Fillable PSP Motor Carrier Enrollment (U.S. Department of Transportation)

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PSP Motor Carrier Enrollment (U.S. Department of Transportation)

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Initial: 1
Telephone: 877-642-9499
www.psp.fmcsa.dot.gov
Monthly Account Holder Agreement – Pre-Employment Screening Program (PSP)
A motor carrier as defined in Terms and Conditions Section 1(a) (‘Monthly Account Holder’) must register with
NIC Federal, LLC (NICF) in order to obtain employer access to Pre-Employment Screening Program (‘PSP’)
records. The information gathered here will be used (a) to register your organization, and the specified users
within it, for this account, (b) to run verification checks regarding the identity of your company and the
individuals you identify as users on your behalf, and (c) for billing and account management purposes.
Entities wishing to access PSP records that do not meet the definition of motor carrier should contact
PSPenrollment@egov.com to determine if they qualify for PSP access as an industry service provider.
To register, read all the information in this Agreement carefully and initial at the bottom of each page to signify
your acceptance of all the terms and conditions contained herein. Next, complete the information required for
this Agreement along with any other required forms detailed in Section Two below, specify a user to be the
signer/administrator, and submit the entire application.
The entire, completed application may be scanned and returned via email to PSPenrollment@egov.com, faxed
to 703-841-6370 or returned via courier to:
NIC Federal, LLC
4601 N Fairfax Drive, Suite 1010
Arlington, VA 22203
Please allow up to ten business days for your enrollment documents to be processed. Then, an email with
activation instructions will be sent to the primary account contact at the email address identified in Section Two.
Once activation is complete, each user will receive an email containing their user name and a temporary
password. Each user will be required to change the temporary password when the user first visits the PSP web
site.
The PSP Monthly Account Holder annual subscription fee for motor carriers with 100 or more power units, as
verified by the Federal Motor Carrier Safety Administration (FMCSA), is $100.00 and for motor carriers with
99 or fewer power units it is $25.00. Neither the annual subscription fee, nor any other charge, will be applied to
your account until such time as the company’s account has been activated and you have received your access
credentials.
You may pay by direct debit from a checking account or credit card by filling out the information in Section
Two. (Account holders may also pay by paper check. Please call 877-642-9499 for more information.)
Thereafter, the annual renewal is $100.00/$25.00 respectively and is billed to your monthly account
automatically on the anniversary of your account activation month.
If you have any questions regarding information contained within this Agreement, please contact NIC Federal,
LLC at 877-642-9499.
Initial: 2
Section 1
1) Complete this Monthly Account Holder Agreement. Don’t forget to list your users in Section 2 and initial the
bottom of each page.
2) NICF will send account activation instructions to the primary account contact email address you have listed
who is designated as the signer/administrator of the account. You may change the administrator after sign up
is completed. BY SUBMITTING THIS AGREEMENT, YOU INDICATE THE ASSENT OF THE
ORGANIZATION IDENTIFIED IN SECTION TWO (the "Monthly Account Holder") TO ALL OF THE
TERMS AND CONDITIONS OF THIS AGREEMENT. IF THE PROSPECTIVE MONTHLY ACCOUNT
HOLDER DOES NOT AGREE TO ALL OF THE TERMS AND CONDITIONS OF THIS AGREEMENT,
DO NOT SUBMIT IT.
3) Upon receipt of the completed Agreement and accurate completion of the verification process, NICF will send
usernames and passwords via email for the other users listed in the Agreement, to the email address you have listed
for each of them.
CUSTOMER SIGNATURE – Your submission of this application
constitutes your signature to the Agreement on behalf of the Monthly
Account Holder, and your express agreement with the items listed on
the right hand side.
Signature: _____________________________________________
Printed Name: __________________________________________
Title: _________________________________________________
Date: __________________________________________________
By my submitting this application on
behalf of the Monthly Account Holder
(which constitutes the delivery of my
signature on it) I agree that:
1. I have read and, on behalf of the
Monthly Account Holder, agree to
the terms and conditions of NICF’s
Monthly Account Holder Agreement
as presented.
2. I represent that I have authority to
bind the Monthly Account Holder,
on whose behalf I am signing, to this
Agreement.
3. I have read and understand, and the
Monthly Account Holder agrees to
be bound by and comply with, the
Limitations on Use of Information
and the Fair Credit Reporting Act
requirements listed under Section 3,
#4 below.
4. The Monthly Account Holder will
obtain and preserve the written
disclosure and authorization of each
Applicant prior to accessing the
Applicant’s information on the PSP
service, using the exact, stand-alone
FMCSA-required document provided
as part of this Agreement.
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Physical Organization Name: ____________________________________(“Monthly Account Holder”)
Address Primary Contact: ________________________________ Title: ________________________
Address 1: ___________________________________________________________________
Address 2: ___________________________________________________________________
City/State/Zip: _________________________________________________________________
Telephone: ___________________________Ext. ______ Fax: ________________________
Email Address for Primary Contact Within Your Organization: __________________________
DOT Number: Number of Power Units in Fleet:
Check all that apply: How did you hear about PSP?
