Form MCS-150A Safety Certification for Application for USDOT Number

Revised Instructions for MCS-150A Form,
Safety Certification for Application for USDOT Number
Topic
I.
II.
III.
IV.
V.
VI.
VII.
VIII.

Page

Federal Motor Carrier Safety Administration (FMCSA) Overview .......................................................................................1
Who Must File .....................................................................................................................................................................1
Purpose of Filing .................................................................................................................................................................1
Exemptions from Filing .......................................................................................................................................................2
Filing Options ......................................................................................................................................................................2
Getting Started....................................................................................................................................................................3
Step-By-Step Instructions ...................................................................................................................................................3
Safety Certification for Application for USDOT Number (MCS-150A form) .........................................................................7

I. Federal Motor Carrier Safety Administration (FMCSA) Overview
The Federal Motor Carrier Safety Administration (FMCSA) registration process requires that companies define the type of
business operation (Motor Carrier, Broker, Shipper, Freight Forwarder and/or Cargo Tank Facility) they plan to establish.
FMCSA’s responsibilities include monitoring and enforcing compliance with the Federal Motor Carrier Safety Regulations
(FMCSR) and the Hazardous Materials Regulations (HMR) governing both safety and commerce. The Agency’s focus on both
concerns—safety and financial responsibility—is reflected in the dual path of its current registration process. Companies may
find that they are subject to both registration requirements—USDOT Number (Forms MCS-150, MCS-150A, MCS-150B) and
Interstate Operating Authority (Forms OP-1, OP-1(P), OP-1(FF), OP-1(MX), or OP-2).
FMCSA encourages all applicants with Internet access to use our online registration assistant
(http://www.fmcsa.dot.gov/online-registration) to determine all FMCSA registration requirements. For applicants that do not
have Internet access, FMCSA can mail instructions, forms, and other materials designed to assist in the off-line registration
process; call FMCSA at 1-800-832-5660.
These instructions assume that the applicant has determined that a USDOT Number is required and that the MCS-150A form
must be submitted.

II. Who Must File
In most cases, to obtain a USDOT Number (required to operate as a Motor Carrier in interstate commerce), applicants must
file an MCS-150A form in conjunction with either an MCS-150 Motor Carrier Identification Report OR an MCS-150B Combined
Motor Carrier Identification Report and HM Permit Application. Interstate commerce is defined as trade, traffic, or
transportation involving the crossing of a State boundary. Either the vehicle, its passengers, or cargo must cross a State
boundary, or there must be the intent to cross a State boundary to be considered an interstate carrier. Intrastate commerce is
trade, traffic, or transportation occurring completely within a single State.
All New-Entrant Motor Carriers beginning their operation on or after January 1, 2003, must now file an MCS-150A Safety
Certification for Application for USDOT Number. A New Entrant is defined as a Motor Carrier not based in Mexico that applies
for a USDOT Number in order to initiate operations in interstate commerce.

III. Purpose of Filing
Section 210(a) of the Motor Carrier Safety Improvement Act (MCSIA) of 1999, now codified as 49 U.S.C. 31144(f), requires
the Secretary of Transportation to establish regulations specifying minimum requirements for applicant Motor Carriers seeking
to operate in interstate commerce. The Federal Motor Carrier Safety Administration (FMCSA) requires applicants to certify that
they have adequate knowledge and procedures in place to comply with the Federal Motor Carrier Safety Regulations
(FMCSR) and the Hazardous Materials Regulations (HMR). This includes applicants certifying they will maintain copies of the
applicable regulations and ensure their employees are also familiar with the regulatory requirements. This certification
requirement is fulfilled by the completion, signing, dating, and submitting of form MCS-150A, Safety Certification for
Application for USDOT Number. Completing these certifications is a one-time responsibility for all New-Entrant Motor Carriers,
and form MCS-150A must be filed with the FMCSA along with the form MCS-150 or MCS-150B, as appropriate, before a
carrier may begin operations.

