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These
instructions will assist you in preparing accurate and complete
application filings. Applications that do not contain the required
information will be rejected and may result in a loss of the
application fee. The application must be typed or printed in
ink. If additional space is needed to provide a response to
any item, use a separate sheet of paper. Identify applicant
on each supplemental page and refer to the section and item
number in the application for each response.
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PAPERWORK
BURDEN. It is estimated that an average of 2 burden
hours per response are required to complete this collection
of information. This estimate includes time for reviewing
instructions, searching existing data sources, gathering
and maintaining the data needed, and completing and reviewing
the collection of information. Comments concerning the accuracy
of this burden estimate or suggestions for reducing this
burden should be directed to the Federal Motor Carrier Safety
Administration (FMCSA), Licensing Team, Suite 600, 400 Virginia
Avenue, S.W., Washington, DC 20024. This collection of information
is required in order for the FMCSA to obtain data and register
applicants to operate as freight forwarders in interstate
and foreign commerce. Please note that an agency may not
conduct or sponsor, and a person is not required to respond
to, a collection of information unless it displays a currently
valid OMB control number. The OMB control number for this
collection is 2126-0016.
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| SECTION
I |
FMCSA AUTHORITY. If you now have any former Interstate
Commerce Commission (ICC), Federal Highway Administration
(FHWA), Office of Motor Carrier Safety (OMCS), or Federal
Motor Carrier Safety Administration (FMCSA) authority or
have an application for authority being processed now by
FMCSA, check the "YES" box and indicate
the docket or the MC number you have been assigned. Example:
MC-987654
APPLICANT'S
LEGAL BUSINESS NAME and DOING BUSINESS AS NAME. The
applicant name should be your full legal business name --
the name on the incorporation certificate, partnership agreement,
tax records, etc. If you use a trade name that differs from
your official business name, indicate this under "Doing
Business As Name." Example: If you are John Jones,
doing business as Quick Way Forwarding, enter "John
Jones" under APPLICANT'S LEGAL BUSINESS NAME and "Quick
Way Forwarding" under DOING BUSINESS AS NAME.
Because
the FMCSA uses computers to retain information about licensed
carriers, it is important that you spell, space, and punctuate
any name the same way each time you write it. Example: John
Jones Forwarding Co., Inc.; J. Jones Forwarding Co., Inc.;
and John Jones Forwarding are considered three separate
companies.
BUSINESS
ADDRESS/MAILING ADDRESS.The business address is
the physical location of the business. Example: 756 Bounty
Street; 15433 State Highway 23. If applicant receives mail
at an address different from the business location, also
provide the mailing address. Example: P.O. Box 3721. NOTE:
To receive pertinent FMCSA notices and to ensure that insurance
documents filed on applicant's behalf are accepted, notify
the FMCSA in writing (Federal Motor Carrier Safety Administration,
Licensing Team, Suite 600, 400 Virginia Avenue, S.W., Washington,
DC 20024) if business or mailing address changes.
REPRESENTATIVE.
If someone other than the applicant is preparing this form,
provide the representative's name, title, position, or relationship
to the applicant, address, and telephone and FAX numbers.
Applicant's representative will be the contact person if
there are questions concerning this application.
U.S.
DOT NUMBER.Vehicle-operating freight forwarders
(i.e., if applicant will provide a pickup or delivery service)
subject to the Federal Motor Carrier Safety Regulations
are required to register with the U.S. Department of Transportation
(U.S. DOT) for a USDOT number before initiating service.
Vehicle-operating freight forwarders that already have been
issued a USDOT number, should provide it; those that have
not obtained a USDOT number should refer to the information
sources under the "Additional Assistance" part
of these Instructions.
FORM
OF BUSINESS. A business is either a corporation,
sole proprietorship, or a partnership. If the business is
a sole proprietorship, provide the name of the individual
who is the owner. In this situation, the owner is the authority
applicant. If the business is a partnership, provide the
name of each partner.
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| SECTION
II |
TYPE
OF AUTHORITY. . Check the appropriate box to confirm
that you are requesting household goods or property freight
forwarder authority. Note: A separate filing fee is required
for each type of authority requested. See "Fee
Policy" in the application form. |
| SECTION
III |
INSURANCE
INFORMATION.
All
freight forwarder applicants must have on file with the
FMCSA proof of adequate insurance as follows:
(a)
Public liability insurance--freight forwarders that perform
transfer, collection, and delivery service must have on
file evidence that you maintain appropriate levels of bodily
injury and property damage (BI&PD) insurance and environmental
restoration coverage--filed on Form BMC-91 or BMC-91X. Complete
the "Insurance Information" in Section III.
NOTE:
Freight forwarders that:
-
do not own or operate any motor vehicles upon the highways
in the transportation of property,
-
do not perform transfer, collection, or delivery services,
and
-
do not have motor vehicles operated under their direction
and control in the performance of transfer, collection,
or delivery services may request a waiver of liability
insurance requirements by checking the appropriate box
in this Section. Operating authority issued to such forwarders
will indicate that BI&PD requirements have been waived.
The waiver is conditional and is valid only as long as
the forwarder remains in compliance with the non-vehicle
operating conditions noted on its operating permit.)
Cargo
insurance--all freight forwarders must have on file minimum
levels of cargo insurance--filed on Form BMC-34:
- $5,000
- for loss of or damage to property carried on any one
motor vehicle; and
-
$10,000 - for loss of or damage to or aggregate of losses
of or damages to property occurring at any one time and
place.