Interstate Carrier ☐ Motor Carrier ☐ Email/ Mail ☐ Trade Association☐
Intrastate Carrier ☐ Passenger Carrier ☐ FMCSA ☐ Print Publication ☐
Other
Billing
Address
Billing
Organization Name: ________________________________ Attention: ___________________
Email Address for Billing (to receive monthly invoice notification): ______________________
Address 1: ___________________________________________________________________
Address 2: ___________________________________________________________________
City/State/Zip: _________________________________________________________________
Telephone: ___________________________Ext. ______ Fax: _______________________
All usage fees incurred will be totaled and billed monthly. You may view your account
information online at any time. Methods of payment include electronic check (ACH debit),
credit card (incurs a surcharge), or paper check. You may also call 877-642-9499 for more
information.
Please check one payment method below:
☐ Banking information
☐ Credit /Debit Information
☐ Paper check
NOTE: NICF does not currently accept ACH payments specifically funded by a foreign source (bank or
company), known as an International ACH Transaction (“IAT”).
As defined by The Electronic Payments Association, formerly the National Automated Clearing House
Association, an IAT means a credit or debit entry that is part of a payment transaction involving a financial
Section 2: Monthly Account Holder Information
Initial: 4
agency office that is not located in the territorial jurisdiction of the United States. For purposes of this
definition a “financial agency” means an entity that is authorized by applicable law to accept deposits or is in
the business of issuing money orders or transferring funds. An office of a financial agency is involved in the
payment transaction if it:
(1) Holds an account that is credited or debited as part of the payment transaction;
(2) Receives payment directly from a person or makes payment directly to a person as part of the payment
transaction; or
(3) Serves as an intermediary in the settlement of any part of the payment transaction.
If your company’s bank account is not located at an institution’s office that is within the territorial jurisdiction
of the United States of America, or if your financial institution is not based within the territorial jurisdiction of
the United States of America, please contact NICF at 877-642-9499 to discuss payment options.
IDENTIFICATION OF SERVICES DESIRED:
Department of Transportation – Pre-Employment Screening Program (‘PSP’) report consisting of (a)
commercial motor vehicle FMCSA-reportable crash reports, if any; (b) inspection reports without
driver-related safety violations, if any; (c) inspection reports with serious driver-related safety violations,
if any; or (d) a “null” report, indicating no record for the driver information searched. NICF is the
exclusive agent for online access to Federal Motor Carrier Safety Administration Pre-Employment Screening
Program records. Monthly Account Holders pay the annual subscription fee to maintain the monthly billing
option, and a $10.00 fee for each search run, whether or not crash or inspection information is available for the
driver.
User name(s) to be assigned to account: (10 users per account. If you require more users, you may purchase
additional accounts, and receive 10 additional users per account. All accounts must have the same
signer/administrator.)
User Email Address (must be unique)
1.
2.
3.
4.
5.
6.
7.
8.
9.
10
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The Monthly Account Holder and NIC Federal, LLC (‘NICF’) wish to contract for the provision of
electronic services from NICF to Monthly Account Holder as per the Terms and Conditions below. NICF
provides online access, from internet-enabled devices, to government databases and information with
related services, specifically including the PSP system. Monthly Account Holder wishes to use these
services made available by NICF.
Terms and Conditions
1. Definitions
(a) ‘Motor carrier’ means
Companies that operate as for-hire motor carriers or as private motor carriers, including
carriers involved in intrastate operations. This includes motor carriers’ agents, officers
and representatives as well as employees responsible for the hiring, supervising, training,
assigning or dispatching of drivers and employees concerned with the installation,
inspection, and maintenance of motor vehicle equipment and/or accessories.
For the purposes of this agreement, motor carrier is referred to as ‘monthly account holder.’
(b) ‘Applicant’ means any individual, other than an employer, who is seeking employment with an
employer and who in the course of his or her employment directly affects commercial vehicle
motor safety. Such term includes a driver of a commercial vehicle including an independent
contractor while in the course of operating a commercial motor vehicle.
(c) ‘Employee’ means any individual, other than an employer, who is employed by an employer and
who in the course of his or her employment directly affects commercial vehicle motor safety. Such
term includes a driver of a commercial vehicle including an independent contractor while in the
course of operating a commercial motor vehicle.
2. What Constitutes The Agreement.
(a) This Agreement sets forth the terms and conditions under which NICF will provide services to
Monthly Account Holder.
(b) Monthly Account Holder, through its authorized representative, acknowledges that its authorized
representative has read this Agreement and agrees on behalf of the entity that it is the complete
and exclusive statement of the agreement between the parties, superseding all other
communications, oral or written. This Agreement consists of this multi-page form, additional
forms required by NICF to obtain its services, certain Fair Credit Reporting Act materials, and
other notices from NICF that say “This Is A Part Of The Agreement Between The Parties” which
may be provided from time to time to Monthly Account Holder unilaterally by NICF. This
Agreement may be modified only by written amendment signed by the parties, except as
otherwise provided for in this paragraph. In the event Monthly Account Holder issues a
purchase order or other instrument covering the services herein specified, it is understood and
agreed that it is for Monthly Account Holder’s internal purposes only and shall in no way modify,
add to, or delete any of the terms and conditions in this Agreement.
