effective dates of current insurance policy: from                      through                           

Reason for request:                                                                                                                   

SIGNATURES

I do hereby certify that I have additional insurance coverage for driving state vehicles.  I also promise to keep this coverage in force as long as I have the need to operate OARDC vehicles.

Driver                                                                                                                       

Department Head                                                                                                      

OARDC Physical Plant                                                                                              

OARDC Director                                                                                                       

This request is not granted until signed by the OARDC Director or his designate.  Upon departmental approval, forward this form along with a copy of the proof of insurance to the OARDC Physical Plant for review.  OARDC Physical Plant will forward form to OARDC Director.