Form Da 2055 PDF Details

Every year, or whenever there's a change in their driving credentials, contractors in Louisiana must complete the Contractor Driver Authorization Form, also known as the DA form. This requirement is essential for any contractor who drives a state-owned, rented, or leased vehicle as part of their duties. The form collects basic information such as the agency name, the driver's license number, the driver's name, and the state where the license was issued. It also includes a section for the agency head or their designee to authorize the contractor's driving privileges, affirming that they have reviewed the driver's official record and training course dates to ensure compliance with the Office of Risk Management (ORM) Loss Prevention requirements. Contractors, on their part, promise to notify the department head of any changes to their driving license details and acknowledge the prohibition against operating the vehicle under the influence. The form, which needs to be signed by both the contractor and the agency head or designated individual, plays a crucial role in maintaining safety and compliance within state business operations, embodying a systematic approach to risk management and accountability.

QuestionAnswer
Form NameForm Da 2055
Form Length2 pages
Fillable?No
Fillable fields0
Avg. time to fill out30 sec
Other namesISSUANCE, ORM, authorization to release vehicle louisiana, vehicle release form dmv

Form Preview Example

STATE OF LOUISIANA

CONTRACTOR DRIVER AUTHORIZATION FORM

TO BE COMPLETED ANNUALLY, UPON CHANGE OF STATE OF ISSUANCE, CLASS OF LICENSE, AND/OR DRIVING

RESTRICTION CHANGE

Agency: ____________________________

Drivers License Number: _______________

Driver Name: _________________________

State of Issuance: _____________________

AGENCY HEAD OR DESIGNEE AUTHORIZATION

By executing this document, I have reviewed the Official Driving Record and Driver Training Course dates and have confirmed the information to be current and in accordance with the ORM Loss Prevention requirements.

My signature authorizes the aforementioned contractor to drive the following on state business as required (check all that apply):

_______

STATE OWNED VEHICLE

 

_______

STATE-RENTED VEHICLE

 

_______

STATE-LEASED VEHICLE

 

______________________________

_________________________

 

DEPARTMENT HEAD

DATE OF AUTHORIZATION

 

(or designated individual)

 

CONTRACTOR ACKNOWLEDGEMENT/AUTHORIZATION

I understand that the use of a state-owned/rented/leased vehicle on state business requires prior written authorization from the Department Head or his/her designee.

Further, by signing this document, I agree to notify the Department Head in writing should any of the following change on my license: Drivers License No., State of Issuance, Class of License, or Driving Restrictions.

I authorize the above agency to obtain my Official Driving Record (ODR) as necessary to comply with the State’s Loss Prevention Program.

I affirmatively acknowledge and understand that operating a state-owned, state-rented or state-leased vehicle while intoxicated as set forth in R.S. 14:98 and 14:98.1 is strictly prohibited, unauthorized, and expressly violates both the terms and conditions of my use of said vehicle, and the agency’s instructions.

My signature on this document shall remain in effect until revoked by the agency or until a new form is executed.

_______________________________

__________________________

CONTRACTOR SIGNATURE

DATE

07/01/2012

DA 2055

ANNUAL SUPPLEMENTAL SIGNATURE PAGE

CONTRACTOR NAME:_____________________________

DRIVERS LICENSE NUMBER:_______________________

DEPARTMENT/AGENCY:___________________________

AGENCY HEAD OR DESIGNEE STATEMENT

By executing this document, I have reviewed the following and have confirmed the information to be current and in accordance with the ORM Loss Prevention requirement:

Official Driving Record

Further, my signature allows the aforementioned contractor to drive a state-owned, rented, or leased vehicle on state business.

______________________________

_________________________

Agency Head

Date of Authorization

(or designated individual)

 

______________________________

_________________________

Agency Head

Date of Authorization

(or designated individual)

 

______________________________

_________________________

Agency Head

Date of Authorization

(or designated individual)

 

______________________________

_________________________

Agency Head

Date of Authorization

(or designated individual)

 

______________________________

_________________________

Agency Head

Date of Authorization

(or designated individual)

 

______________________________

_________________________

Agency Head

Date of Authorization

(or designated individual)

 

______________________________

_________________________

Agency Head

Date of Authorization

(or designated individual)

 

(DUPLICATE SUPPLEMENTAL SIGNATURE PAGE AS NEEDED)

07/01/2012

DA 2055 Supp.-1