Section 3: Terms and Conditions
Initial: 6
(c) MONTHLY ACCOUNT HOLDER IS RESPONSIBLE AND LIABLE FOR EACH AND
EVERY ACTION TAKEN ON THE PSP SERVICE UNDER ANY USERNAME AND
PASSWORD ASSOCIATED WITH IT, WHETHER OR NOT SUCH USE WAS AUTHORIZED
BY MONTHLY ACCOUNT HOLDER. Each authorized holder of a username and password
associated with Monthly Account Holder is also responsible for any actions taken on the PSP
service by anyone using that username and password, whether or not authorized by the authorized
user. Monthly Account Holder’s account administrator may deactivate any username and
password by using the account administration function, or by calling NICF at 877-642-9499.
3. Reservation Of Right To Cancel or Withdraw Service. NICF reserves the right to withdraw any service
without consulting Monthly Account Holder prior to withdrawing such service and shall have no liability
whatsoever to Monthly Account Holder in connection with deletion or elimination of any such service.
4. Compliance With Laws and Limitation On Use Of Information. Monthly Account Holder agrees and
understands that:
(a) Limitation On Use Of Information. Pursuant to federal statute, the information obtained from the
PSP database may only be used for pre-employment screening of Applicants, and only by the
Monthly Account Holder. Monthly Account Holder further agrees not to share an Applicant’s
safety performance information in any way with anyone other than those company employees
involved in the hiring process and the Applicant. This includes company employees not involved
in the hiring process, and any other company or individual outside your company other than the
Applicant.
(b) Compliance With Laws Generally. Under no circumstances may Monthly Account Holder, or any
other party acting by or through Monthly Account Holder or using Monthly Account Holder’s
ID/account numbers, use data received from or through NICF, including PSP information, in any
way except in full and complete compliance with all applicable laws. Monthly Account Holder
further agrees to comply with all applicable federal and state laws with respect to each commercial
driver Applicant and the information available in the PSP database.
(c) Fair Credit Reporting Act. (FCRA) Monthly Account Holder agrees that it will:
1). PROVIDE TO NICF, prior to initially accessing any records from PSP, and as
required periodically by NICF thereafter, a form certifying certain informational
statements and promises under the FCRA and, if applicable, the Driver Privacy
Protection Act (“DPPA”), regarding use of the PSP information and certain notices to be
given to Applicants by the Monthly Account Holder. The disclosure and authorization
form is included as a part of this Agreement (“Monthly Account Holder FCRA Employer
Certification”).
2). OBTAIN the Applicant’s signature to the disclosure and authorization form, in
advance of making a request for their information in the PSP system, using the FMCSA-
required disclosure and authorization form included as part of this Agreement
(“Important Disclosure Regarding Background Reports from the PSP Online Service”). The
disclosure and authorization form must be used in whole, exactly as provided, by Monthly
Account Holder to obtain the signed authorization of each Applicant for which it accesses
the PSP database. NOTE: The disclosure and authorization form must be presented as
one document. The disclosure and authorization language may not be combined with any
other language or document.
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3). INFORM each Applicant in writing if information about the Applicant from the PSP
database has been used in the hiring screening process.
4). PROVIDE each Applicant a complete and full copy of the information on the
Applicant that was obtained from the PSP database if required under the FCRA.
5). INFORM each Applicant that he or she has a right to dispute the completeness or
accuracy of any information obtained from the PSP database by visiting
https://dataqs.fmcsa.dot.gov. ONLY FMCSA-DOT, AND NOT NICF, IS AUTHORIZED
TO RECEIVE DISPUTES CONCERNING THE COMPLETENESS OR ACCURACY
OF PSP DATABASE INFORMATION, CONDUCT AN INVESTIGATION WITH
RESPECT TO THE DISPUTED INFORMATION, REVIEW ALL RELEVANT
INFORMATION, AND TAKE ANY OTHER ACTION WITH RESPECT TO THE
DISPUTE. NICF IS A CONDUIT BETWEEN FMCSA AND THE MONTHLY
ACCOUNT HOLDER, AND PERFORMS ONLY MECHANICAL ACTS IN
CONNECTION WITH TRANSMITTING THE INFORMATION CONTAINED IN THE
PSP DATABASE. NICF HAS NO AUTHORITY, AND NO RESPONSIBILITY, TO
REVIEW ANY DISPUTE-RELATED INFORMATION OR CONDUCT AN
INVESTIGATION WITH RESPECT TO THE DISPUTED INFORMATION. NICF
HAS NO AUTHORITY, AND NO RESPONSIBILITY, TO DETERMINE WHETHER
ANY ITEM OF INFORMATION DISPUTED BY A CONSUMER IS ACCURATE OR
COMPLETE OR CANNOT BE VERIFIED. NICF HAS NO AUTHORITY, AND NO
RESPONSBILITY, TO MODIFY, DELETE, OR PERMANENTLY BLOCK THE
REPORTING OF, ANY ITEM OF INFORMATION CONTAINED IN THE PSP
DATABASE. NICF HAS NO AUTHORITY, AND NO RESPONSIBILITY, TO
REPORT THE RESULTS OF ANY DISPUTE INVESTIGATION TO ANY
CONSUMER REPORTING AGENCY THAT RECEIVED THE INFORMATION.
