Client Information Form

PART I.

A. WHERE APPLICABLE, SERVICES WILL INCLUDE: 

1) Maintaining qualified random testing consortium pools for individuals requiring C/TPA testing services, as well as for regulated company employees, e.g., Owner Operators, or Carrier Company Drivers, respectively.  Our service standards shall meet or exceed minimum testing rates set forth by the DOT for each calendar year, or other percentages as defined by the company clients designating us as their C/TPA of record for their test safety sensitive employees. 

2) Coordinate and manage a random selection and notification methods as minimally consistent with DOT and/or other regulated controlled substance and alcohol testing requirements, where applicable, as requested by carrier company clients for their test safety sensitive employees. 

3) Maintaining of records documenting the participation and compliance of individual testing consortium participants and/or a Carrier Company’s participation in Dock-Right Expedited, Inc’s Driver and Carrier Services random testing programs and will provide our clients with these records, other records documenting compliance, and information, where applicable, within 48 hours of notification via text, email, or direct phone contact. 

4) Upon a company client or individual consortium participant’s request via email or completion of a consent form provided, release of documented compliance records and/or drug and alcohol testing history and information per DOT and other regulatory agency protocols or Carrier Company’s Drug and Alcohol policy shall be forwarded to the appropriate recipient.  All testing and regulatory compliance records are maintained for the preceding 5 years.  Documentation, records, and other compliance information requested may include verification of participation in our Full Service C/TPA Carrier Compliance Program, and/or documentation of current enrollment of a carrier company client’s test safety sensitive employees, consortium enrolled employee’s statuses of regulatory compliance, and upon request, clearinghouse queries, pre-employment testing, and assistance in preparation of Management Information System Reports (MIS), in advance of a scheduled enforcement inspection date.  SAP Drivers and Owner operators opting for our limited C/TPA Clearinghouse Compliance Program, receive the aforementioned record keeping, reporting, and document management / forwarding services, though test result reporting, clearinghouse status updating, and forwarding of records and documentation is limited to documentation clearinghouse management for the duration of enrolment in consortium testing, with all records and documentation maintained for up to 5 years. 

5) All mandated reporting of violations are made within the FMCSA Clearinghouse per the applicable FMCSA regulations, as required by the Federal Code of Regulations, for designate C/TPA service providers.  Carrier Company clients are required to designate Dock-Right Expedited Inc as their C/TPA in order to authorize the conducting of queries and reporting of violations for testing consortium enrolled employees on their behalf; as well as for negative test result reporting resulting in status changes.  Individual testing consortium participants are also required to designate Dock-Right Expedited Inc – Driver & Carrier Services as their designated C/TPA in order for reporting of test results resulting in status changes within the Clearinghouse.  

B. WHERE APPLICABLE, THE FOLLOWING SERVICES SHALL BE COORDINATED:

6). Location of proximally located test specimen collection sites, based on a company employee or consortium participant’s geographic location, DOT compliant testing forms with coordinated for specimen analyses by laboratories certified by the Department of Health and Human Services’ SAMHSA Agency. 

7) As required by DOT regulations, a Medical Review Officer (MRO) from the aforementioned “certified” laboratories shall provide test result notifications to the individual consortium pool participant or Carrier Company/employee and blind specimens will be processed and handled by designated specimen analyzing laboratories as per DOT regulations and MRO compliant protocols.  

PART II.

A. CLIENT OLIGATIONS AND RESPONSIBILITIES:

8)  To qualify for, and maintain enrollment in the Dock-Right: DOT Compliance & Testing Solutions C/TPA program services subscribed to, provided by “Dock-Right DOT-Compliance & Testing Solutions”, hereafter referred to as “the Company” OR “our Company”, the MOTOR CARRIER CLIENT AND/OR CONTRACT DRIVER, hereafter referred to as, “the Client” agrees to following, WHERE APPLICABLE, to the service package subscribed to by “the Client”. :

a) Maintain a Company Policy for controlled substance and alcohol (D&A) misuse implemented before initiating testing. Complete verification of prior drug, alcohol and driving violations for each new SAFETY SENSITIVE EMPLOYEE (SSE).

b) For reasons of reasonable suspicion testing, THE CLIENT agrees to have a person who supervises SAFETY SENSITIVE EMPLOYEES (SSEs), or employees trained in the aid of recognizing the signs and symptoms of substance abuse and alcohol misuse.

c)  Notify OUR COMPANY immediately of any changes in CLIENT information including name, address, telephone number(s), (office, mobile and/or emergency numbers), fax number(s), authorized contact(s), Designated Employer Representative (DER) or enrolled CARRIER CLIENT employee(s) information.

d)  Notify OUR COMPANY immediately of any changes in the status of a DRIVER CLIENT’S or CARRIER CLIENT’s SSE employee(s) including termination, out-of-service, S.S.E. license changes, etc. (The Company understands that if there is more than a 30-day lapse of enrollment in a random testing program, they are responsible to have the S.S.E. submit to a pre-employment drug testing before returning to a safety sensitive position.)

