Passenger Authorization & Release

Passenger Authorization & Release

AUTHORIZATION:

Approval is hereby granted in accordance with 49 C.F.R. 392.60 et sec. for the transporting of the individual designated below in a non-driver status between the points and dates indicated and in the power unit indicated. The transporting of said individual is governed by 49 C.F.R. 329.60 and 392.61, which section states as follows: “Except in case of emergency, no driver shall permit a motor vehicle to which he is assigned to be driven by any person not authorized to drive such vehicle by the motor carrier in control thereof.”

Note: This permit must be approved by the Safety Department. This document must be carried, while in effect, on the power unit at all times by the driver to whom issued.

Authority is granted to ______Social Security # ______

to transport his/her ______whose name is ______

Social Security # ______in non-driver status, is to cover any trip from

______to all points in the USA and/or return to ______.

Beginning date______Expiration Date______

______

Driver Signature Date Safety Department Signature

Release:

The following language is a release and substantially affects your rights in the event of injury or death. Do not sign the form unless you understand what you are signing. If you have any questions, those questions should be answered by the safety director before you sign below.

I hereby release and hold harmless any Creech company and its officers, directors, and employees and any subsidiary corporations from any and all liability for personal injury, death and loss of or damage to property in any way arising form my status as a non-driver, whether a passenger, or during any loading, unloading, or other use of a power unit (including any other attached equipment) in which I am authorized as a non-driver hereunder, whether or not said liabilities are caused or contributed to by any negligence or willful actions of any Creech company. or its officers, directors, or employees.

I have read and understand the foregoing and execute the same freely and voluntary on the date indicated.

______

Non-Driver Signature (Legal Guardian if Minor) Date

Authorization of Payroll Deduction

By signing below, I hereby agree to allow $______to be deducted from my next payroll check. I understand fully that it will be deducted as a onetime payment in full for the purpose of participating in the company’s rider program. I have freely chosen to purchase the program on an

☐Annual basis(March-Oct) - $120.00 per passenger ( 25% discount)

☐Monthly basis - $20.00 per passenger

I fully understand that this onetime deduction is nonrefundable regardless of use, and that no portion will be returned to me.

Driver Signature______Date______

Name______

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