Basic Package includes: $649. Add-Ons

Transcription

1 New Authority Package When starting a trucking company there are many steps involved. We are here to help you. With NASTC s New Authority Package you will get: US DOT Number Motor Carrier Authority BOC-3 Process Agents Drug and Alcohol Program Phone: Fax: There are still other things that you must do to become operational. Below is a list of items that you are required to have. NASTC is available to help you with these things if you find you need assistance. Checklist for Items to Be Completed By You Unified Carrier Registration Pay your Federal Heavy Vehicle Use Tax(HVUT) with the IRS (Form 2290) Set up your IRP acct in your state and purchase your base plate Obtain your IFTA stickers Purchase any state permits After you begin hauling your own freight, you also have day-to-day responsibilities that you must perform. Recordkeeping Responsibilities Build Driver Qualification files Enroll in a Drug and Alcohol Program and do your pre-employment drug screening Maintain Hours of Service, Accident, and Maintenance Records Be prepared for your New Entrant Audit Basic Package includes: $649 US DOT Number Motor Contract Carrier Authority BOC-3 Process Agents Drug and Alcohol Program NASTC New Authority Package Add-Ons Unified Carrier Registration $90 NASTC Insurance Services Call Each additional test $35 Reasonable Suspicion Kit $79.95

2 Phone: Fax: FORM OP-1 Application For Motor Property Carrier And Broker This application is for businesses requesting operating authority as a motor carrier, broker, and/or U.S. based enterprise carrier of property or household goods. SECTION 1 - Applicant Information Do you have operating authority from or an application being processed by the FMCSA, FHWA, OMCS, or ICC? qyes qno If YES, identify the MC/FF Number (or lead docket number): Legal Business Name DOT Number (If available. If not, see instructions.) Doing Business As Name (If different from Legal Business Name.) Physical Business Address Street Name and Number (No P.O. Box) City State Zip Phone Fax Mailing Address (If different from Physical Business Address above.) Street Name and Number City State Zip Company Representative (Person who can respond to inquires.) Name Title Contact Phone Ext Form Of Business - Select Only One q Corporation State of Incorporation: Tax ID q Sole Proprietorship Legal Name of Owner: Social Security Number q Partnership Legal Name of Each Partner: Tax ID Separate each name by a comma. SECTION 2 - Type of Operating Authority Check box(es) for each type of Authority requested. YOU MUST SUBMIT A FILING FEE OF $300 FOR EACH BOX CHECKED. q Motor Contract Carrier of Property (except Household Goods) q Broker of Property (except Household Goods) q Motor Contract Carrier of Household Goods. q Broker of Household Goods. SECTION 3 - Insurance Information Applicants that will operate commercial motor vehicles must complete this section. The dollar amounts in parentheses represent the minimum amount of bodily injury and property damage (liability) insurance coverage you must maintain and have on file with the FMCSA. NOTE: Refer to the instructions for information about cargo insurance requirements for motor common carriers and United States-based enterprise carriers, and surety bond/trust fund agreement filings for brokers. Applicant will operate any vehicle having a gross vehicle weight rating (GVWR) of 10,000 pounds or more to transport: q Non-hazardous commodities ($750,000) q Hazardous materials referenced in the FMCSA s insurance regulations at 49 CFR ($1,000,000) q Hazardous materials referenced in the FMCSA s insurance regulations at 49 CFR ($5,000,000) Applicant will operate ONLY vehicles having a gross vehicle weight rating (GVWR) under 10,000 pounds to transport: q Any quantity of Division 1.1, 1.2, or 1.3 material; any quantity of Division 2.3, Hazard Zone A, or Division 6.1, Packing Group I, Hazard Zone A material; or highway route controlled quantities of a Class 7 material as defined in 49 CFR ($5,000,000) q Commodities other than those listed above ($300,000) SECTION 4 - Safety Certification (for vehicle-operating applicants only) Applicants Subject To Federal Motor Carrier Safety Regulations If you will operate vehicles of more than 10,000 pounds GVWR and are, thus, subject to pertinent portions of the U.S. DOT s Federal Motor Carrier Safety Regulations (FMCSRs) at 49 CFR, Chapter 3, Subchapter B (Parts ), you must certify as follows: Applicant has access to and is familiar with all applicable U.S. DOT regulations relating to the safe operation of commercial vehicles and the safe transportation of hazardous materials and it will comply with these regulations. In so certifying, applicant is verifying that, at a minimum, it: 1. Has in place a system and an individual responsible for ensuring overall compliance with FMCSRs; 2. Can produce a copy of the FMCSRs and the Hazardous Materials Transportation Regulations; 3. Has in place a driver safety training/orientation program; 4. Has prepared and maintains an accident register (49 CFR Part ); 5. Is familiar with DOT regulations governing driver qualifications and has in place a system for overseeing driver qualification requirements (49 CFR Part 391); 6. Has in place policies and procedures consistent with DOT regulations governing driving and operational safety of motor vehicles, including drivers hours of service and vehicle inspection, repair, and maintenance (49 CFR Parts 392, 395, and 396); 7. Is familiar with and will have in place on the appropriate effective date, a system for complying with U.S. DOT regulations governing alcohol and controlled substances testing requirements (49 CFR Part 382 and 49 CFR Part 40). q Yes q No