NICF ALSO DOES NOT CONTROL THE TIME FRAME WITHIN WHICH FMCSA
CONDUCTS ANY DISPUTE INVESTIGATION. ANY DISPUTE CONCERNING THE
COMPLETENESS OR ACCURACY OF PSP DATABASE INFORMATION SHOULD
BE RAISED DIRECTLY WITH FMCSA BY CONTACTING THE OFFICE OF
FINANCIAL MANAGEMENT, DEPARTMENT OF TRANSPORTATION,
WASHINGTON, DC 20590 (202) 366-1306.
6). INFORM each Applicant that he or she may obtain more information about the
FCRA, including information on rights under his or her state’s law which may be greater
than under the FCRA, at www.consumerfinance.gov/learnmore, and that the Applicant
may report violations to the Office of Financial Management, Department of
Transportation, Washington, DC 20590 (202) 366-1306.
(d) Governing Laws. This Agreement shall be governed by and construed according to the laws of
the State of Kansas as such laws are applied to contracts made and to be performed entirely in
Kansas without regard to conflict of law principles. All actions not subject to arbitration hereunder
shall be brought in whole or in part in the District Court of Johnson County, Kansas or the U.S.
District Court of Kansas, and each party submits and consents to the jurisdiction of those courts
and waives any and all objections to jurisdiction or venue that it may have thereto.
5. Conditions of Use.
(a) Disclosure to and Authorization of Applicant. Monthly Account Holder will provide the
proscribed disclosure and authorization form to each Applicant and will obtain Applicant’s
signature on such form, in advance of and prior to accessing the PSP database for the
Initial: 8
Applicant’s information, and it will retain and preserve such executed disclosure and
authorization form in its files and records for purposes of audit. Monthly Account Holder
agrees it will use the FMCSA-required disclosure and authorization language included as
part of this Agreement (“Important Disclosure Regarding Background Reports from the PSP
Online Service”) in whole, exactly as provided, to obtain Applicant authorization.
(b) Hours of Service: Service will generally be provided on a non-guaranteed basis seven (7) days per
week, twenty-four (24) hours per day, excluding scheduled maintenance as designated from time
to time by NICF at its sole discretion, and necessary unscheduled maintenance or Force Majeure
events.
(c) User IDs: NICF will issue to the Monthly Account Holder a maximum of ten (10) user IDs per
annual fee. Monthly Account Holder is responsible for preserving the secrecy of its user IDs and
for ensuring that access to services and use of any of its user IDs are controlled by it and that, in
those instances where a purchase order provides time and/or dollar and/or database limitations, use
of the system does not exceed those limitations. Monthly Account Holder is liable for any and
all charges for services to any of its user IDs whether or not authorized by Monthly Account
Holder. Monthly Account Holder’s account administrator may deactivate any username and
password for any user ID associated with its account number by using the account administration
function or by calling NICF at 877-642-9499.
(d) Copyright and Ownership of Information: Monthly Account Holder agrees to comply with any
copyright notices and other limitations on use applicable to services, databases, or other
information provided through NICF. All commercial driver information furnished by PSP is the
property of the Federal Motor Carrier Safety Administration, Department of Transportation, of the
United States of America. All software applications, code, documentation, forms, trademarks,
service marks, copyrights, and other materials required to use PSP are the property of NICF and
its affiliates and licensors unless otherwise expressly identified.
(e) Data Retention. Monthly Account Holder agrees to maintain the safety performance
information and all other PSP or FCRA related employment transaction records, such as the
disclosure and authorization form, on any Applicant for three years from the date a hiring
decision was made.
(f) Notice. The PSP system is maintained and operated under the jurisdiction of the Secretary
of the U.S. Department of Transportation, a part of the executive branch of the government
of the United States of America. The PSP system contains information that is protected by
federal law, including but not limited to the Privacy Act of 1974. A federal statute, 18 U.S.C.
section 1001, imposes sanctions on persons who knowingly or willfully make a materially
false or fictitious statement, or any other type of misrepresentation, in connection with a
matter handled by the executive branch. Violations of 18 U.S.C. section 1001 may result in
sanctions against the person(s) committing the violation, which may include fines or
imprisonment. Accessing the PSP system for any purpose other than pre-employment
screening, and without having first obtained the consent of the Applicant, may well be such
a violation.
