YOU MUST REGISTER IF YOU ARE A PRIVATE OR FOR-HIRE MOTOR CARRIER OPERATING:



Similar documents
APPLICATION FOR AN INTRASTATE MOTOR CARRIER CERTIFICATE

PART 387. Minimum Levels of Financial Responsibility for Motor Carriers. (Interstate and Intrastate Commerce)

FLORIDA DEPARTMENT OF AGRICULTURE AND CONSUMER SERVICES

New Medical Certification Requirements A Guide for Commercial Driver s License (CDL) Holders

Driver s Application for Employment Applicants will be tested for illegal drugs

GEORGIA DEPARTMENT OF PUBLIC SAFETY MCCD, REGULATIONS COMPLIANCE P.O. Box 1456 ATLANTA, GEORGIA (404) OR (404)

CLASS B LIMOUSINE CARRIER CERTIFICATE

Do I need a USDOT Number?

Authority for $389 in as little as 3 weeks This includes MC, DOT & BOC-3 Any permits you may need can be applied for after you become active

South Carolina Department of Motor Vehicles

TEXAS CITY POLICE DEPARTMENT

TEXAS DEPARTMENT OF TRANSPORTATION GENERAL SERVICES DIVISION INTERSTATE TRANSPORTATION OF GOODS (FREIGHT) SERVICES PUBLICATION

APPLICATION FOR EMPLOYMENT DOT APPLICATION FOR TRUCK DRIVERS

Dear Applicant: Sincerely, Barbara Wasiljov Barbara Wasiljov Administrative Specialist

SELF-CERTIFICATION/MEDICAL EXAMINER S CERTIFICATION FACT SHEET

TRANSPORT WORLDWIDE, LLC

ALL AMERICAN TRUCKING CO. LLC Carrier Sign on Checklist

Individual LLC Partnership Corporation Joint Venture Trust Principal or Majority Owner (please include all principals)

Application for Employment

Federal Motor Carrier Safety Administration, DOT Pt. 376 SUBPART I RESOLVING DISPUTES WITH MY MOVER WHAT MAY I DO TO RESOLVE DISPUTES WITH MY MOVER?

BOAT. TRANSPORTERS NMMA Transportation Task Force FOR. Recommended BEST PRACTICES. nmma.org GOVERNMENT RELATIONS

BROKER CARRIER AGREEMENT. THIS AGREEMENT is made and entered into on, 200, by and between REED FREIGHT SERVICES, INC. ( BROKER ) and ("CARRIER").

Fleet Registration Instruction Manual

BEFORE THE NORTH CAROLINA UTILITIES COMMISSION RALEIGH, NORTH CAROLINA APPLICATION FOR CERTIFICATE OF EXEMPTION TO TRANSPORT HOUSEHOLD GOODS

Canal Truck Insurance Application

Vehicle Registration and Licensing Minnesota Trucking Regulations

HAZARDOUS MATERIALS TRANSPORTATION ACT Act 138 of The People of the State of Michigan enact:

Kentucky Transportation Cabinet Department of Vehicle Regulation Division of Motor Carriers Charter Bus Authority Application

TDF 1(07-13) APPLICATION FOR INTRASTATE MOTOR CARRIER LICENSE 1. USDOT Number FEIN/SSN Applicant Doing business as (trade name if any)

APPLICATION FOR CERTIFICATE OF AUTHORITY - BUS

Obtaining and Maintaining Minnesota Intrastate For-Hire Operating Authority Minnesota Trucking Regulations

CURRENT SPECIAL PROVISIONS FOR LIABILITY INSURANCE

TABLE OF CONTENTS. Contact Information Regarding Fleet Operations...2. Driver Qualifications...3. Fleet Operations...4. Use of Personal Vehicles...

Ritter Plumbing Co., Inc. Application for Employment (An Equal Opportunity Employer)

Drivers first day of driving (hire date) (for company use only)

To separate a composite load into individual shipments and route to different destinations.

