Policy and Manual Management System (PAMMS)
Georgia Department of Human Services

Office of Facilities and Support Services

    • 1410 Records Management
    • 1425 Coordinated Transportation System
    • 1430 Risk Management
    • 1450 Space Management and Leasing
    • 1460 DHS Personal Property Management
    • 1470 Real Property Management
    • 1480 Selection of Design, Engineering and Survey Professionals
  • MAN1425 Coordinated Transportation System Transportation Manual
    • Chapter 1 Coordinated Transportation
      • Contractor Lifecycle
      • Rider and Trip Type Eligibility Determination
      • General Trip Information
      • Transportation Service and Payment (Including TRIP$ Application)
      • Complaints
    • Chapter 2 Vehicle Management
      • Authorized Levels of Vehicles
      • Vehicle Lifecycle
      • Vehicle Obligations
      • Vehicle Monitoring and Inspections
      • Driver Requirements, Programs, and Recordkeeping
      • Administrative Vehicles
      • Confidentiality and Privacy Standards
    • Chapter 3 Risk Management and Insurance
      • Certificate of Insurance
      • Insurance for State Owned and State Leased Vehicles
      • Insurance for Coordinated Transportation Provider-Owned Vehicles
      • Insurance for Personal Vehicles Use by State Employees
      • Insurance for Volunteers
    • Appendices
      • Appendix 1 Glossary
      • Appendix 2 Process Map Legend
      • Appendix 3 Administrative Documents Review
      • Appendix 4 Monthly Program Report – Trip, Miles, and Hour Analysis
      • Appendix 5 Report of Certified or In-Kind Cost
      • Appendix 6 Complaint Form
      • Appendix 7 Complaint Resolution Form
      • Appendix 8 Vehicle Acquisition via Purchase Checklist
      • Appendix 9 HOLMAN Insights Security Access Application
      • Appendix 10 DHS Administrative Vehicle Log
      • Appendix 11 Site Visit Questionnaire
      • Appendix 12 RTO Vehicle Transfer/Surplus Questionnaire
      • Appendix 13 Statement of Understanding
      • Appendix 14 DOAS Surplus Vehicle Inspection Form
      • Appendix 15 DOAS Form RMS101-4 Driver Safety Tips
      • Appendix 16 DHS Form 101-1 Driver Acknowledgment
      • Appendix 17 DOAS RMS101-2 Motor Vehicle Use Program Driver Notification
      • Appendix 18 Daily Vehicle Inspection Sheet
      • Appendix 19 Annual Safety Inspection Report
      • Appendix 20 Driver Qualification Folder (DQF) Checklist
      • Appendix 21 Site Visit Summary Report
      • Appendix 22 DHS Vehicle Requirements and Monitoring Form
      • Appendix 23 DHS Vehicle Requirements and Monitoring Form – Administrative Vehicles
      • Appendix 24 Vehicle Operator Initial Accident and Incident Reporting Form
      • Appendix 25 Vehicle Operator Accident and Incident Follow-Up Reporting Form
      • Appendix 26 Regional Transportation Office Initial Accident and Incident Reporting Form
      • Appendix 27 Regional Transportation Office Accident and Incident Follow up Reporting Form
    • Exhibits
      • Exhibit 1 Sample Notice of Intent to Contract
      • Exhibit 2 Sample FY20XX Evaluation Summary - Consumers
      • Exhibit 3 Sample HSP Satisfaction Survey Summary
      • Exhibit 4 Sample Quarterly Report Card
      • Exhibit 5 Sample Corrective Action Plan
      • Exhibit 6 Sample Cure Notice
      • Exhibit 7 Sample Termination Notice
      • Exhibit 8 Sample Annual Contract Evaluation Summary
      • Exhibit 9 Sample Invoice Backup Report
      • Exhibit 10 Sample Invoice Summary Report
      • Exhibit 11 Sample Draft Invoice
      • Exhibit 12 Sample Annual Financial Plan
      • Exhibit 13 Sample Monthly Financial Report
      • Exhibit 14 Sample Quarterly Financial Report
      • Exhibit 15 Sample DHS Complaint Performance Log
      • Exhibit 16 GA DOR Motor Vehicle Tag/Title Application (MV-1 Form)
      • Exhibit 17 Vehicle Request Approval Criteria
      • Exhibit 18 Sample Manufacturer Statement of Origin
      • Exhibit 19 Non-Leased Vehicles Odometer Disclosure Statement (Form GA-25)
      • Exhibit 20 Sample Asset Creation Form
      • Exhibit 21 Sample Driver-Check Sticker Application
      • Exhibit 22 Vehicle Identification/Markings
      • Exhibit 23 Vehicle Title Handling Instructions
      • Exhibit 24 Corrective Action and Redline Action Items List
      • Exhibit 25 Pass/Fail Inspection Sticker
      • Exhibit 26 Sample Certificate of Insurance
Office of Facilities and Support Services
  • Division of Child Support Services
  • Division of Family and Children Services
  • Office of Budget Administration
  • Office of Facilities and Support Services
  • Office of Financial Services
  • Office of General Counsel
  • Office of Information Technology
  • Office of Inspector General
  • Office of Legislative Affairs and Outreach
  • Office of Refugee Services
  • PAMMS Help
  • Office of Facilities and Support Services
  • MAN1425 Coordinated Transportation System Transportation Manual
  • Exhibits
  • Exhibit 18 Sample Manufacturer Statement of Origin
PDF
Edit this Page

Exhibit 18 Sample Manufacturer Statement of Origin | MAN1425

1425 606
Exhibit 17 Vehicle Request Approval Criteria Exhibit 19 Non-Leased Vehicles Odometer Disclosure Statement (Form GA-25)

This page was built using the Georgia Department of Human Services Antora UI.