Instructions for form MCS-150A (Revision 6/29/2007)

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IV. Exemptions from Filing
If the company meets one or more of the following criteria, then filing a Safety Certification for Application for USDOT Number
(MCS-150A) is not required:
x

The company is an active Motor Carrier which began operating prior to January 1, 2003.

x

An individual/company classified as a “vehicle registrant only” by a State motor vehicle agency for purposes of
commercial vehicle registration. The FMCSRs only require interstate Motor Carriers to obtain a USDOT Number. In
select states (see list at www.fmcsa.dot.gov/registration-licensing/registration-USDOT.htm) however, all registrants of
commercial motor vehicles, even non-Motor Carrier registrants, are required to obtain a USDOT Number as a
necessary condition for commercial vehicle registration. State classification as a “vehicle registrant only” means the
State will issue the registration and license plates for commercial vehicles, with the understanding that the vehicles
will not operate as Motor Carriers. Although a USDOT Number is issued, it is provided solely for the purpose of
facilitating State commercial vehicle registration and does not satisfy FMCSA’s safety requirements.
In most instances, commercial motor vehicles are both registered to and operated by the same company under a
single USDOT Number. In the case of “vehicle registrant only” classification, however, the vehicle registrant and the
Motor Carrier responsible for the safe operation of the commercial vehicle are two different entities, each with its own
USDOT Number. In completing the MCS-150 or MCS-150B (which should be done before the MCS-150A), if the
response provided in item number 22 was, “F. Vehicle Registrant Only,” then the MCS-150A is not required.

V. Filing Options
There are two options for filing the necessary forms to obtain a USDOT Number:
x
x

Completing and filing the required forms online, or
Completing a printed copy and mailing to the FMCSA

FMCSA strongly encourages applicants to use the electronic, online process since it has built-in edit checks and
simple yes-and-no questions for easy, accurate completion. It is also significantly faster than applying by mail. The
estimated time to complete the form MCS-150A online is approximately 9 minutes.
x

Option 1: Filing Online (recommended)
o We encourage you to print all related form instructions prior to completing the online forms.
o To complete and submit application form(s), go to: www.fmcsa.dot.gov/online-registration.
o Upon submission, a USDOT Number for the company is issued immediately, if the application is approved.
o FMCSA suggests that you record the USDOT Number that is assigned.

x

Option 2: Filing Paper by Mail
o Submit all required MCS and/or OP forms together.
o Once the application is completed, FMCSA suggests making a copy for the company’s files.
o Mailed applications, on average, take four to six weeks processing time.
o Notification of USDOT Number will be sent to the mailing address provided in items 8-11 of submitted forms.
o Mail completed application form(s) to:

Federal Motor Carrier Safety Administration
Attention: USDOT Number Application
1200 New Jersey Avenue SE
Washington, DC 20590
Note: Applications that are incomplete, unreadable, or unsigned will be rejected and returned via mail, delaying
the receipt of the company’s USDOT Number.

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VI. Getting Started
Prior to completing the form, FMCSA encourages all applicants to review the requirements detailed in the FMCSRs and the
HMRs. The FMCSRs include rules regarding Controlled Substances and Alcohol Use and Testing; Commercial Driver's
License Standards, Requirements and Penalties; Safety Fitness Procedures; Minimum Levels of Financial Responsibility for
Motor Carriers; Filing of Identification Report and Marking of Vehicles; General Qualifications of Drivers; Driving of Commercial
Motor Vehicles; Parts and Accessories Necessary for Safe Operation; Hours of Service of Drivers; Inspection, Repair and
Maintenance; Driving and Parking Rules; Transportation of Migrant Workers; Transportation of Hazardous Materials; and
Rules of Practice for Motor Carrier Safety and Hazardous Materials Proceedings. The HMRs include additional rules regarding
the registration of cargo tank facilities and the registration of persons or companies who offer for transport, or actually
transport, hazardous materials.
The regulations issued by the U.S. Department of Transportation and its operating administrations are published in the Federal
Register and compiled in Title 49 of the U.S. Code of Federal Regulations (CFR). Copies of appropriate volumes of the CFR in
book format may be purchased from the Superintendent of Documents, U.S. Government Printing Office, telephone (202) 5121800. For online access to search, view and print relevant regulations, visit the FMCSA Rules and Regulations Web site at
www.fmcsa.dot.gov/rules-regulations/rules-regulations.htm, or visit the electronic Code of Federal Regulations Web site at
www.gpoaccess.gov/fr/index.html. In addition to the regulations, the FMCSA offers other educational and technical assistance
materials on its Web site at www.fmcsa.dot.gov.
Educational and technical assistance material regarding the requirements of the FMCSRs and HMRs is available to all
applicants. This material can help the new entrant motor carrier operate safely by understanding Federal regulations and
establishing systems to ensure compliance with the FMCSRs. Applicants should access the FMCSA’s “A Motor Carrier's
Guide to Improving Highway Safety” at www.fmcsa.dot.gov/safety-security/eta.
Have a copy of the completed MCS-150 or MCS-150B form available when filling out form MCS-150A. To ensure timely
processing, verify that responses provided in these items is consistent across forms before filing them.