9) MAINTENANCE AND CONTINUATION OF SUBSCRIBED SERVICES DESCRIBED HEREIN, REQUIRE THAT THE CLIENT AGREES TO:

e)  Have any new CARRIER CLIENT’s safety sensitive employee (S.S.E.) hires complete a pre-employment drug screen.  Employees can only be added to the Random Pool with a negative DOT drug test result, in accordance with FMCSA CFR §382.301.

f)  Each CLENT OR CARRIER COMPANY CLIENT’S S.S.E. employee must proceed immediately to the closest available authorized drug and/or alcohol collection site once they are notified of a random testing site selection.

g)  In the event of extenuating circumstances, the Client agrees to document and provide such documentation to our company for any reason(s) leading to the failure to comply with all requests for a random test, in a timely manner.  Failure of driver CLIENTS to randomly test or CARRIER CLIENTS to Failure of CARRIER CLIENTS to randomly test enrollees in the testing consortium may result in termination and the release of this information to any applicable and appropriate regulatory enforcement agencies, as described in FMCSA CFR § 40.167, § 40.331, § 40.345, and § 40.35.

h)  Clients agree to comply with the and determine if post-accident drug and alcohol testing is necessary following any accident, as described within FMCSA CFR §382.303.

i)  Ensure a S.S.E. does not resume employment prior to SAP approval and Return-to-Duty testing.

10)  Clients agree to inform our Company immediately, and/or remove S.S.E. drivers from service upon notification from either:

 a). Medical Review Officer (MRO) that S.S.E. tested positive on a DOT drug test; or

b) Breath Alcohol Technician (BAT) or Saliva Alcohol Technician that the S.S.E. ’s confirmation test  result has an alcohol concentration of .04 or greater.

c) Where applicable, it is the Responsibility of the client to establish an alternate provision  pertaining to post accident testing when collection site or personnel is unavailable (e.g. out of the area, after hours, on extended holidays, etc.)

d) Have available a same gender observer, if necessary, when a direct observed collection is required, and the collection site is unable to provide a same gender observer.

11)  Services provided by our COMPANY involving assistance in preparation of the Management  Information System Report (MIS), the CARRIER CLIENT shall contact our company at least two full (2) business days prior to a scheduled enforcement inspection date.  The 2-business day requirement does not apply to service package arrangements wherein CARRIER CLIENT does not have all employed drivers enrolled in our consortium testing services, as additional time may be required.

12) The CLIENT accepts full responsibility for understanding the obligations under this “SERVICES AND COMMUNICATIONS AGREEMENT” and service agreement requirements for participating as a recipient of a subscribed services package provided by OUR COMPANY in a manner that is compliant with DOT regulations. The CLIENT agrees to waive any rights or claims intending to requiring our company to indemnify the client in the event of losses or damages which are the result of non-compliance with DOT/FMCSA procedures and protocols, or processing and administrative errors of any kind by any certified laboratory, medical review officer (MRO) or collection site providing services pursuant to the clauses in this “SERVICE AND COMMUNICATIONS AGREEMENT” with OUR COMPANY , and including any claim, loss, liability, damage, detriment or obligation arising from any matter other than their willful misconduct or gross negligence in breach of OUR COMPANY’S SERVICE AGREEMENT with THE CLIENT .  Clients agree to hold harmless from and against any and all claims, losses, damages, costs or liabilities and penalties imposed on “THE CLIENT” for non-compliance to applicable parts of FMCSA 49 CFR Part 40.  Indemnification shall include being held harmless for any legal fees and other expenses resulting from any alleged or actual breach of service contract within this service and communications agreement.  “THE CLIENT” AND “OUR COMPANY” agree that should any suit or action be implemented to enforce the terms outlined in this “SERVICE AND COMMUNICATIONS AGREEMENT”, the prevailing party will be entitled to reasonable attorney fees surrounding litigation and appeal.

PART III.

A)  Terms and Conditions

13)   This SERVICES AND COMMUNICATIONS AGREEMENT shall be governed in all respects by state law, where applicable, except to the extent specifically preempted by federal regulations, The Department of Transportation regulations governing drug and alcohol testing programs (49 CFR Part 40) and that DRIVER or CARRIER service recipients (also referred to as 'THE CLIENT') are responsible for all aspects of compliance with these regulations, and that these stipulations apply even if OUR COMPANY has been designated as a service agent.