3 FORM OP-1 Application For Motor Property Carrier And Broker - Page 2 Exempt Applicants If you will operate only small vehicles (GVWR under 10,000 pounds) and will not transport hazardous materials, you are exempt from Federal Motor Carrier Safety Regulations, and must certify as follows: Applicant is familiar with and will observe general operational safety guidelines, as well as any applicable State and local laws and requirements relating to the safe operation of commercial motor vehicles and the safe transportation of hazardous materials. q Yes q No SECTION 5 - Affiliations Disclose any relationship you have or have had with any other FMCSA-regulated entity (including entities licensed by the FHWA, OMCS, or ICC) within the past 3 years. Examples include, but are not limited to, a percentage of stock ownership, a loan, or a management position. If this requirement applies to you, provide the name of the company, MC/FF Number, USDOT Number, and that company s latest DOT safety rating. If you require more space, attach the information to this application form.

4 FORM OP-1 Application For Motor Property Carrier And Broker - Page 3 SECTION 6 - Applicant s Oath This oath applies to all supplemental filings to this application. The signature must be that of the applicant, not the legal representative. I,, verify under penalty of perjury, under the laws of the United States of America, (Print Name) that all information supplied on this form or relating to this application is true and correct. Further, I certify that I am qualified and authorized to file this application. I know that willful misstatements or omissions of material facts constitute Federal criminal violations punishable under 18 U. S. C by imprisonment up to 5 years and fines up to $10,000 for each offense. Additionally, these misstatements are punishable as perjury under 18 U. S. C. 1621, which provides for fines up to $2,000 or imprisonment up to 5 years for each offense. I further certify under penalty of perjury, under the laws of the United States, that I have not been convicted, after September 1, 1989, of any Federal or State offense involving the distribution or posseddion of a controlled substance, or that if I have been so convicted, I am not ineligible to receive Federal; benefits, either by court order or operation of law, pursuant to Section 5301 of the Anti-Drug Abuse Act of 1988 (21 U. S. C. 862). I certify that the applicant is not domiciled in Mexico, or owned or controlled by persons of that country. (NOTE: The preceding sentence does not pertain to applicants that are United States-based Enterprise Carriers of International Cargo and/or Household Goods.) I hereby authorize Service of Process Agents, Inc. to file the necessary designation of agent form with the Federal Motor Carrier Safety Administration (formerly Federal Highway Administration) to assure my company s compliance with 49 C. F. R. 366 in all states. According to FMCSA Ruling, the filing of a BOC-3 form listing all 48 states will meet the requirement to designate agents and will comply with the requirement for obtaining FMCSA authority. I authorize NASTC to represent my company and such representation expires upon the granting of this authority. Signature _ Title Date Payment Options You will see an immediate charge on your credit card to FMCSA for $ Three to six weeks later, NASTC will charge the remaining $ to your card. Credit Card - Payment Authorization qvisa qmastercard Name (exactly as it appears on card Credit Card Number Expiration Date CSV Doing Business As Name (If different from Legal Business Name.) Total Payment Amount $ Credit Card Billing Address Street Name and Number City State Zip Phone Number Associated With Credit Card Signature _ Date

