Driver Compliance Form (Vehicle Inspection)
| Driver First |
Devan
|
| Driver Last Name |
Momon
|
| Last four of Social | 3059 |
| Pic. of Current DL | |
|
|
| DL Expiration Date | August 8, 2022 |
| Position | Delivery Expert |
| Location |
6705 5748 Evers Rd., Ste #101 San Antonio, TX 78238 210-680-0370 |
| Is this Team Member a New Hire or Current Employee? | Current Employee |
| Please take a picture of the completed GPS Acknowledgement from GoFormz. | |
| Primary Car? | Primary Car |
| Insurance Information | |
| Name of Insurance Carrier |
USAA
|
| Policy # |
006748802U71043
|
| Policy Effective Date | April 5, 2021 |
| Policy Expiration Date listed on the Card |
October 5, 2021 |
| Pic of Current Insurance Card with Team Members Name listed as Insured Driver. | |
|
|
| Car Information | |
| Year | 2012 |
| Make | Nissan |
| Model |
Roug
|
| License Plate Number |
NZV7034
|
| Registration Expiration Date | December 31, 2021 |
| Color | Silver |
| Pic of the Car | |
|
|
| FRONT | |
| Does The Vehicle Have Either A Cell Phone Mount Or An Onboard Integrated Hands Free System? |
Yes |
| Is the Drivers Seat Belt Functional? |
Yes |
| Is the Drivers Horn Functional? |
Yes |
| Are both Left and Right High Beams Functional? | Yes |
| Are both Left and Right Head Lights Functional? | Yes |
| Are Both Left and Right Front Turn Signals Functional ? | Yes |
| Are Both Left and Right Front Hazard Lights Functional ? |
Yes |
| The Rear View Mirror Intact and Operational? | Yes |
| Are the Side View Mirrors Intact and Operational? | Yes |
| Tire Condition | |
| Tire condition (Driver Front) PENNY TEST REQUIRED | Yes |
| Photo | |
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| Tire condition (Passenger Front) PENNY TEST REQUIRED | Yes |
| Photo | |
|
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| Tire condition (Passenger Rear) PENNY TEST REQUIRED | Yes |
| Photo | |
|
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| Tire condition (Driver Rear) PENNY TEST REQUIRED | Yes |
| Photo | |
|
|
| REAR | |
| Are Both Left and Right Rear Tail Lights Functional? |
Yes |
| Are Both Left and Right Rear Brake Lights Functional? |
Yes |
| Is the Third Brake Light (Center Of Rear Window) Functional? | Yes |
| Are Both Left and Right Rear Hazard Lights Functional? |
Yes |
| Are Both Left and Right Rear Turn Signals Functional? |
Yes |
| Are Both Left and Right Reverse Lights Functional? | Yes |
| MISC. | |
| Windshield Glass | Yes |
| Windshield Washer Fluid | Yes |
| Are the Windshield Wipers and Blades Functional? | Yes |
| Any excessive Body damage? | No |
| Photo | |
| Is Vehicle Free of Any 3rd Party Advertising? | Yes |
| Photo | |
| SIGNATURES | |
Signature of Driver
|
|
| Date | June 18, 2021 |
| Printed Name Of Company Representative |
Angela Lima
|
Signature of Company Representative
|
|
| Date | June 18, 2021 |