6. Payment.
(a) Invoices. Invoices for all services rendered will be prepared by NICF and provided electronically
by NICF. Invoices will be paid by automatic direct debit or direct charge to a credit card
approximately five calendar days after the invoice is made available to Monthly Account Holder.
Alternate payment arrangements may be considered. Please call 877-642-9499. Rates will be in
Initial: 9
accordance with the current NICF rate schedule, which may include a surcharge if payments are
made by credit card.
(b) Taxes. In addition to the rates contained herein, Monthly Account Holder shall pay NICF for sales,
use, and excise taxes incurred by NICF, if any, in providing services to Monthly Account Holder.
(c) Delinquency Charges. Past due invoices will be subject to a delinquency charge of 1.5% of the
amount in arrears per month, or the legal limit, whichever is less. Monthly Account Holder agrees
to pay all costs of collection of delinquent accounts, including reasonable attorney’s fees, as
permitted by law.
(d) Default: An account is in default if it is past due or if Monthly Account Holder declares bankruptcy
or is insolvent. In the event of default, NICF may, at its sole option, block the Monthly Account
Holder from use of the account either temporarily, until the past due amount is paid, or
permanently, regardless of payment. Not exercising this option at any particular time does not
constitute a waiver nor prevent NICF from exercising this option at any other time. NICF may, at
its discretion, require that additional steps be taken to secure the likelihood of payment by Monthly
Account Holder.
7. Limitation of Liability.
(a) The remedies set forth in this Agreement are exclusive and in no event shall NICF, its affiliates,
directors, officers, agents, or employees be liable for special, indirect, incidental, or consequential
damages, including, but not limited to, lost income or lost revenues, whether such damages arise
out of breach of contract, negligence, strict liability, or any other theory of liability. Such damages
shall in any event be limited to the charges paid for the previous month by Monthly Account
Holder for the services in connection with which a claim of liability is asserted or imposed.
Monthly Account Holder specifically understands and recognizes that the system by which these
services are offered to it is experimental and may experience problems of various kinds resulting
in an inability to provide services.
(b) Monthly Account Holder agrees that NICF will not be liable for any claim or demand of any nature
or kind whether asserted against NICF or against Monthly Account Holder by any third party,
arising out of the services or materials provided or their use. There are no third party beneficiaries
of this Agreement except as expressly set forth herein. Monthly Account Holder agrees to
indemnify and hold NICF harmless from claims of third parties arising out of the Monthly Account
Holder’s (a) use of the services, (b) materials provided pursuant to this Agreement, or (c) breach
of applicable law.
(c) NICF shall not be liable for or deemed to be in default for any delays or failure in performance or
interruption of service resulting directly or indirectly from any cause or circumstances beyond its
reasonable control, including problems with or delays caused by its database or other providers.
(d) No action or suit, regardless of form, other than an action for payments due NICF, arising out of
the transactions pursuant to this Agreement may be brought by either party more than one year
after the cause of the action accrues.
(e) NICF, federal, state, county and local government agencies and universities, professional
associations and all other parties who may from time to time provide information for access
through the PSP service or NICF’s other online services, if any, shall at no time be liable for any
errors in or omissions from information available in the PSP database.
Initial: 10
(f) NICF does not alter, supplement, or modify the information contained in the PSP database owned
by the Federal Motor Carrier Safety Administration, Department of Transportation (FMCSA-
DOT), and therefore is not a data provider but acts as an authorized “gatekeeper” and “conduit” to
the FMCSA-DOT information. The PSP database refers to the information maintained by the
FMCSA-DOT. The PSP (sometimes with the word service or system at the end) refers to the
system operated by NICF through which the database information is accessed electronically.
8. Warranty. NICF MAKES NO WARRANTIES EXPRESS OR IMPLIED, INCLUDING BUT NOT
LIMITED TO ANY IMPLIED WARRANTIES OF AVAILABILITY, ACCURACY,
COMPLETENESS, FITNESS FOR A PARTICULAR PURPOSE OR OF MERCHANTABILITY.
Monthly Account Holder acknowledges and agrees that the services provided by NICF are merely access
and reporting services that are dependent upon the accuracy, completeness and integrity of government
maintained databases and information. NICF cannot and does not guarantee that the services will be
uninterrupted or error free, or that the information provided will be accurate, complete or up to date.
Accordingly, Monthly Account Holder agrees that it uses the services at its own risk.
9. Rate Changes. Rates are as set forth in Section 2 of this Agreement and are established by NICF at its
sole discretion. Rates may change at any time.
