ID-100 SUPERIOR COURT OF CALIFORNIA, COUNTY OF STREET ADDRESS: MALING ADDRESS: CITY AND ZIP CODE: BRANCH NAME: FOR COURT USE ONLY NAME OF DEFENDANT: STREET ADDRESS: MAILING ADDRESS: CITY AND ZIP CODE: HOME TELEPHONE NO.: WORK TELEPHONE NO.: DRIVER'S LICENSE NO.: CASE NUMBER: ORDER TO INSTALL IGNITION INTERLOCK DEVICE Under Vehicle Code section 23575, the court orders: a functioning Ignition Interlock Device be installed on the following vehicles owned or operated by defendant: Make a. b. c. 1. This order does not reinstate the defendant's driving privilege. 2. Installation must be no later than (specify a date no later than 30 days from the date of conviction): 3. Defendant must present this form to the installer at the time of installation. 4. Defendant must return completed Ignition Interlock Installation Verification (form ID-110) to the no later than (specify a date no later than 30 days from the date of conviction): 5. Defendant must take vehicles to the installer for calibration 60 days other (specify frequency): following the date of installation. 6. Defendant must make payments directly to the installer and must adhere to the payment plan for installation of the ignition device. 7. Without a court order, the devices may not be removed prior to (specify a date no later than three years from the date of conviction): 8. Defendant's employer requires defendant to drive a vehicle owned by the employer within the course and scope of defendant's employment. Defendant must provide the employer with the Notice to Employers of Ignition Interlock Restriction (form ID-150) . Defendant must keep a copy of the Notice to Employers of Ignition no later than (specify date): Interlock Restriction in defendant's possession or keep the original or a copy in the employer's vehicle. court probation dept. Model Year Color License Plate No. and/or VIN 9. Defendant must maintain current insurance and registration on all vehicles owned. 10. Other (specify): Date: I acknowledge receipt of this order. (TYPE OR PRINT NAME OF DEFENDANT) (DEFENDANT'S SIGNATURE) Date: JUDICIAL OFFICER OF THE SUPERIOR COURT Form Approved for Optional Use Judicial Council of California ID-100 [Rev. July 1, 2008] Page 1 of 2 Vehicle Code, §§ 23575, 23576 www.courtinfo.ca.gov American LegalNet, Inc. www.FormsWorkflow.com ORDER TO INSTALL IGNITION INTERLOCK DEVICE (Ignition Interlock Device) SHORT TITLE: CASE NUMBER: WHAT IS A VIOLATION OF THIS ORDER? 1. Failure to have ignition interlock devices installed within 30 days of the date of this order. 2. Failure to return completed Ignition Interlock Installation Verification (form ID-110) to the court or probation department (as indicated on the reverse) within the time limit specified in this order. 3. Failure to comply three or more times with any requirement for the maintenance or calibration of the ignition interlock devices. 4. Failure to comply with any court order. 5. Default on any payment plan arranged with the installer or ordered by the court, resulting in failure to comply herewith, absent a showing in court of good cause. 6. If defendant has a valid driver's license, driving any vehicle without an ignition interlock device except as provided below and except for employer-owned vehicles required to be operated within the course and scope of employment. A motor vehicle owned by a business entity that is wholly or partly owned or controlled by defendant is not a motor vehicle owned by an employer subject to the exemption. 7. Failure to maintain current license and registration on any vehicle owned by defendant. 8. Failure to notify any person who rents, leases, or loans a motor vehicle to defendant of the restriction imposed by this order. 9. Requesting or soliciting any person to blow into an ignition interlock device or to start a motor vehicle equipped with the device for the purpose of providing defendant with an operable motor vehicle. 10. Tampering with or circumventing the operation of an ignition interlock device. Under Vehicle Code section 23575 only, it is an affirmative defense to Violation Numbers 7, 8, and 9 if defendant can show that he or she leased, rented, or borrowed a vehicle for emergency use when no other feasible alternative was available, or for a bona fide business purpose when away from defendant's regular place of business. WHAT WILL HAPPEN IF YOU VIOLATE THIS ORDER? Under Vehicle Code section 23575, if a defendant fails to provide proof of installation within the ordered time limit, absent a showing of good cause, the court must notify the Department of Motor Vehicles. YOUR RIGHTS 1. If you are required to install ignition interlock devices under Vehicle Code section 23575, and you have a medical condition that you believe prevents you from breathing with sufficient strength to activate the devices, you have the right to present a physician's statement to the court documenting the condition and to have the court determine whether the medical condition does make use of the devices medically impossible. 2. If your driving privilege has been revoked or suspended under Vehicle Code section 23575, and it is restored before the end of the period ordered herein for installation of the ignition interlock devices, you may petition the court to review whether continued restriction is necessary. Defendant: Call the ignition interlock device installer within 48 hours of this order and arrange for the installation of the device(s). The court will provide you with a list of manufacturers certified by the Department of Motor Vehicles. Contact a certified manufacturer to locate an installer. ID-100 [Rev. July 1, 2008] ORDER TO INSTALL IGNITION INTERLOCK DEVICE (Ignition Interlock Device) Page 2 of 2