05_MotorVehicleDriverCertification

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. Type of Vehicle DateOffenseLocation Operated
Date #1

MonthDayYear
Date
Offense #1
Location #1
Type of Vehicle Operated #1
Date #2

MonthDayYear
Date
Offense #2
Location #2
Type of Vehicle Operated #1
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.
Drivers Signature

Clear
Date of Certification

MonthDayYear
Date
BRAVO MOTOR CARRIERS INC, 9009 North East Loop Ste 200 Houston, TX 77029

(Motor Carrier's Name and Motor Carrier's Address)
Reviewed by Signature

Clear
U.S. DEPARTMENT OF TRANSPORTATION MOTOR CARRIER SAFETY PROGRAM ANNUAL REVIEW OF DRIVING RECORD
Name Last
First
MI
SSN
This day I reviewed the driving record of the above-named driver in accordance with 391.25 of the Federal Motor Carrier Safety Regulations. I considered any evidence that the driver has violated applicable provisions of the Federal Motor Carrier Safety Regulations and the Hazardous Materials Regulations. I considered the driver's accident record and any evidence that he/she has violated laws governing the operation of motor vehicles, and gave great weight to violations, such as speeding, reckless driving and operation while under the influence of alcohol or drugs, that indicate that the driver has exhibited a disregard for the safety of the public. Having done the above, I find that.

the driver meets the minimum requirements for safe driving, orthe driver is disqualified to drive a motor vehicle pursuant to 391.15
Date of Review

MonthDayYear
Date
Reviewed by Signature and Title

Clear
Should be Empty:

MOTOR VEHICLE DRIVER'S CERTIFICATION OF VIOLATIONS