INFORMATION NEEDED FOR FILING YOUR APPLICATION TO BECOME A CARRIER

STANDARD TORT CLAIM FORM PACKET

STATE OF CALIFORNIA FARM LABOR CONTRACTOR LICENSE. Forms & Instructions. Contents:

NC General Statutes - Chapter 20 Article 13 1

Your base jurisdiction is determined by your answers to the following questions:

US DOT Employment Application

Individual LLC Partnership Corporation Joint Venture Trust Principal or Majority Owner (please include all principals)

APPLICANT INSTRUCTIONS / INFORMATION

The Colorado State Patrol Commercial Vehicle Safety Units January 2011

IMPORTANT NOTICE REGARDING BACKGROUND REPORTS FROM THE PSP Online Service

EXHIBIT D INSURANCE REQUIREMENTS

SLM BROKERS GEHR RD WAYNESBORO PA PHONE: FAX:

Workers Compensation Coverage Verification Form

Assembly Bill No. 175 Committee on Transportation

Form 503 General Information (Assumed Name Certificate) Commentary

Trucker s Handbook PUB 194 (2-15)

Commercial Motor Vehicle Marking. And Identification Regulations

FACT SHEET. Involuntary Transfer of Ownership of a Vehicle by Court Order

DMV. OREGON TRAFFIC ACCIDENT AND INSURANCE REPORT Tear this sheet off your report, read and carefully follow the directions.

BROKER AND CARRIER AGREEMENT

APPLICATION FORM MANITOBA SAFETY FITNESS CERTIFICATE (SFC) for Regulated Vehicles

THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. PERSONAL INJURY PROTECTION COVERAGE MINNESOTA

TEXAS NON-SUBSCRIBER OCCUPATIONAL ACCIDENT INSURANCE POLICY APPLICATION

New Medical Certification Requirements A Guide for Commercial Driver s License (CDL) Holders Frequently Asked Questions (FAQs)

OREGON TRAFFIC ACCIDENT AND INSURANCE REPORT

Application for Emergency or Temporary Authority To Transport Passenger or Household Goods

REMARKS: VEHICLE IDENTIFICATION NUMBER (VIN) OREGON TITLE # MAKE DIESEL HYBRID ELECTRIC PROPANE

Reference #: Date. Received: police report, Last Name. Middle Name. 2. Date of Birth: 4. Social Security. Zip Code. Apt # City. State. State.

RULES OF THE DEPARTMENT OF PUBLIC SAFETY

Kentucky Transportation Cabinet Department of Vehicle Regulation Division of Motor Carriers Transportation Network Company Authority Application

Prefiled pursuant to Article III, Section 2(A)(4)(b)(i) of the Constitution of Louisiana.

COMMERCIAL VEHICLE CERTIFICATE AND INSURANCE REGULATION

Cigna Health and Life Insurance Company (Cigna) Texas Individual and Family Plan Enrollment Application / Change Form

Truck Application DESCRIPTION OF OPERATIONS. LIABILITY COVERAGE Complete for desired coverages by indicating limits of insurance.

NEW YORK MOTOR VEHICLE NO-FAULT INSURANCE LAW COVER LETTER POLICYHOLDER POLICY NUMBER DATE OF ACCIDENT CLAIM NUMBER

Present in Person or Mail the Standard Tort Claim Form and Supporting Documents to:

DRIVER EMPLOYMENT APPLICATION Name (first, middle, last) Date: Hire Date (office use only) New Hire Re-Hire Position Applying For: Full Time Part Time

Large Fleet Trucking Program Guidelines (20+ power units)

SUBCHAPTER H. CANCELLATION, DENIAL, AND NONRENEWAL OF CERTAIN PROPERTY AND CASUALTY INSURANCE COVERAGE 28 TAC , , AND 5.

Designated Agent means the party with which the division contracts under Section , C.R.S.

( or the Virginia DMV website ( for information regarding the differences between these two plans.

Home Inspector License Application

FICA Alternative Plan Direct Rollover Request

NEBRASKA ADMINISTRATIVE CODE

Chapter GEORGIA AUTOMOBILE INSURANCE PLAN

NEW YORK CHANGES IN BUSINESS AUTO, BUSINESS AUTO PHYSICAL DAMAGE, MOTOR CARRIER AND TRUCKERS COVERAGE FORMS

Form 636 General Information (Certificate of Conversion of a Limited Liability Company Converting to a Corporation) Commentary. Instructions for Form

KENTUCKY DEPARTMENT OF REVENUE OFFER IN SETTLEMENT APPLICATION CHECKLIST. Form 12A018 (08/12)

domicile, including but not limited to Personal Injury Protection (PIP) and Personal Property insurance (PPI), must be carried.