5 REASON FOR FILING (Mark only one) (Application for USDOT Number) NEW APPLICATION BIENNIAL UPDATE OR CHANGES OUT OF BUSINESS NOTIFICATION REAPPLICATION (AFTER REVOCATION OF NEW ENTRANT) 1. NAME OF MOTOR CARRIER 2. TRADE OR D.B.A. (DOING BUSINESS AS) NAME 3. PRINCIPAL ADDRESS 4. CITY 5. STATE/PROVINCE 6. ZIP CODE+4 7. COLONIA (MEXICO ONLY) 8. MAILING ADDRESS 9. CITY 10. STATE/PROVINCE 11. ZIP CODE COLONIA (MEXICO ONLY) 13. PRINCIPAL BUSINESS PHONE NUMBER 14. PRINCIPAL CONTACT CELL PHONE NUMBER 15. PRINCIPAL BUSINESS FAX NUMBER 16. USDOT NO. 17. MC OR MX NO. 18. DUN & BRADSTREET NO. 19. IRS/TAX ID NO. 20. INTERNET ADDRESS EIN SSN 21. CARRIER MILEAGE (to nearest 10,000 miles for last calender year) YEAR 22. COMPANY OPERATION (Mark all that apply) A. Interstate Carrier B. Intrastate Hazmat Carrier C. Intrastate Non-Hazmat Carrier D. Interstate Hazmat Shipper E. Intrastate Hazmat Shipper 23. OPERATION CLASSIFICATION (Mark all that apply) A. Authorized For-Hire D. Private Passengers (Business) G. U. S. Mail J. Local Government B. Exempt For-Hire E. Private Passengers (Non-Business) H. Federal Government K. Indian Tribe C. Private Property F. Migrant I. State Government L. Other 24. CARGO CLASSIFICATIONS (Mark all that apply) A. GENERAL FREIGHT G. BUILDING MATERIALS M. PASSENGERS S. GARBAGE, REFUSE, TRASH Y. PAPER PRODUCT B. HOUSEHOLD GOODS H. MOBILE HOMES N. OIL FIELD EQUIPMENT T. U.S.MAIL Z. UTILITY C. METAL:SHEETS, COILS, ROLLS I. MACHINERY, LARGE OBJECTS O. LIVESTOCK U. CHEMICALS AA. FARM SUPPLIES D. MOTOR VEHICLES J. FRESH PRODUCE P. GRAIN, FEED, HAY V. COMMODITIES DRY BULK BB. CONSTRUCTION E. DRIVE AWAY/TOWAWAY K. LIQUIDS/GASES Q. COAL/COKE W. REFRIGERATED FOOD CC. WATER WELL F. LOGS, POLES, BEAMS, LUMBER L. INTERMODAL CONT. R. MEAT X. BEVERAGES DD. OTHER 25. HAZARDOUS MATERIALS (CARRIER OR SHIPPER) (Mark all that apply) (C) CARRIER (S) SHIPPER (B) BULK IN CARGO TANKS (NB) NON-BULK IN PACKAGES A. DIV 1.1 B. DIV 1.2 C. DIV 1.3 D. DIV 1.4 E. DIV 1.5 F. DIV 1.6 G. DIV 2.1 (Flam. Gas) H. DIV 2.1 LPG I. DIV 2.1 (Methane) C S B NB J. DIV 2.2. T. DIV NUMBER OF VEHICLES THAT WILL BE OPERATED IN THE U.S. OWNED TERM LEASED TRIP LEASED 27. DRIVER INFORMATION Straight Trucks Within 100-Mile Radius Beyond 100-Mile Radius Truck Tractors K. DIV 2.2D (Ammonia) L. DIV 2.3A M. DIV 2.3B N. DIV 2.3C O. DIV 2.3D P. Class 3 Q. Class 3A R. Class 3B S. COMB LIQ Trailers Hazmat Cargo Tank Trucks INTERSTATE C S B NB Hazmat Cargo Tank Trailers U. DIV 4.2 V. DIV 4.3 W. DIV 5.1 X. DIV 5.2 Y. DIV 6.2 Z. DIV 6.1A AA. DIV 6.1B BB. CC. DIV 6.1 POISON DIV 6.1 SOLID DD. CLASS 7 Motorcoach INTRASTATE C S B NB EE. HRCQ FF. CLASS 8 GG. HH. CLASS 8A CLASS 8B II. CLASS 9 JJ. KK. LL. ELEVATED TEMP MAT. INFECTIOUS WASTE MARINE POLLUTANTS MM. HAZARDOUS SUB (RQ) NN. OO. HAZARDOUS WASTE ORM Number of vehicles carrying number of passengers (including the driver) School Bus Mini-bus 16+ TOTAL DRIVERS 28. IS YOUR USDOT NUMBER REGISTRATION CURRENTLY REVOKED BY THE FEDERAL MOTOR CARRIER SAFETY ADMINISTRATION? Yes No If Yes, enter your USDOT Number. 29. PLEASE ENTER NAME(S) OF SOLE PROPRIETOR(S), OFFICERS OR PARTNERS AND TITLES (e.g. president, treasurer, general partner, limited partner) Passenger Van C S B NB Limousine 9-15 TOTAL CDL DRIVERS CERTIFICATION STATEMENT (to be completed by authorized official) I,, certify that I am familiar with the Federal Motor Carrier Safety Regulations and/or Federal Hazardous Materials Regulations. Under penalties of perjury, I declare that the information entered on this report is, to the best of my knowledge and belief, true, correct, and complete. Signature Date Title (Please print)

