MOTOR VEHICLE DRIVER’S CERTIFICATION OF VIOLATIONS
I certify that the following is a true and complete list of traffic violations (other than parking violations) for which I have been convicted or forfeited bond or collateral during the past 12 months.
If no violations are listed above, I certify that I have not been convicted or forfeited bond or collateral on account of any violation required to be listed during the past 12 months.
Driver's Name:
____11/20/2008 ___ I acknowledge online submission
(Date of Certification) of this form is my authorized signature.
(Driver’s Signature)
_Dedicated Logistics, Inc._________________ _2896 Centre Pointe dr, St. Paul, MN 55113 __
(Motor Carrier’s Name) (Motor Carrier’s Address)
_____________________________________ _____________________________________
(Reviewed By: Signature) (Title)
|