10. Notice. All notices, consents and other communications to NICF under this Agreement shall be made in
writing, shall be deemed given (a) when received, if delivered personally by hand (with written
confirmation of receipt), (b) on the same business day when sent by facsimile during regular business
hours at the place of delivery or on the next business day after transmission if sent by facsimile after
regular business hours at the place of delivery, in each case with written confirmation of transmission,
(c) one (1) business day after the day sent by overnight courier (with written confirmation of receipt), in
each case at the following address and facsimile number (or to such other address or facsimile number as
NICF may have specified by notice given to Monthly Account Holder pursuant to this provision):
President (LEGAL NOTICE)
NIC Federal, LLC
4601 N Fairfax Drive, Suite 1010
Arlington, VA 22203
With a copy to:
General Counsel, NIC Inc. (LEGAL NOTICE)
25501 West Valley Parkway
Suite 300
Olathe, Kansas 66061
All notices, consents and other communications to Monthly Account Holder under this Agreement may
be given in the same manner as notices to NICF as set forth above. Such notices shall be deemed given
at the times specified above for notices to NICF, provided that such notices are sent to the addresses set
forth in Section 2 under the heading of "Billing Address" (or to such other address, facsimile number or
email as Monthly Account Holder may have specified by notice given to NICF pursuant to this
provision). Notice may also be sent to Monthly Account Holder via email to the email address specified
in Section 2 above under the heading of "Physical Address", in which case such notice will be deemed
given on the same business day when sent if sent during regular business hours at the place of delivery
or on the next business day after transmission if sent by email after regular business hours at the place of
delivery.
Initial: 11
11. Trade name/Trademark/Copyright. Monthly Account Holder agrees that it will not use the trademark
“NICF” or “NIC Federal, LLC” or any of NICF’s service marks, including “PSP,” identified in any fashion
unless specifically authorized to do so in writing by NICF. Monthly Account Holder agrees not to tamper
with, alter, or change in any fashion any databases or software code, applications or programs made
available to Monthly Account Holder by NICF.
12. General.
(a) Waiver: The waiver, modification, or failure to insist by NICF on any of these terms or conditions,
shall not void, waive, or modify any of the other terms or conditions nor be construed as a waiver
or relinquishment of NICF’s right to performance of any such term or terms.
(b) Severability: If any provision or part of the Agreement shall be declared illegal, void, or
unenforceable, the remaining provisions shall continue in full force and effect.
(c) Assignment: This Agreement is not assignable or transferable by Monthly Account Holder and
any attempted assignment or transfer shall be null and void and of no force or effect. NICF may
assign this Agreement and/or the payments due to NICF without notice to or requirement for
Monthly Account Holder’s permission or approval.
(d) Termination: Monthly Account Holder may terminate the PSP account at any time by providing
written notice to NICF via email, fax or courier. Monthly Account Holder will be responsible for
payment of any outstanding charges on the PSP account. NICF will retain the annual subscription
payment.
(e) Audit Of Use: Monthly Account Holder agrees to keep accurate records regarding its use of
the PSP service, including preserving Applicant advance execution of the disclosure and
authorization form, regarding the use to which the database information has been put.
Monthly Account Holder’s retention of the Applicant’s signed and completed FMCSA-required
disclosure and authorization form serves as evidence that the Applicant approved your access
to their record in the PSP system. Failure to maintain the Applicant’s signed and completed
disclosure and authorization form may result in a conclusion that your company did not provide
the mandated disclosure or obtain the Applicant’s signed authorization prior to accessing the
PSP system, and may result in administrative, civil, or criminal sanctions against your company
and any persons involved in the PSP access and Applicant disclosure and authorization
processes. Monthly Account Holder agrees and consents that its use of such records is subject
to audit whether by email, on-site, or otherwise, by NICF, FMCSA-DOT, or the designated
representative(s) of either of them, at any reasonable time. Monthly Account Holder agrees
that it will cooperate with any such audit and will make its records available to the auditors
as required; further it understands and agrees that any violations of the conditions of use or
requirements for access to the PSP database information may result in sanctions against
Monthly Account Holder, or referral for civil or criminal prosecution. Such action may range
from Monthly Account Holder’s suspension, for a fixed period of time, from using a service, to
termination of the privilege of receiving access to a service, and may include liability of Monthly
Account Holder to NICF and/or the U.S. DOT, or referral for civil or criminal prosecution.
General Audit Procedure: In the event your company is selected for audit, you will receive a notice
of audit and directions for audit completion via email to the Monthly Account Holder primary
account contact and/or account users, and/or notification via mail or courier. You will be required
to furnish copies of all requested FMCSA-required Applicant signed disclosure and authorization
form(s) within a specified number of days which will be set forth in the notice of audit. Failure to
respond with copies of the requested disclosure and authorization forms meeting the
Initial: 12
standards established in this Agreement by the stated deadline may result in the conclusion
that your company did not disclose to the Applicant and/or receive the Applicants’ signed
authorization in advance of accessing their record in the PSP system, and may result in
sanctions against the company and the persons involved. See section 4 of this Agreement.
You may also be contacted by telephone, email, or site visit, and be required to answer
questions regarding your company’s access and use of PSP information.