6 NASTC MEMBER REGISTRATION AUTHORIZATION FORM BOC-3 I hereby authorize Service of Pr ocess Agents, Inc., to file the necessary designation of agent form with the Federal Motor Carrier Safety Administration (formerly Federal Highway Administration) to assure my company's compliance with 49 C.F.R. 366 in all states. According to FMCSA Ruling, the filing of a BOC-3 form listing all 48 states will meet the requirement to designate agents and will comply with the requirement for obtaining FMCSA authority. DOCKET NUMBER US DOT (if any) MC / MX / FF USDOT # LEGAL NAME DOING-BUSINESS-AS NAME (if any) Street: City, State, Zip: BUSINESS ADDRESS Street: City, State, Zip: MAILING ADDRESS (if different) Name of Contact Person: Telephone: Fax: Date: Signature of Authorized Person: Type or Print Name: Please complete and fax to Or angel.clark@nastc.com THANK YOU! v

7 THE NATIONAL ASSOCIATION OF SMALL TRUCKING COMPANIES -NAPS- DRUG TESTING PROGRAM AGREEMENT TO PARTICIPATE COMPANY NAME PHONE PHYSICAL ADDRESS FAX ADDRESS COMPANY CONTACT 1: 2: COLLECTION SITE We recognize that NASTC, Inc. is acting as a consortium/third party administrator and we acknowledge and allow NASTC, Inc. to serve as an intermediary for the collection and distribution of test results, paperwork, and MRO decisions. We understand that all laboratory work will be done by an approved lab. We understand that the lab will provide kits, chain of custody forms, mailing expense, and will inventory the needed supplies to us at our location or at the location of the collection site. We understand that NASTC will contract with a Medical Review Officer (MRO) to review all tests. We understand that we will be billed by NASTC for our drug tests and that payment is due in full to NASTC in ten (10) days from receipt of invoice. We understand that the rate per test for the lab work and MRO services is $35.00 per test. Collection costs are not included in this Agreement and will need to be negotiated with the collection site. We understand that in the fourth quarter of every year, if we have processed a minimum of one test for that calendar year, we will be billed $35.00 for the cost of a blind sample report that will be provided to us from NASTC to ensure our compliance with Part of the Federal Motor Carrier Safety Regulations. We understand that there is an initial setup fee of $ for members and $ for nonmembers, this fee is included in the cost for the NAPS Service. This fee pays for the written company drug policy and two Collector Certification Courses. NASTC REPRESENTATIVE COMPANY REPRESENTATIVE DATE:

