Mileage/Transportation Waiver Today's Date * Full Name (Last, First, M) * Agency Driver Guidelines It is a requirement that all employees or agents of Amicable Healthcare, Inc. who are authorized to drive a vehicle to transport clients, hold an acceptable driving record, valid State issued driver’s license, and current auto insurance coverage. Instructions: Employee is required to provide their own transportation to the client’s home Employee’s transportation must be reliable to get to the home on time and on errands Employee is responsible for maintaining a valid Washington State Unrestricted Motor Vehicle Operation License and a current automobile insurance policy Employee is responsible for all repairs, traffic violations and accidents Employee will only be reimbursed for the authorized client shopping or errand mileage at the IRS rate. There are limits on the total number of miles in a month the employee may be reimbursed based on clients’ monthly mileage eligibility. All mileage must be documented Employees always while on duty shall only utilize vehicles that are covered by liability insurance, consistent with laws and regulation of the state of Washington. Proof of sufficient liability insurance is required before transportation is authorized Though not mandatory, however, employees are encouraged to carry comprehensive coverage (full coverage) to include under/uninsured motorist coverage No job related transportation mileage can be reimbursed by the agency if the client is not authorized Checkboxes * I will transport a client by motor vehicle and understand that I must carry a current driver’s license and covered by required liability insurance. I agree to notify the agency if my auto insurance changes. I understand that in the event of an accident involving my own vehicle, my own automobile insurance is primary when I am transporting myself or clients. I understand that a change to my driving record may make me ineligible to drive on behalf of the agency. I will NOT transport a client by motor vehicle. Employee Initial's * Submit