14)  In the event of a CLIENT’s non-compliance to 49 CFR Part 40, continuing failure to comply with 49 CFR Part 40, OUR COMPANY reserves the right to expel the CLIENT and their SSE enrollees from all random selection pools of our testing consortia. If expulsion occurs, this may result in notification to the Department of Transportation (DOT), as in the event of a service provider audit.  DRIVER CLIENTS will be terminated from the consortium testing and clearing house management services package or for any positive drug or alcohol test result or failing to respond to random testing requirements.  The CLIENT is required to stay compliant with all DOT/FMCSA requirements, applicable to this service agreement, where applicable.

PART IV

A)  COMUNICATIONS AND TEXT MESSAGING CONSENT AGREEMENT

15)  Consent to Receive SMS Messages. 

By subscribing to our COMPANY’s services you hereby consent to receive SMS messages (including text messages), and telephone calls (including prerecorded and artificial voice and autodialed) from us, our agents, representatives, affiliates, or anyone communicating on our behalf at the specific number(s) you have provided to us, with service-related information, questions about your use of the Services, and/or Even Account and marketing information. You certify, warrant, and represent that the telephone number you have provided to us is your contact number and not someone else’s. You represent that you are permitted to receive calls and text messages at the telephone number you have provided to us. You agree to promptly alert us whenever you stop using a telephone number.  This consent to receiving communications includes those from our agents, representatives, affiliates, and anyone calling on our behalf may use such means of communication described in this section even if you will incur costs to receive such phone messages, text messages, e-mails, or other means. Standard message and data rates may apply to all SMS messages (including text messages). 

16)  Termination of Consent to receive SMS Messages.  Termination of consent to receive text messages, can be carried out by written text response, via text or email, with the words, “Unsubscribe”, maintains the right to terminate the enrollee from consortium services, unless an alternate form of communication described herein is provided to OUR COMPANY.  

17)  In the event an alternate mode of communication is not arranged and requested in writing by OUR COMPANY at the time a termination of consent notification is received by our company, the client agrees that OUR COMAPANY will retain the right to terminate the enrollee from any and all subscribed service packages immediately, without a refund for any pre-paid service package term, and the CLIENT agrees to waive any claim to liabilities for loss incurred as a result of the CLIENT or CARRIER CLIENT’s SSE enrollees voluntary disenrollment from OUR COMPAY’s services which may result without an alternate form of communication having been established at the time of termination of communication consent by the Client or an SSE enrollee employed by a CARRIER CLIENT.  

18)  Termination of consent to receive any and all communications including phone calls from our company by the CLIENT or CAREER CLIENT’s SSE employees may be requested at any time in writing, via email or text, and the CLIENT agrees that OUR COMAPANY will retain the right to terminate the enrollee from any and all subscribed service packages immediately, without a refund for any pre-paid service package term, and the CLIENT agrees to waive any claim to liabilities for loss incurred as a result of the CLIENT or CARRIER CLIENT’s SSE enrollees voluntary disenrollment from OUR COMPAY’s services which may result.  

19)  In the event an SSE employee terminates consent for communications as described in clause 17 and 18, a Carrier Client will be granted a service credit for a new SSE Employee hire they wish to enroll, for the remaining service package term pre-paid for the SSE Employee terminated from our receiving services from OUR COMPANY.

B. OTHER CONSENTS FOR COMMUNICATION BY CLIENTS:

20)  Client or SSE enrollee agrees to give consent for results received from an MRO to be transmitted to a DER in a confidential manner, where applicable.  

21)  Client agrees to establish an acceptable means for secure transmission of results, and where required, transmit any required consents for OUR COMPANY, as designated C/TPA, to provide services, e.g. where required by MRO or a certified laboratory. 

22)  Client agrees to communicate any follow-up testing requirements for retained SSE employee following a positive test result, and/or decisions for termination or retention based on test results or refusal. 

23)  The client agrees to provide for consent for OUR COMPANY to notify the carrier DER when selections are made, where applicable for the services subscribed to by the client.  

24)  The client agrees to provide a list of names and ID numbers (or SSN) of safety sensitive employees, and to provide S.S.E. lists via email or fax, at the time of initiating services or adding enrollees. 

As the CLIENT (or designated representative of the CARRIER CLIENT), I hereby agree to the terms of this Agreement and further acknowledge that I/we must participate with every aspect of this SERVICES AND COMMUNICATIONS AGREEMENT, where applicable to services in which I am subscribing. I/we do realize that “DOCK-RIGHT: DOT Compliance & Testing Services” reserves the right to terminate CLIENT enrollment as a participant should I/we fail to abide by the terms set forth in this agreement, including those terms applicable to random test notifications. This agreement shall be extended automatically for each quarterly term for a service package subscribed to, until the CLIENT provides written notice of desire to terminate this SERVICES AND COMMUNICATIONS AGREEMENT, and I/we understand this agreement may result in cancellation by “DOCK-RIGHT: DOT Compliance & Testing Services”, as described in this SERVICES & COMMUNICATIONS AGREEMENT for issues such as non-payment of quarterly fees, or at the end of a pre-paid term of service.