Form BPA F 5200.02e BPA F 5200.02e Motor Vehicle Driver Attestation for Contract Personnel

CUI
U.S. DEPARTMENT OF ENERGY – BONNEVILLE POWER ADMINISTRATION (BPA)
BPA F 5200.02e
(11/2023)
MOTOR VEHICLE DRIVER ATTESTATION FOR CONTRACT PERSONNEL
Prior editions unusable

OMB Control
Number xxxx-xxxx
Expires xx/xx/xxxx

PRIVACY ACT STATEMENT:
Authority: 40 U.S.C. § 601 and 16 U.S.C. § 839f authorize the collection of this information.
Purpose: BPA will use this information to authorize the operation and use of Government-owned or leased vehicles for official
business.
Routine Uses: Information provided on this form may be disclosed to a federal agency to facilitate the requesting agency's
decision regarding the use of a Government-owned or leased vehicle by contracted personnel. This information will be used to
verify that a contract worker possesses a valid driver’s license when required to drive for BPA business.
Additional routine use disclosures may be found in Privacy Act System of Records “DOE-23 – Property Accountability System”.
Disclosure: This information is mandatory only when a contract worker’s job requires driving a Government-owned or leased
vehicle; it is voluntary otherwise. Failure to provide some or all of the requested information may result in the denial or
withdrawal of your authorization to operate a motor vehicle for official business.
SECTION 1 – CONTRACT WORKER
All BPA personnel are expected to drive responsibly to save lives, time, and money, in spite of the conditions around them and the
actions of others. Adherence to state and federal laws and regulations, and BPA rules and procedures for safe driving is expected
of all personnel. Driving safely is a fundamental requirement for the continuation of authorization to drive on the behalf of the
Government.
You must complete the required training outlined below and sign this attestation before operating a Government owned or
leased vehicle (GOV). Documents referenced are provided as part of the Onboarding package. Return this attestation to the
Supplemental Labor Office via DocuSign once employer completes and signs Section 2.
I have a valid state driver's license to operate the type of vehicle(s) I am required to operate and I will carry it at all times
while operating a motor vehicle for official BPA business.
or
A U.S. Driver’s License is not required for this contract assignment.
Note - DO NOT mark this box without checking with your employer first.
I certify that I have read and understand the Fleet Users Guide and that I will comply with all rules and regulations
governing the use of Government owned and leased motor vehicles and that I have read and understand the penalties for
unofficial use.
I certify that I have read and understand BPA's Asset Management Instructions, Section III.
For GSA leased vehicles (G plated), I certify that I have read and understand the GSA Guide to Your Fleet Vehicle (also
located in vehicle).
I certify that I have read and understand BPA's Safety Occupational Health Manual 420-670 and 420-120-02.
I certify that I have watched the GSA Fleet Fuel Card Training and that I am aware of the difference between authorized and
unauthorized purchases, and that there may be serious repercussions for misuse.
I will notify my employer immediately if any issues arise that would impact my ability to safely and legally operate a
government motor vehicle.
1.a. Contract Worker Name (printed)

1.b. Signature

1.c. Date

CONTROLLED DISTRIBUTION
Access is restricted to those with a Lawful Government Purpose and must be protected and marked when
printed or distributed.
Filled in by BPA →

Controlled by:
Name/Agency/Org/Contact Info:

CUI Category:
PRVCY
Date:
File Code: FE-1130; Retention: Destroy 3 years after separation or 3 years after rescission of authorization to operate equipment,
whichever is sooner.

CUI
U.S. DEPARTMENT OF ENERGY – BONNEVILLE POWER ADMINISTRATION (BPA)
BPA F 5200.02e
(11/2023)
MOTOR VEHICLE DRIVER ATTESTATION FOR CONTRACT PERSONNEL
Prior editions unusable

OMB Control
Number xxxx-xxxx
Expires xx/xx/xxxx

SECTION 2 – EMPLOYER
We will confirm that the worker listed above has a valid, unexpired driver’s license without restrictions that would prevent
them from carrying out the duties of the assignment as outlined. We will immediately notify SLMO if any issues arise that
would impact their ability to fulfill the duties of the assignment.
or
A U.S. Driver’s License is not required for this position.

2.a. Representative’s Name

2.b. Company’s Name

2.c. Signature

2.d. Date

Paperwork Reduction Act Burden Statement:
This data is being collected to ensure government vehicles are only driven by licensed personnel. The information you supply will
be used to authorize the use of government owned vehicles. Public reporting burden for this collection of information is
estimated to average 60 minutes (1 hour) per response, including the time for reviewing instructions, searching existing data
sources, gathering, and maintaining that data needed, and completing and reviewing the collection of information.
Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for
reducing this burden, to Office of the Chief Information Officer, Enterprise Policy Development & Implementation Office, IM-22,
Paperwork Reduction Project (OMB control number xxxx-xxxx), U.S. Department of Energy, 1000 Independence Ave SW,
Washington, DC, 20585-1290; and to the Office of Management and Budget (OMB), OIRA, Paperwork Reduction Project (OMB
control number xxxx-xxxx), Washington, DC 20503.
Notwithstanding any other provision of the law, no person is required to respond to, nor shall any person be subject to a penalty
for failure to comply with a collection of information subject to the requirements of the Paperwork Reduction Act unless that
collection of information displays a currently valid OMB control number.
The Paperwork Reduction Act (PRA) of 1995 requires each Federal agency to seek and obtain approval from the Office of
Management and Budget (OMB) before undertaking a collection of information directed to 10 or more persons of the general
public, including persons involved in or supporting the operations of Government-owned, contractor-operated facilities.
Submission of this data is mandatory.

File Code: FE-1130; Retention: Destroy 3 years after separation or 3 years after rescission of authorization to operate equipment,
whichever is sooner.