Attachment A

Ignition Interlock Agreement

This is an agreement between the Department of Public Safety, Driver and Vehicle Services and

______________________________. As part of this agreement the participant agrees to the following

terms and condition:

1. Participant must drive only a motor vehicle equipped with a functioning and certified
______
ignition interlock device during the entire program until notified by Driver and
Vehicle Services that they are eligible to have the device removed.
______ 2. Participant must not tamper with, circumvent or otherwise misuse the device. Any
suspected violation will be evaluated by the Department and sanctions may be
imposed. These sanctions could include removal from the program and non-credit for
the revocation time period spent using the ignition interlock device.
______ 3. Participant is responsible for all reports indicating use of alcohol by the ignition
interlock device. Any indication of use of alcohol detected by the device will be
considered use of alcohol by the participant and will be taken into consideration
when the Department of Public Safety evaluates the participant’s driving privileges.
______ 4. Participants who have a no use of alcohol or drug restriction on their driver license
will be considered in violation of that restriction if alcohol is detected by the ignition
interlock device and they will be subject to cancellation for a longer time period.
______ 5. Participant must have their vehicle calibrated by a licensed service provider and
serviced every 30 days or as indicated by the interlock device
______ 6. Participant is responsible for understanding how to use the ignition interlock device
and will be responsible for any misuse of the device.
______ 7. Participant must provide proof of insurance for the vehicle equipped with the ignition
interlock device.
______ 8. Participant must indemnify and hold harmless the State of Minnesota and any
political subdivision, the Department and its officers, employees and agents from all
claims, demands and actions as a result of property damage and or injury or death to
persons which may arise, directly or indirectly, out of any act or omission by the
participant during the use of an ignition interlock device.
______ 9. Participant is responsible for all cost incurred from the participant in the program.

I have read the above the conditions and by signing this agreement understand that any violation of
these conditions may result in sanction being imposed. These sanctions may include removal from
the program and/or non-credit for the revocation time period spent using the ignition interlock
device.

Signed ____________________________________________ Date________________

Participant’s:
Name____________________________ Address _______________________________________

Telephone Number___ ___________________ Email Address ____________________________