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DRIVER INFORMATION <br /> I. What is the name and title of the person who hires your drivers? Jerome Parker, GM <br /> 2. Do you have any family members under the age of 21 that are primary drivers of a company auto? ❑ Yes No <br /> 3. Anv family member(s)driving company vehicles? <br /> F1 Yes �,No If Yes,please provide name(s): <br /> 4. By percentage,please indicate the number of years your drivers have been commercially licensed (Percentage should equal 100%) <br /> 2.5 Years or less: % Between 2.5&5 Years: % Between 5 Years& 10 Years: % 10 Years or More: % <br /> During the last 12 months, how many drivers have you Replaced? Added? <br /> 6. Drivers pay scale is: ® Union ❑Non-Union <br /> ?. Drivers pay is calculated by: ❑Trip ❑Mileage ❑Hourly ❑Other: (explain) <br /> S. Drivers maximum hours: <br /> A. Driving: 10 Daily 50 Weeklv <br /> B. On Duty: 10 Daily 50 Weekly <br /> 9. Do your drivers carry cellular phones? [E Yes ❑No If Yes,are the cell phones hands free? ❑Yes ®No <br /> 10. Do you ever lease vehicles with drivers? ❑Yes ®No If Yes,explain: <br /> 11. Do you provide Workers' Compensation insurance for ALL drivers? ® Yes ❑No If Yes,please specify insurance <br /> carrier: <br /> EQUIPMENT INFORMATION <br /> I. Do you own or operate any for-hire vehicles not listed on the attached Equipment Schedule? ❑ Yes ®No <br /> 2. Are all vehicles registered in the same EXACT name? ® Yes ❑ No. If No, please provide a copy of at least one <br /> registration for as many names as vehicles have been registered under. <br /> NOTE: Copies of all registrations must be provided for vehicles registered in the states of NY,MA,FL,GA and AZ. <br /> 3. Are all units registered in the same state? ® Yes ❑No Please list state(s)where vehicles are registered: <br /> 4. Are units relocated anytime during the year? ❑Yes ❑No If Yes, please explain: <br /> Schedule for all locations. (Attach separate sheet if necessary.) <br /> Location #1 Location#2 Location#3 <br /> A. Address: 555 East Wood St <br /> B. Type of operation:(office, <br /> terminal,garage,etc.) Garage <br /> C. No.of units stored outside <br /> and maximum values: <br /> D. Is lot fenced? Yes <br /> E. Night watchman or guard: No <br /> F. Area: (square footage) <br /> G. Person(s)in charge/title: Jerome Parker, GM <br /> H, is there a dispatcher at this <br /> location? No <br /> 6. Please explain completely if any equipment is not garaged or stored at the above locations. <br /> Lancer Bus,'1 one Application(09113) Page 5 of 10 <br />