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ATTACHMENT D: EXAMINER ATTESTATION FORM <br />Department of Licensing Page 27 of 36 Contract No. K9319 <br /> <br /> <br /> <br /> <br />1. I attest to reading the contract between the Contractor and the <br />Department of Licensing, specifically the Statement of Work <br />(SOW). The SOW outlines my duties and responsibilities as a Third- <br />Party Examiner. <br /> <br />2. Any disciplinary actions taken by the Department will be reflected <br />on me as the Examiner. <br /> <br />3. I have been provided a copy of Attachment B: Compliance Matrix <br />and understand the consequences outlined in the document. <br /> <br />4. I understand I am not able to test an individual that I have trained. <br /> <br />5. I will keep all information regarding drivers who are being tested <br />confidential. <br /> <br />6. It is my responsibility to maintain my eligibility by conducting 10 <br />tests per calendar year. <br /> <br />7. I will provide service to all classes of vehicles I am contracted and <br />certified to test. <br /> <br /> <br /> <br />Signature: _______________________________________________________ Date: ________________ <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br />Name: Date: <br />Docusign Envelope ID: 4798BD77-1E90-44A1-9098-432C0EDF7393