CG-950A Application for Special Permit

DEPARTMENT OF
TRANSPORTATION
U.S. COAST GUARD
CG-950A (Rev. 4-00)

APPLICATION FOR SPECIAL PERMIT

FORM APPROVED
OMB
NO. 2115-0133

An agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a valid OMB control number.
The Coast Guard estimates that the average burden for this report is 10 minutes. You may submit any comments concerning the accuracy of this burden estimate or any
suggestion reducing the burden to: Commandant (G-MOC), U.S. Coast Guard, Washington, DC 20593-0001 or Office of Management and Budget, Paperwork Reduction
Project (2115-0578), Washington, DC 20503.
INSTRUCTIONS
1.
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3.

This form should be completed to the fullest extent possible. Incomplete information will delay processing of this application and may be cause for denial of special
permit issuance.
Upon completion, this form should be mailed or delivered to the Coast Guard’s senior operational commander for the Marine Event of National Significance. For
foreign (non-U.S.)-flag vessels, a copy of the official safety certificates issued by the vessel’s flag authority should be included with this application. Any
supplemental authorizations issued by the flag authority for the event should also be included.
Questions concerning this form, including address information for mailing, can be directed to your event sponsor or to Commandant (G-MOC).

Date of Request:
Marine Event of National Significance (title):
Date/Period of Vessel Participation in Event:
U.S. Ports to be visited:
(date/location)

Vessel Name:

Flag of Registry:

Official (IMO) Number:

Gross Tonnage:

Owner Information:

Operator Information:

Name:
Address:

Phone:
Email:
1

Public Vessel? (Y/N):

2

3

Certified by Flag Authority? (Y/N):

Valid Load Line Certificate? (Y/N):

4

Certificate of Financial Responsibility (COFR)? (Y/N):

5

Engaged in Commercial Service? (Y/N):

Moored Attraction Vessel? (Y/N):

Maximum number of Passengers and/or Sail Trainees to be carried during the event:
Passengers:
Sail Trainees:

DEPT. OF TRANSPORTATION, USCG, CG-950A

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APPLICATION FOR SPECIAL PERMIT
Vessel Name:

Primary Lifesaving Equipment (indicate number & capacity for each):
Lifeboats
Liferafts
Bouyant Apparatus
Life Preservers (number adult/children)

Firefighting Systems/Equipment:
Fixed extinguishing systems (space protected/type)
e.g. engine room/CO2
Portable extinguishers (number/type)
e.g. 2 / 20lb dry chem.

The undersigned hereby certifies that sufficient safety arrangements will be made as necessary for the safety of the lives of
passengers on board in case of accident.

Master, Owner, or Agent

FOOTNOTES:
1. “Public Vessel” means a vessel that is owned, or demise chartered, and operated by the United States Government or a government of
a foreign country and is not engaged in commercial service.
2. “Commercial Service” includes any type of trade or business involving the transportation of goods or individuals, except service
performed by a combatant vessel.
3. The Coast Guard will request detailed safety information for vessels lacking Flag certification in the form of either IMO certificates
(Passenger Ship Safety or Special Purpose Ship Code certificates) or other official designation by the Flag authority.
4. A Certificate of Financial Responsibility (COFR) is required for all self-propelled (motor or sail) vessels over 300 gross tons, with the
exception of public vessels.
5. “Moored Attraction Vessel” means a vessel that takes on passengers while moored and charges for admission. Such vessels are
subject to inspection as passenger vessels; Coast Guard Moored Attraction Vessel policy will apply.
DEPT. OF TRANSPORTATION, USCG, CG-950A

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