VII. Step-By-Step Instructions
These instructions will assist in the preparation of a complete and accurate MCS-150A application. The instruction numbers
below correspond to the numbered items on form MCS-150A. When completing the application, print clearly in ink or type all
information.
1-17 — All Applicants must complete Items 1 through 17.
Items 1 through 17 correspond to completed Items 1 through 20 (excluding items 9, 12 and 14) information included on forms
MCS-150 or MCS-150B. If filing form MCS-150A online, the system will automatically populate Items 1 through 17 with the
corresponding MCS-150 or MCS-150B information.
18. Safety Certifications — All applicants required to file MCS-150A (subject to the FMCSRs) must complete certification
items 18A through 18B.6, and 18.C (1-3) AND provide an authorized official’s signature and title, and the date, in item 19.
If the company transports Hazardous Materials, then items 18.B.7. (a-e) must also be completed.
If the company operates as a cargo tank carrier engaged in the transport of Hazardous Materials, then item 18.B.8.must also
be completed.
18A. Certification of understanding of current regulations — Applicant certifies that the company maintains current copies
of applicable regulations, including FMCSRs and HMRs, and ensures all company personnel are aware of and understand
current regulations.
18B. Certification of implementing required tasks and measures prior to commencing U.S. Operations — In the
following areas: Driver Qualifications, Hours of Service, Drug and Alcohol Testing, Vehicle Condition, Accident Monitoring
Program, Production of Records, Hazardous Materials (if applicable), and Cargo Tank Transport of Hazardous Materials (if
applicable). This section references the appropriate parts and subparts of Section 49, U.S. Code of Federal Regulations and is
provided to help clarify the intent of what is covered by the certification statement.
1.

Driver Qualifications (49 CFR Parts 383 and 391, www.fmcsa.dot.gov/49cfr-383, www.fmcsa.dot.gov/49cfr391):
a.

Applicants must certify that a system is in place to ensure that all their commercial motor vehicle drivers
meet the minimum qualifications specified in 49 CFR Parts 383 and 391, if applicable, and are properly
licensed for the vehicle(s) driven. The applicant certifies that they are knowledgeable about the requirements
and the specific exemptions for certain drivers.

b.

Applicants must certify that procedures are in place to review each driver's employment record and driving
record for the preceding three years, in accordance with Section 391.23. An investigation designed to gauge
a driver’s qualifications and competence behind the wheel must be made within 30 days of the date of

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employment. The applicant certifies that they are knowledgeable about the requirements and the specific
exemptions for certain drivers.

2.

3.

c.

Applicants must certify that a program is in place to review the driving record of each driver at least once
every 12 months. A note stating the results of this review shall be included in the Driver's Qualification File.
The applicant certifies that they are knowledgeable about the requirements and the specific exemptions for
certain drivers.

d.

Applicants must certify that all drivers are at least 21 years of age, except for those meeting the 391.2
exemption for farm custom operations, apiarian (bee-related) industries, and certain farm vehicle drivers. In
these instances, the applicant certifies that they are knowledgeable about the requirements and the specific
exemptions for certain drivers. Applicants must also be able to certify that each driver possesses a valid
commercial motor vehicle operator's license, commonly known as a Commercial Driver’s License (CDL). In
instances where drivers are operating commercial vehicles not subject to the Commercial Driver’s License
requirements of Part 383, the applicant certifies that they are knowledgeable about the licensing
requirements and are aware that their drivers are required to have a valid operator’s license.

