My pizza insurance

BY KOELE INC

By completing the form below, you agree to and understand the following.

 

I am aware that consumer and motor vehicle reports may be obtained as part of my evaluation of my job application and/or employment with this company.

 

The reports may be procured by the employer or its insurance company representatives and items contained in the reports may be disclosed to the employing franchisee owner/manager and to the corporate office for risk management purposes.  These reports may include personal information obtained from state motor vehicle departments, my driving record, an assessment of my insurability for the insurance program, or other consumer reports.

 

This company does not provide insurance for personal vehicles when used for delivery or company business.  Accidents that occur while you are using your personal vehicle will not be covered.  This applies to both liability and physical damage to your vehicle.  Your personal auto insurance will be expected to perform and defend you in the event of an accident that occurs during a pizza delivery or company business.  You, as an employee, are covered by Workers Compensation Insurance for injuries that occur to you while employed by this company.

 

You are hereby advised to contact your personal insurance agent/company to notify them of your intent to use your vehicle for delivery or company business purposes.  You will be informed if there is coverage for you while engaging in a delivery or other company business.  Please show your agent/company this form.

 

By filling out this form, and providing an electronic signature, I hereby provide my authorization for this company or their insurance company representatives to procure such information and reports, as well as additional reports about me from time to time as deemed appropriate, to evaluate my insurability or for other permissible purposes.

Delivery Driver Authorization

Koele Insurance & Real Estate
1110 Main St.Hull, IA51239US
Phone: 7124391122 Website: www.mypizzainsurance.com