Example Oregon carrier. The answer is no.

Instructions for Completing the Intermodal Equipment Provider Identification Report Application for U.S. DOT Number (MCS-150C)

Contingent Liability Application (Bobtail & Deadhead)

Transcription:

General Information for Original Texas Motor Carrier Application, PO BOX 12984, Austin, Texas 78711-2984 Form 1899 (Rev. 2/04) Page 1 of 5 YOU MUST REGISTER IF YOU ARE A PRIVATE OR FOR-HIRE MOTOR CARRIER OPERATING: a vehicle or a combination of vehicles with a gross weight, registered weight, or gross weight rating in excess of 26,000 pounds, which is designed or used for the transportation of cargo in furtherance of any commercial enterprise; a tow truck, regardless of the gross weight rating (if you are unsure whether or not the vehicle is a tow truck, contact 1-800-299-1700 and select option 3, then 1 from the automated menu); a vehicle designed or used to transport more than 15 passengers (including the driver); a vehicle, regardless of gross weight rating, used to transport hazardous materials in a quantity requiring placarding as defined in the Federal Hazardous Materials Transportation Act (49 U.S.C. 5101); or VEHICLES EXEMPTED FROM THE ABOVE LIST ARE: vehicles used exclusively in interstate commerce under USDOT/FMCSA/FHWA/ICC Permit or Certificate or Registration and currently registered under the Single State Registration System (SSRS); vehicles operated by a foreign motor or motor private carrier defined in 49 USC 13102 and currently registered under the SSRS. cotton vehicles registered in accordance with the Texas Transportation Code, 502.277; vehicles transporting LP Gas and registered with the Texas Railroad Commission pursuant to the Texas Natural Resources Code, 113.131 and 116.072; vehicles transporting liquor under a private carrier permit issued in accordance with the Texas Alcoholic Beverage Code, Chapter 42; motor vehicles used to transport passengers operated by an entity whose primary function is not the transportation of passengers, such as a vehicle operated by a hotel, daycare center, public or private school, nursing home, or similar organization; farm vehicles with a gross weight, registered weight, and gross weight rating of less that 48,000 lbs. used to transport your own product, equipment and supplies; or vehicles operated by a governmental entities. To properly file the application you must: complete the application in its entirety (signature is required); enclose the appropriate fees; 1. Application filing fee 2. Vehicle fees: Registration may be obtained for the duration of 7 days, 90 days, 1 year (annual), or 2 years (biennial). If selecting 2-year registration, the fee is $20 for each vehicle. For 2-year registration of tow trucks, the fee is $50 for each tow truck. Household goods carriers may not obtain a 7-day or 90-day certificate of registration. 3. Insurance filing fee. 4. Payment of fees may be in the form of a check, cashier s check, or money order payable to the Texas Department of Transportation; or MasterCard, Visa, American Express, Discover, or Escrow Account. A $1 processing fee will be charged for all credit card transactions. ALL FEES ARE NON-REFUNDABLE. file proof of liability insurance on a Form E or E2 (contact your insurance agent); file proof of cargo insurance on a Form H (Uniform Motor Carrier Cargo Certificate of Insurance) accompanied by a Form I (Uniform Motor Carrier Cargo Insurance Endorsement). This requirement applies only to household goods carriers or tow truck carriers that perform non-consent tows (contact your insurance agent). NOTE: The Texas Department of Transportation will notify the applicant of any deficiencies. If the applicant does not comply within 45 days of the notification, the application will be withdrawn and the department will retain all fees. A new application with appropriate fees will be required. Notice To Interstate Carriers Registering As A Texas Motor Carrier: You can receive credit for fees paid to Texas under the Single State Registration System. Please check with your base state to determine the amount paid for Texas so proper fees can be calculated. A copy of your Single State Receipt must be submitted with the Original Motor Carrier Application to verify the correct amount owed to Texas.

