Contractor'S Statement Of Compliance Form With Cdl Testing Program Requirements (Page 2 of 2) in pdf

Contractor'S Statement Of Compliance Form With Cdl Testing Program Requirements Page 2

Contractor’s Statement of Compliance with

CDL Testing Program Requirements

Due to the nature of the work that this contractor may perform for this employer, this

contractor must use employees who perform safety-sensitive functions for which a Commercial

Driver’s License (CDL) is typically required. Section 49 CFR 382.301(c)(2) of the federal CDL

regulations requires that, prior to the first time an employer uses a CDL employee employed by

another entity (i.e., a contractor to whom the township is awarding a contract), and every six

months of the contract, this employer must certify that any CDL employees used by each

contractor remain covered by a qualified CDL drug and alcohol testing program.

An original signed copy of this form must be permanently retained by the employer with

this contract and a new form received every 6 months of the contract’s duration.

If the contractor is not participating in a qualified CDL drug and alcohol testing program

at the time of the awarding of the contract, or at any six-month re-certification point, then all the

contractor’s CDL employees must obtain a negative result on a pre-employment drug test before

beginning (or continuing) contracted work for this employer.

Contractor Name__________________________________________________________________________

By signing here, I, as the contractor’s authorized representative, verify that the contractor named above is a current

participant in the below identified CDL testing program conforming to 49 CFR Part 40.

Contractor’s Authorized Representative ________________________________________________________

Today’s Date ____/____/____

Signature of Authorized Representative ________________________________________________________

CDL Testing Program Name ________________________________________________________________

Testing Program Contact Person ____________________________________________________________

Testing Program Address __________________________________________________________________

Phone #: (

)

City ______________________________ State _____ Zip __________

Contact person confirms program conforms to 49 CFR Part 40?

(_____) Yes

(______) No

Contact person confirms list of contractor’s CDL employees covered in this program and that all drivers are

qualified to driver under 49 CFR Part 382.301?

(_____) Yes

(______) No

Rev 2/15

PSATS CDL Program Form Contractor

Contractor'S Statement Of Compliance Form With Cdl Testing Program Requirements Page 2