Appropriate
insurance forms must be filed within 90 days after the date
notice of your application is published in the FMCSA Register:
Form BMC-91 or BMC-91X for bodily injury and property damage,
Form BMC-34 for cargo liability, Form BMC-84 for broker
surety bond, and Form BMC-85 for broker trust fund agreement.
The
FMCSA does not furnish copies of insurance forms. You must
contact your insurance company to arrange for the filing
of all required insurance forms.
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| SECTION
IV |
SAFETY
CERTIFICATION. Vehicle-operating freight forwarder applicants
must complete the safety certification. You should check the
"YES" response only if you can attest to the truth
of the statements. The "Applicant's Oath" at the
end of the application form applies to all certifications,
and false certifications are subject to the penalties described
in that oath.
If you
operate only vehicles with a gross vehicle weight rating
under 10,000 pounds and will not transport hazardous materials,
you are exempt from the U.S. DOT safety fitness regulations;
however, you must certify that you are familiar with and
will observe general operational safety fitness guidelines
and applicable State and local laws relating to the safe
operation of commercial motor vehicles.
You
must check only one of the boxes in this section.
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SECTION
V
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CERTIFICATION.
All forwarder applicants must complete this certification
concerning compliance with statutory licensing requirements
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SECTION
VI
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CONTROL
RELATIONSHIPS. All forwarder applicants must disclose
and describe pertinent control relationships.
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SECTION
VII
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AFFILIATIONS.All
applicants must disclose pertinent information concerning
affiliations, if any, with other former ICC, FHWA, or OMCS;
now FMCSA-licensed entities.
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SECTION
VIII |
APPLICANT'S OATH. Applications
may be prepared by the applicant or an authorized representative.
In either case, the oath must be signed by the applicant.
In the case of companies, an authorized employee in the ownership
structure may sign. An individual with power of attorney to
act on behalf of the applicant may sign, provided that proof
of the power of attorney is submitted with the application. |
| LEGAL
PROCESS AGENTS |
All
applicants must designate a process agent in each State where
operations are authorized. Process agents who will accept
legal filings on applicant's behalf are designated on Form
BOC-3. Form BOC-3 must be filed within 90 days after
the date notice of the application is published in the FMCSA
Register. |
| STATE
NOTIFICATION |
Before
beginning new or expanded interstate operations, you must
contact the appropriate regulatory agencies in every State
involved in your operations to obtain information regarding
various State rules applicable to interstate authorities.
It is the applicant's responsibility to comply with any pertinent
State regulations and procedures. Begin this process by contacting
the transportation regulatory agency for the State in which
your business is located. |
MAILING
INSTRUCTIONS
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To
file for authority you must submit an original and one
copy of this application with the appropriate filing fee
to FEDERAL MOTOR CARRIER SAFETY ADMINISTRATION, P.O. Box 70935, Charlotte, NC 28272-0935.
NOTE:
RETAIN A COPY OF THE COMPLETED APPLICATION FORM AND ANY
ATTACHMENTS FOR YOUR OWN RECORDS.
ALL
DOCUMENTS WITH FEES ATTACHED:
FEDERAL
MOTOR CARRIER SAFETY ADMINISTRATION
P.O. Box 70935
Charlotte, NC 28272-0935
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FOR
EXPRESS MAIL ONLY
QLP Wholesale Lockbox - NC0810
Lockbox #70935
1525 West WT Harris Blvd.d
Charlotte, NC 28262
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FOR
CREDIT CARD USERS ONLY:
FMCSA, Licensing Team
Suite 600, 400 Virginia Avenue, S.W.
Washington, DC 20024
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| ADDITIONAL
ASSISTANCE |
FMCSA
INFORMATION SOURCES
Additional
information on obtaining operating authority or monitoring
the status of your applications is available through the
Automated Response Capability (ARC) telephone system. After
dialing (202) 358-7000, press 1, then request appropriate
menu number indicated below. You may use the ARC 24 hours
a day, 7 days a week to obtain information in the following
areas:
Information
Requested MENU NUMBER
Status
of your application = 1
(NOTE:
Tracking the status of your application can
be simplified and expedited if you refer to the
assigned docket number when making inquiries.
You will be informed of your docket number by letter sent
on the date notice of your application appears
in the FMCSA Register.)
Assistance
in filing your application = 3
Status
of insurance and process agent filing = 2
If you
require information that is not available in the automated
response system the ARC will guide you to an appropriate
staff member who will be able to assist you in other areas.
U.
S. DEPARTMENT OF TRANSPORTATION INFORMATION SOURCES
U.S.
DOT Registration and Safety Ratings
- To
obtain information on registering with U.S. DOT (filing
Form MCS-150) or to request a safety fitness review, write
to:
Director, Office of Data Analysis & Information Systems
FEDERAL MOTOR CARRIER SAFETY ADMINISTRATION
400 7th Street, S.W. - MC-RIS
Washington, DC 20590
or
call: (800) 832-5660 (Automated response system)
- For
information concerning a carrier's assigned safety rating,
call: (800) 832-5660
U.S.
DOT Hazardous Materials Regulations
- To
obtain information on whether the commodities you intend
to transport are considered to be hazardous materials:
Refer to the provisions governing hazardous materials
in the Federal Motor Carrier Safety Regulations at Parts
170 through 189 of Title 49 of the Code of Federal Regulations
(CFR), particularly the Hazardous Materials Table at
49 CFR Part 172, or contact U.S. DOT at (202) 366-6121.
- To
obtain information about DOT hazardous materials transportation
registration requirements:
Contact
U.S. DOT at (202) 366-4109.
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