8 Controlled Substances and Alcohol Policy Customized Policy Order Form Company Name: Company Contact: This policy was prepared by The National Association of Small Trucking Companies (NASTC) and is protected by copyright. It was prepared for use as a tool to assist our member companies in the development of their own company policy. It has been reviewed by attorneys to insure it is in compliance with all Federal Motor Carrier Safety Regulations at the time it was written and is recommended for use to our members without changes. Although it is our goal to keep you apprised of regulatory changes that might affect the content of this policy via our quarterly newsletters and special communiqués, we cannot guarantee compliance with Federal, State or Local laws. I understand that The National Association of Small Trucking Companies (NASTC) prepared this policy for the purpose of assisting us in the formulation of our own policy and understand that the responsibility for the content of the policy we issue is ours alone. I agree to honor the copyright and distribute this policy, or any copies of this policy, before and after it is customized, to only my company s officers, employees and independent contractors operating under my company s authority. Name of company official (please print) Signature ===================================================================== I would like to order the following copies of my customized company policy: Quantity Description Price Total 1 Master Copy $95.00 n/c-included Additional Master Copy In 3 ring binder $10.00 Driver Copies Spiral bound $ 7.00 Driver copies In 3 ring binder $10.00 Master Copies are single sided to simplify editing, printing or copying Driver Copies are double sided to reduce volume and conserve paper Shipping Charges will be added to each order FAX Completed Order Form to NASTC at Call if you have any questions at

9 The National Association of Small Trucking Companies 104 Stuart Drive Hendersonville, TN (615) FAX (615) DRIVER ROSTER Attn: NASTC Company Name: Date: Driver Name SS#

10 Motor Carrier s Name Address US DOT # Driver Employment Application Applicant Name: Social Security #: Current Address: Date of Birth: City: St. Zip Residence Past 3 Years Address: City: St. Zip How Long? Address: City: St. Zip How Long? Address: City: St. Zip How Long? Experience and Qualifications - Driver MAKE A PHOTO COPY OF THE DRIVERS LICENSE AND MEDICAL CERTIFICATE Applicant list the states and license numbers of all licenses held for the past 3 years. STATE LICENSE # EXPIRATION DATE CLASS A, B, ENDORSEMENTS Equipment Class Straight Truck Tractor Semi Trailer Tractor with Doubles Tractor with Triples Tractor with Tank Other Type of Equipment Van,Flat,Tank,etc DRIVING EXPERIENCE DATES From To Approx # of Miles Total DATE Accidents/Crashes for the past 3 years or more Nature of Accident (Backing, Head-on, Rollover, Turning) Fatalities Injuries Applicant s Signature DATE The National Association of Small Trucking Companies