(f) Arbitration: The parties hereto agree that any dispute, controversy or claim arising out of or
relating to the interpretation of this Agreement or the performance or breach thereof shall be
submitted to and settled by binding arbitration in Johnson County, Kansas, in accordance with the
Commercial Arbitration Rules of the American Arbitration Association then in effect, with one
arbitrator selected by the AAA, which arbitrator shall have experience in the trucking industry and
with employment matters in general. The arbitration award determined by the arbitrator shall be
final and judgment upon the award of the arbitrator may be entered by any court having competent
jurisdiction. The only circumstances in which disputes between the parties will not be subject to
the requirement to arbitrate is where a party makes a good faith determination that a breach of the
terms of the Agreement is such that damage resulting from the breach will be so immediate,
irreparable, severe, or otherwise incapable of adequate redress that a temporary restraining order,
preliminary injunction, or other immediate injunctive relief is the only adequate remedy for such
breach.
End.
Initial: 13
Re: Fair Credit Reporting Act
Consumer Report Certification Requirements
To Monthly Account Holder:
Pursuant to the Federal Fair Credit Reporting Act (the “FCRA”) the undersigned, on behalf of the commercial
driver employer I represent (the “Employer”), hereby certifies the following regarding each of the Pre-
Employment Screening Program records (the “Records”) that Employer is requesting:
1. The requested Records will be used for pre-employment screening purposes only;
2. Prior to this request, Employer provided each Applicant a clear and conspicuous written disclosure that
the Employer is permitted to obtain the Records for employment purposes;
3. Each Applicant has provided the Employer with written authorization permitting Employer to obtain a
copy of the Applicant’s Records with PSP;
4. If an Applicant applies in person: Prior to taking any adverse action as to the Applicant's application for
employment, if such action would be based upon information which came, or partly came, from Records
received from PSP, Employer will provide the Applicant with: (1) a copy of the Records; and (2) a written
description of his/her rights under the FCRA prepared by the Consumer Financial Protection Bureau.
5. If an Applicant applies by mail, telephone, computer, or other similar means: If Employer elects to take
an adverse action as to the Applicant's application for employment (for instance, deciding not to hire)
based upon information which came, or partly came, from Records received from PSP, Employer may,
instead of the notice required in paragraph 4, move forward with taking such adverse action if Employer,
within three (3) business days of taking such action, notifies the Applicant:
a. That the adverse action has been taken based upon information which came, or partly came, from
Records received from PSP;
b. Of the name, address, and telephone number of the U.S. Federal Motor Carrier Safety Administration,
of the Department of Transportation, (“FMCSA-DOT”) (which maintains the PSP database), which
are Federal Motor Carrier Safety Administration, 1200 New Jersey Avenue SE, Washington, DC
20590, (800) 832-5660, TTY (800) 877-8339.
c. That FMCSA-DOT did not, and NICF (which operates the PSP service) did not, make the decision to
take the adverse action and is unable to provide to the Applicant the specific reasons why the adverse
action was taken;
d. That Applicant may, if proper identification is provided, request from the Employer a free copy of
Applicant's Records with PSP; and
e. That Applicant has a right to dispute incomplete or inaccurate information in the Records by visiting
https://dataqs.fmcsa.dot.gov and that ONLY FMCSA-DOT, and NOT NICF, is authorized to receive
disputes concerning the accuracy or completeness of PSP database information, conduct an investigation
with respect to the disputed information, review all relevant information, and take any other action with
respect to the dispute, including modifying, deleting, or permanently blocking the reporting of any item
of information contained in the PSP database, and reporting the results of any dispute investigation to
any consumer reporting agency that received the information.
Initial: 14
If a request is made by the Applicant to the Employer for Applicant’s Records with PSP, and proper
identification is provided, Employer agrees to provide Applicant with a free copy of Applicant's Records
with PSP within three (3) business days of his or her request.
6. For all Applicants who apply in person, if after a reasonable time following the notice set forth in
paragraph 4, an adverse action is taken based upon information which came, or partly came, from Records
received from PSP, Employer will provide the affected Applicant the same information as that described
in 5a, 5b, 5c and 5e above and will also inform the Applicant that:
a. Applicant may, if proper identification is provided, request a free copy of Applicant's PSP Record
from FMCSA-DOT if such request is made within 60-days of receiving notice that the adverse
action has been taken; and
7. Any information contained in any Record that Employer obtains from PSP will not be used in violation
of any applicable Federal or State or local equal employment opportunity laws or regulations; and
8. To the extent any information in the Record from the PSP is “personal information” subject to the Driver
Privacy Protection Act, found at 18 U.S.C. sections 2721 and following, the Record will only be used for
commercial drivers’ license employer verification purposes as permitted by 18 U.S.C. section 2721(b)(9).
If you would like to view 18 U.S.C. section 2721, click here
http://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title18-section2721&num=0&edition=prelim
If you would like to read the wording of the federal FCRA rules cited in this statement or if you would like more
information about the Fair Credit Reporting Act and your obligations as a prospective employer under that Act,
click here www.consumerfinance.gov/learnmore
THE BELOW DISCLOSURE AND AUTHORIZATION LANGUAGE IS FOR MANDATORY USE BY ALL
ACCOUNT HOLDERS
IMPORTANT DISCLOSURE
REGARDING BACKGROUND REPORTS FROM THE PSP Online Service
In connection with your application for employment with ______________________________ (“Prospective Employer”), Prospective
Employer, its employees, agents or contractors may obtain one or more reports regarding your driving, and safety inspection history
from the Federal Motor Carrier Safety Administration (FMCSA).