Hours of Service (Part 395, www.fmcsa.dot.gov/49cfr-395):
a.

Applicants must certify that the company has implemented recordkeeping systems and procedures to
maintain and review drivers’ records of duty status for violations of Part 395 of the FMCSRs concerning
driver Hours of Service (HOS) requirements. The applicant’s response certifies that they are knowledgeable
about the requirements and applicable exceptions.

b.

Applicants must certify that the company has ensured drivers are knowledgeable of the HOS requirements
and will comply with the Part 395 regulations, as applicable. Specifically, this certification ensures the
applicant Motor Carrier and its drivers are familiar with and are abiding by applicable 10/11, 14/15, and
60/70-hour rules as well as the requirement for preparing daily log entries in drivers’ own handwriting for
each 24-hour period. The HOS rules apply to all Motor Carriers and drivers, with exceptions found in Section
395.1. Applicants operating under these exceptions must certify that they are knowledgeable about the
specific circumstances under which some drivers may be excepted from the HOS requirements in 49 CFR
Part 395.

Drug and alcohol testing (49 CFR, Part 382, www.fmcsa.dot.gov/49cfr-382, and 49 CFR, Part 40,
www.dot.gov/ost/dapc/NEW_DOCS/part40.html?proc):
a.

4.

Applicants must certify that the company is knowledgeable about and is complying with the drug and alcohol
regulations in 49 CFR Part 382 and 49 CFR Part 40, if applicable and that it has a program in place for
systematic testing of drivers. These requirements include pre-employment, post-accident, random,
reasonable suspicion, return-to-duty, and follow-up testing. Drivers required to have a CDL are subject to the
controlled substance and alcohol testing rules. This requirement extends to those drivers currently covered
by the rule, including interstate and intrastate truck and motor coach operations. Exceptions from these
requirements are outlined in 49 CFR § 382.103(d). Applicants operating under these exceptions are not
required to certify to these requirements and should respond “not applicable” (N/A) to this item.

Vehicle condition (49 CFR, Part 396, www.fmcsa.dot.gov/49cfr-396):
a.

Applicant must certify that the company has a procedure in place to systematically inspect, repair, and
maintain, or cause to be systematically inspected, repaired, and maintained, all motor vehicles subject to its
control as required by 49 CFR Part 396. Motor carriers must maintain the following information for every
vehicle they have controlled for 30 days or more:
x

Identifying information, including company number, make, serial number, year, and tire size

x

A schedule of inspections to be performed, including type and due date

x

Inspection, repair, and maintenance records

x

Records of tests conducted on buses with pushout windows, emergency doors, and marking lights

Every commercial vehicle, including each segment of a combination vehicle, is also required to receive a
periodic inspection meeting the requirements of Section 396.17 at least once every 12 months.
b.

Prior to requiring or permitting a driver to operate or continue to operate a commercial vehicle, every Motor
Carrier or its agent shall ensure repairs are made with regard to any violations and defects listed on
inspection reports. This requirement includes, but is not limited to, violations listed on roadside vehicle
inspections and driver daily vehicle inspection reports.

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5.

Accident monitoring program (Part 390, /www.fmcsa.dot.gov/49cfr-390):
a.

Applicant certifies that it has a program in place for monitoring vehicle accidents and that the company shall
maintain for a period of one year after an accident occurs, an accident register containing at least the
information outlined below.
A list of accidents, containing for each accident:

b.

6.

Date of accident, city or town in which—or most near where—the accident occurred, the State in which
the accident occurred, driver name, number of injuries, number of fatalities, and whether hazardous
materials (other than fuel spilled from the fuel tanks of motor vehicles involved in the accident) were
released.

2.

Copies of all accident reports required by State or other governmental entities or insurers.

Applicants must certify that they have established accident countermeasures and driver training programs to
reduce accidents. The FMCSA Accident Countermeasures Manual (http://www.fmcsa.dot.gov/accidentmanual) was developed to assist Motor Carriers in analyzing their accidents and incidents, and developing
strategies to reduce the number of future occurrences.

Production of records (49 CFR, Part 390, www.fmcsa.dot.gov/49cfr-390):
a.

7.

1.