Original Texas Motor Carrier Application PO Box 12984, Austin, Texas 78711-2984 Form 1899 (Rev. 2/04) Page 2 of 5 Please type or print legibly in blue or black ink Check here if oversize/overweight permit is needed By signing and submitting this application, I certify that the information provided on this form is true and correct, that I am authorized to execute and file this document on behalf of the motor carrier, and that the motor carrier: (1) is in compliance with the drug testing requirements contained in 49 C.F.R. Part 382; (2) has knowledge of, and will conduct operations in accordance with, applicable federal and state laws and rules relating to motor carrier safety, including Texas Transportation Code, Chapters 541-600, 643, and 644; and (3) has the required insurance as set forth in 43 TAC 18.16. THIS IS A GOVERNMENT RECORD. FALSIFYING INFORMATION ON GOVERNMENT RECORDS IS A FELONY. Name of Motor Carrier Street Address (Physical address must be provided) Mailing Address (If different from physical address) Business Phone ( ) - Fax ( ) - Applicant is a(n) Corporation Partnership Individual Social Security Number (Required by State law) - - Company Owner, Partners or Corporation Officers (attach additional sheet if necessary) Does this carrier belong to a drug-testing consortium? Yes No If "Yes" is checked, please list the names of all persons operating the consortium (attach an additional sheet if necessary). Registration 1-year 2-year Duration 7-day 90-day Type No. Type of Motor Carrier Operation (More than one cargo type may be checked) Persons Operating Consortium: 1. 2. NOTE: Household goods carriers may not obtain 7- day or 90-day registration Insurance Requirements (See reverse side for required limits) 1. Hazardous Materials (HAZ) $1 million OR $5 million 2. Tow Truck (TOW) $300,000 OR $500,000 Does carrier perform non-consent tows? Yes No $50,000 per vehicle cargo insurance (If carrier performs non-consent tows) 3. Passenger (BUS) No. of passengers: $500,000 OR $5 million 4. Foreign Bus (BUS) No. of passengers: $1.5 million OR $5 million 5. Household Goods (HHG) $500,000 AND $5,000 cargo insurance (HHG carriers only) 6. Foreign Carriers (Domiciled outside of U.S.A.) $750,000 7. Other than 1 through 6 above (OTHER) $500,000 Legal Agent and Texas Address for Service of Process. For the purpose of administrative or civil service, each out-of-state motor carrier shall have and continuously maintain with the department a legal agent domiciled in Texas. A Texas-domiciled motor carrier that has a legal agent in Texas shall provide the name and address. The legal agent may be a Texas resident, a domestic corporation, or a foreign corporation whose primary function is to serve as an agent of process in Texas with a Texas address (P.O. Box may not be used). Legal Agent s Name Phone ( ) - Street Address Applications may be faxed to (512) 465-3521 if paying by credit card or if no fees are due. Please do not mail this document if faxed. Allow 3 business days before calling to verify receipt of faxes. To be Completed by Applicant Payment Method (Make payable to Texas Department of Transportation) ALL FEES ARE NON-REFUNDABLE Application Filing Fee $100 $ (1-year or 2-year Registration) Check, Cashier s Check or Money Order Application Filing Fee Escrow/PAC Account Number: $25 $ (90-day Registration) MasterCard, Visa, Discover, or American Express (A $1 fee will be charged) Application Filing Fee $5 (7-day Registration) $ $100 Liability Insurance Filing Fee $ Credit Card Account Number: Expiration Date: Cargo Insurance Filing Fee $100 (HHG carriers or tow truck carriers that $ perform non-consent tows) Signature of Owner, Partner, Officer or Authorized Agent Printed/Type Total Vehicle Fees From page 4, Motor Carrier Equipment Report Total Amount Remitted $ The Texas Department of Transportation maintains the information collected on this form. With a few exceptions, you are entitled upon request to be informed about the information that we collect about you. Under 552.021, 552.023, and 559.004 of the Texas Government Code, you are entitled to receive and review this information, and to have us correct erroneous information. $