When the application for employment is submitted in person, if the Prospective Employer uses any information it obtains from FMCSA
in a decision to not hire you or to make any other adverse employment decision regarding you, the Prospective Employer will provide
you with a copy of the report upon which its decision was based and a written summary of your rights under the Fair Credit Reporting
Act before taking any final adverse action. If any final adverse action is taken against you based upon your driving history or safety
report, the Prospective Employer will notify you that the action has been taken and that the action was based in part or in whole on this
report.
When the application for employment is submitted by mail, telephone, computer, or other similar means, if the Prospective Employer
uses any information it obtains from FMCSA in a decision to not hire you or to make any other adverse employment decision regarding
you, the Prospective Employer must provide you within three business days of taking adverse action oral, written or electronic
notification: that adverse action has been taken based in whole or in part on information obtained from FMCSA; the name, address, and
the toll free telephone number of FMCSA; that the FMCSA did not make the decision to take the adverse action and is unable to provide
you the specific reasons why the adverse action was taken; and that you may, upon providing proper identification, request a free copy
of the report and may dispute with the FMCSA the accuracy or completeness of any information or report. If you request a copy of a
driver record from the Prospective Employer who procured the report, then, within 3 business days of receiving your request, together
with proper identification, the Prospective Employer must send or provide to you a copy of your report and a summary of your rights
under the Fair Credit Reporting Act.
Neither the Prospective Employer nor the FMCSA contractor supplying the crash and safety information has the capability to correct
any safety data that appears to be incorrect. You may challenge the accuracy of the data by submitting a request to
https://dataqs.fmcsa.dot.gov. If you challenge crash or inspection information reported by a State, FMCSA cannot change or correct this
data. Your request will be forwarded by the DataQs system to the appropriate State for adjudication.
Any crash or inspection in which you were involved will display on your PSP report. Since the PSP report does not report, or assign, or
imply fault, it will include all Commercial Motor Vehicle (CMV) crashes where you were a driver or co-driver and where those crashes
were reported to FMCSA, regardless of fault. Similarly, all inspections, with or without violations, appear on the PSP report. State
citations associated with Federal Motor Carrier Safety Regulations (FMCSR) violations that have been adjudicated by a court of law
will also appear, and remain, on a PSP report.
The Prospective Employer cannot obtain background reports from FMCSA without your authorization.
AUTHORIZATION
If you agree that the Prospective Employer may obtain such background reports, please read the following and sign below:
I authorize _______________________ (“Prospective Employer”) to access the FMCSA Pre-Employment Screening Program (PSP)
system to seek information regarding my commercial driving safety record and information regarding my safety inspection history. I
understand that I am authorizing the release of safety performance information including crash data from the previous five (5) years
and inspection history from the previous three (3) years. I understand and acknowledge that this release of information may assist the
Prospective Employer to make a determination regarding my suitability as an employee.
I further understand that neither the Prospective Employer nor the FMCSA contractor supplying the crash and safety information has
the capability to correct any safety data that appears to be incorrect. I understand I may challenge the accuracy of the data by
submitting a request to https://dataqs.fmcsa.dot.gov. If I challenge crash or inspection information reported by a State, FMCSA cannot
change or correct this data. I understand my request will be forwarded by the DataQs system to the appropriate State for adjudication.
I understand that any crash or inspection in which I was involved will display on my PSP report. Since the PSP report does not report,
or assign, or imply fault, I acknowledge it will include all CMV crashes where I was a driver or co-driver and where those crashes
were reported to FMCSA, regardless of fault. Similarly, I understand all inspections, with or without violations, will appear on my
PSP report, and State citations associated with FMCSR violations that have been adjudicated by a court of law will also appear, and
remain, on my PSP report.
I have read the above Disclosure Regarding Background Reports provided to me by Prospective Employer and I understand that if I
sign this Disclosure and Authorization, Prospective Employer may obtain a report of my crash and inspection history. I hereby
authorize Prospective Employer and its employees, authorized agents, and/or affiliates to obtain the information authorized above.
Date: __________________________ _______________________________________
Signature
___________________________________________
Name (Please Print)
NOTICE: This form is made available to monthly account holders by NIC on behalf of the U.S. Department of Transportation,
Federal Motor Carrier Safety Administration (FMCSA). Account holders are required by federal law to obtain an Applicant’s written
or electronic consent prior to accessing the Applicant’s PSP report. Further, account holders are required by FMCSA to use the language
contained in this Disclosure and Authorization form to obtain an Applicant’s consent. The language must be used in whole, exactly as
provided. Further, the language on this form must exist as one stand-alone document. The language may NOT be included with other
consent forms or any other language.
NOTICE: The prospective employment concept referenced in this form contemplates the definition of “employee” contained at 49
C.F.R. 383.5.
LAST UPDATED 2/11/2016
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Completed 16 July 2020

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