11 Date of Conviction Moving Traffic Convictions and Forfeitures for the past 3 years. Offense Location Type of Motor Vehicle Operated A. Have you ever been denied a license, permit or privilege to operate a motor vehicle? [ ] Yes [ ] No B. Has any license, permit or privilege ever been revoked? [ ] Yes [ ] No If yes attach statement giving details. This company requires all Drivers who drive Commercial Motor Vehicles (CMV) which require a Commercial Drivers License (CDL), to be controlled substances tested with a negative result prior to driving. Do you consent to such Testing? [ ] Yes [ ] No EMPLOYMENT RECORD All for past 3 years and Commercial Driving Experience for the past 10 years Last Employer: Position held: From: To Address: City: ST: Telephone #: Reason For Leaving: While employed there were you subject to the Federal Motor Carrier Safety Regulations [ ] Yes [ ] No Was the duties and responsibilities designated as a safety sensitive function in any DOT regulated mode subject to alcohol and controlled substances testing requirements as required by 49 CFR part 40 [ ] Yes [ ] No Last Employer: Were you subject to the Safety Position held: From: To Regulations while employed Address: City: ST: [ ] Yes [ ] No Telephone #: Reason For Leaving: While employed there were you subject to the Federal Motor Carrier Safety Regulations [ ] Yes [ ] No Was the duties and responsibilities designated as a safety sensitive function in any DOT regulated mode subject to alcohol and controlled substances testing requirements as required by 49 CFR part 40 [ ] Yes [ ] No Last Employer: Were you subject to the Safety Position held: From: To Regulations while employed Address: City: ST: [ ] Yes [ ] No Telephone #: Reason For Leaving: While employed there were you subject to the Federal Motor Carrier Safety Regulations [ ] Yes [ ] No Was the duties and responsibilities designated as a safety sensitive function in any DOT regulated mode subject to alcohol and controlled substances testing requirements as required by 49 CFR part 40 [ ] Yes [ ] No Last Employer: Were you subject to the Safety Position held: From: To Regulations while employed Address: City: ST: [ ] Yes [ ] No Telephone #: Reason For Leaving: While employed there were you subject to the Federal Motor Carrier Safety Regulations [ ] Yes [ ] No Was the duties and responsibilities designated as a safety sensitive function in any DOT regulated mode subject to alcohol and controlled substances testing requirements as required by 49 CFR part 40 [ ] Yes [ ] No Last Employer: Were you subject to the Safety Position held: From: To Regulations while employed Address: City: ST: [ ] Yes [ ] No Telephone #: Reason For Leaving: While employed there were you subject to the Federal Motor Carrier Safety Regulations [ ] Yes [ ] No Was the duties and responsibilities designated as a safety sensitive function in any DOT regulated mode subject to alcohol and controlled substances testing requirements as required by The National Association of Small Trucking Companies

12 49 CFR part 40 [ ] Yes [ ] No Last Employer: Were you subject to the Safety Position held: From: To Regulations while employed Address: City: ST: [ ] Yes [ ] No Telephone #: Reason For Leaving: While employed there were you subject to the Federal Motor Carrier Safety Regulations [ ] Yes [ ] No Was the duties and responsibilities designated as a safety sensitive function in any DOT regulated mode subject to alcohol and controlled substances testing requirements as required by 49 CFR part 40 [ ] Yes [ ] No This certifies that this application was completed by me, and that all entries on it and information in it are true to the best of my knowledge. Applicant s Signature DATE Before submitting this application, this is to inform you that the information you provide in this application will be used to contact your previous employers for the purpose of investigating your previous employment and safety performance history, including your drug and alcohol testing results while employed at your previous employers. That we will contact the State(s) in which you currently or have held a Commercial Driver s License in the last 3 years to obtain a record of your driving history. We will also obtain from the U.S. Department of Transportation, Federal Motor Carrier Safety Administration the information it has on you relating to the last 3 years of Safety and 5 years of crash history. I certify that this application was completed by me, that all entries on it are true and complete to the best of my knowledge, and that I have authorized the release of the information indicated above. Signature Date Addendum I, (print name) hereby authorize my previous employer s to release any and all information relating to my driving, operating and employment history to NASTC, Inc. as required by 49 CFR and and other applicable parts of the regulations. 1. Any and all information relating to my employment history 2. Any and all information relating to my driving and accident history. 3. Any and all information relating to drug and alcohol tests 4. My driving record from the State(s) in which I currently have or have had a Driver s License in the last 3 years. 5. Roadside Inspection and Crash Data from the U.S. Department of Transportation, Federal Motor Carrier Safety Administration dating back to five years. 6. At least once every twelve (12) months hereafter, obtain a driving record from each state in which I hold a driver s license during that period. (Date) (Applicant s signature) The National Association of Small Trucking Companies

13 Driver s Statement of Driver s On-Duty Hours (Previous 7 days statement) Instructions: 49 CFR 395.8(j)(2) Motor carriers, when using a driver for the first time or intermittently, shall obtain from the driver a signed statement giving the total time on duty during the immediately preceding 7 days and the time at which the driver was last relieved from duty prior to beginning work for the motor carriers. 49 CFR On duty time includes driving and working time for another motor carrier and/or performing any compensated work for a person who is not a motor carrier. Driver s Name (please print) Social Security No. (last 4 numbers only) Day Date Hours Worked Total Hours I hereby certify that the information given above is true and correct. I was last relieved from duty at am pm on Time Day Month Year Driver s Signature Date