Form 1899 (Rev. 2/04) Page 3 of 5 Insurance Requirements PO Box 12984, Austin, Texas 78711-2984 Before an application is approved, an insurance company authorized to do business in Texas must provide proof of required insurance. Liability insurance coverage is filed on a Form E or E2 and is submitted with the carrier s Texas Motor Carrier Application. Please do not submit a Form E with limits. This will result in the form being returned. Household goods carriers or tow truck carriers that perform nonconsent tows are also required to provide proof of cargo insurance on a Form H and I. Each insurance filing must be accompanied by a $100 filing fee made payable to the Texas Department of Transportation. All insurance filing forms are available through your insurance company. Type No. and Type of Motor Carrier 1 - HAZ Description Transporters of Hazardous Substances (regardless of weight) a. Hazardous substances, as defined in 49 Code of Federal Regulations (CFR) 171.8, transported in cargo tanks, portable tanks, or hopper-type vehicles, with capacities in excess of 3,500 water gallons; or any quantity of Division 1.1, 1.2, and 1.3 materials, any quantity of Division 2.3, Hazard Zone A, or Division 6.1, Packing Group I, Hazard Zone A material; in bulk Division 2.1 or 2.2; or highway route controlled quantities of a Class 7 material, as defined in 49 CFR 173.403. Minimum Insurance Requirement $5,000,000 2 - TOW 3 - BUS 4 - BUS 5 - HHG 6 b. Oil listed in 49 CFR 172.101: hazardous waste, hazardous materials, and hazardous substances as defined in 49 CFR 171.8 and listed in 49 CFR 172.101, but not mentioned in paragraphs (a) or (b) of this subsection and petroleum products that are lubricants or fuels Tow Truck Carriers a. Gross weight, registered weight, or gross weight rating of 26,000 pounds or less b. Gross weight, registered weight, or gross weight rating over 26,000 pounds c. In addition to automobile liability insurance described above, tow truck carriers that perform non-consent tows must file a Form H (Uniform Motor Carrier Cargo Certificate of Insurance) accompanied by a Form I (Uniform Motor Carrier Cargo Insurance Endorsement) with the following limits Bus Operators a. Vehicles designed or used to transport more than 15 passengers (including the driver) but less than 26 passengers (not including the driver) b. Vehicles designed or used to transport 26 passengers or more (not including the driver) Foreign Domiciled Bus Operators $1,000,000 $300,000 $500,000 $50,000 per vehicle $500,000 $5,000,000 a. Vehicles designed or used to transport 15 passengers or less (including the driver) $1,500,000 b. Vehicles designed or used to transport 16 passengers or more (including the driver) $5,000,000 Household Goods Movers In addition to automobile liability insurance as described in number 7 below, cargo insurance must be filed on Form H (Uniform Motor Carrier Cargo Certificate of Insurance) accompanied by a Form I (Uniform Motor Carrier Cargo Insurance Endorsement) with the following limits Per Shipment $5,000 Aggregate $10,000 Foreign Carriers (Domiciled outside of the U.S.A.) transporting cargo other than cargo listed above $750,000 7 - OTHER All Others Private or for-hire motor carriers with a gross weight, registered weight, or gross weight $500,000 rating in excess of 26,000 pounds Note: Motor carriers whose primary business is transportation for compensation or hire, and who operate between two or more incorporated cities, towns, or villages, shall provide worker s compensation or accident insurance coverage for all employees. (Not filed with TxDOT.)

Motor Carrier Equipment Report PO BOX 12984, Austin, Texas 78711-2984 CERTIFICATE NUMBER Form 1899 (Rev. 2/04) Page 4 of 5 By signing and submitting this application, I certify that the information provided on this form is true and correct, that I am authorized to execute and file this document on behalf of the motor carrier, and that the motor carrier: (1) is in compliance with the drug testing requirements contained in 49 C.F.R. Part 382; (2) has knowledge of, and will conduct operations in accordance with, applicable federal and state laws and rules relating to motor carrier safety, including Texas Transportation Code, Chapters 541-600, 643, and 644; and (3) has the required insurance as set forth in 43 TAC 18.16. FALSIFYING INFORMATION ON GOVERNMENT RECORDS IS A FELONY. INSTRUCTIONS Type or print legibly in blue or black ink. Provide all required information on all vehicles. This form will be returned if not signed. List each vehicle you will operate. Do not list trailers. If additional space is needed, please make a copy of this page. Name of Motor Carrier Street Address (Physical Address Must be Provided) Business Phone ( ) Mailing Address (If Different from Physical Address) Type of Motor Carrier Make of Truck TOW = Tow Truck HAZ = Hazardous HHG = Household Goods BUS = Bus OTHER = Other Cargo Not Listed Unit Number Year of Vehicle COMPLETE Vehicle Identification Number (VIN) Type of Motor Carrier Operation TOW HAZ HHG BUS OTHER 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. Applications may be faxed to (512) 465-3521 if paying by credit card or if no fees are due. Please do not mail original application if faxed. Allow 3 business days before calling to verify receipt of faxes. Payment Method (Make payable to the Texas Department of Transportation) Check, Cashier s Check or Money Order Escrow/PAC Account Number: MasterCard, Visa, Discover, or American Express (A $1 fee will be charged for all credit card transactions.) Credit Card Account Number: Expiration Date: To be Completed by Applicant (FEES ARE NON-REFUNDABLE) Registration Duration (Check One): 1-year 2-year For 1-year Registration: Number of Tow Trucks X $25 = $ Number of Other Vehicles X $10 = $ For 2-year Registration: Number of Tow Trucks X $50 = $ Number of Other Vehicles X $20 = $ TOTAL VEHICLE FEES $ Signature of Owner, Partner, Officer or Authorized Agent X Print or Type : The Texas Department of Transportation maintains the information collected on this form. With a few exceptions, you are entitled upon request to be informed about the information that we collect about you. Under 552.021, 552.023, and 559.004 of the Texas Government Code, you are entitled to receive and review this information, and to have us correct erroneous information.

Form 1899( Rev. 2/04) Page 5 of 5 Make of Truck Unit Number Year of Vehicle COMPLETE Type of Motor Carrier Operation Vehicle Identification Number (VIN) TOW HAZ HHG BUS OTHER 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. 15. 16. 17. 18. 19. 20. 21. 22. 23. 24. 25. 26. 27. 28. The Texas Department of Transportation maintains the information collected on this form. With a few exceptions, you are entitled upon request to be informed about the information that we collect about you. Under 552.021, 552.023, and 559.004 of the Texas Government Code, you are entitled to receive and review this information, and to have us correct erroneous information.

HAVE YOU: Check List for Original Texas Motor Carrier Application and Equipment Report PO Box 12984, Austin, Texas 78711-2984 Provided the same name on the application and equipment report? Provided your Social Security Number if you are filing as an individual? Provided names of corporate officers or partners if you are filing as a corporation or partnership? Selected registration duration? 7-day or 90-day registration with effective and expiration dates or 1-year registration or 2-year registration Marked the boxes indicating the type of motor carrier operation and the amount of insurance coverage required? HAZ - Hazardous Materials TOW - Tow Truck (check box to indicate if carrier performs non-consent tows) BUS - Bus HHG - Household Goods OTHER - Other Cargo Not Listed Provided a legal agent, if applicable? Enclosed a check, cashier s check, or money order payable to the Texas Department of Transportation, or provided your credit card information for the following fees? Application fees $100 or $25 (90-day registration) or $5 (7-day registration) $100 fee per insurance filing Vehicle fees $10 per vehicle for 7-day, 90-day, or 1-year registration of vehicles other than tow trucks or $20 per vehicle for 2-year registration of vehicles other than tow trucks or $25 per tow truck for 7-day, 90-day, or 1-year registration or $50 per tow truck for 2-year registration. Requested from your insurance company proof of automobile liability insurance to be filed on a Form E or E-2? Insurance filings must show effective and expiration dates for 7-day and 90-day registration. Insurance filings must be in the same name as shown on your application. Requested from your insurance company proof of cargo insurance to be filed on a Form H accompanied by a Form I (household goods carriers or tow truck carriers that perform non-consent tows)? Completed the fee and payment information on both the Original Texas Motor Carrier Application and Motor Carrier Equipment Report? Included the make of each truck, unit number, year of vehicle, COMPLETE vehicle identification number (VIN) and the type of motor carrier operation on the equipment report? Signed the application and equipment report? Your Application Will Be Delayed If ALL Information Is Not Submitted Your Application Will Be RETURNED For Failure To Provide Fees Or Proof Of Insurance