Applicants must certify they can and will produce all records and documents required by the FMCSRs for
inspection within 48 hours of a request by a special agent or authorized representative of the FMCSA, or
other authorized Federal or State official as required by 49 CFR § 390.29.

Hazardous Materials (49 CFR, Part 107, www.fmcsa.dot.gov/49cfr-107, and 49 CFR, Parts 171-180,
www.fmcsa.dot.gov/49cfr-171):

NOTE: Complete this certification only if the Motor Carrier will transport hazardous materials; otherwise indicate “N/A.”
a.

Applicants transporting hazardous materials must certify that they are fully aware of the requirements found
in the U.S. DOT Hazardous Materials Regulations (HMR) and have established training programs for
personnel. A Motor Carrier that transports hazardous materials, whether interstate or intrastate, must comply
with the Federal Hazardous Materials Regulations, 49 CFR 171-180. These regulations include
requirements regarding registration, training, shipping papers, labels, placards, and packages.
An employer engaged in the transport of hazardous materials shall ensure that all employees, as
appropriate, are trained in accordance with the requirements prescribed in subpart H of Part 172 and 49
CFR Part 177.816. The purpose of the training requirements in Part 172 Subpart H of the HMR is to ensure
that each employer trains its employees to safely load, unload, handle, store and transport hazardous
materials. Hazardous materials training must cover general awareness/familiarization, and include functionspecific, safety, and modal-specific training (such as driver training). In addition, drivers must receive training
on the safe operation of motor vehicles that will be transporting hazardous materials, in accordance with
§177.816.

b.

Applicant certifies it has a system and procedures in place for ensuring the inspection, repair, and
maintenance of reusable hazardous materials packaging and for record maintenance in accordance with
HMRs. Periodic testing of reusable packaging, including cylinders, cargo tanks, and intermediate bulk
containers, is necessary to ensure that the packaging continues to perform to the specifications to which it
was originally constructed. For example, cargo tanks require periodic retesting according to the table in
§180.407, while §180.205 contains the general requirements for re-qualification of cylinders. Companies
should be aware of the tests and required frequency of testing for the packaging used.

c.

Applicant must certify that they have a system and procedures in place for filing and maintaining hazardous
materials shipping documents. Each person who provides the shipping paper must retain a copy of the
shipping paper, or an electronic image thereof—as required by §172.200(a) —that is accessible at or
through its principal place of business. For hazardous waste, the shipping paper copy must be retained for
three years after the material is accepted by the initial carrier. For all other hazardous materials, the shipping
paper copy must be retained for 375 days after the material is accepted by the initial carrier.

d.

Hazardous materials carriers must have procedures in place to ensure commercial vehicles are properly
marked and placarded for the material being transported. Placards and labels provide hazard class
information. Additional markings are placed on hazardous materials packaging and transport vehicles to
convey identification numbers and information that labels and placards normally do not provide. The
pleading provisions contained in Part 172, Subparts D-F apply to each person or company who offers a
hazardous material for transport, or who transports a hazardous material subject to the HMR. The HMR
require most vehicles hauling hazardous materials to be placarded. Placards alert people to the potential
dangers associated with the particular hazmat contained in a motor vehicle, freight container, cargo tank or

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portable tank. Placards also help emergency response personnel properly identify and respond to potential
hazards in case of a hazardous materials incident.
e.

8.

No person required to file a registration statement under 49 CFR Part 107, Subpart G, may transport
hazardous materials or cause them to be transported or shipped without a current annual Certificate of
Registration on file. Carriers may register with the Pipeline and Hazardous Materials Safety Administration
(PHMSA) by contacting the registration program at (202) 366-4109 or the Hazardous Materials Information
Center at (800) 467-4922.

For Cargo Tank (CT) Carriers of HM Only (49 CFR Part 180, www.fmcsa.dot.gov/49cfr-180)

NOTE: Complete this certification if the company is a Cargo Tank Carrier of Hazardous Materials; otherwise indicate
“N/A.”
a.

Carriers operating specification cargo tanks must have a system in place to ensure the tanks are tested and
inspected as specified in 49 CFR Part 180. This includes external visual, internal visual, and lining
inspections, as well as pressure and thickness tests. Facilities/individuals conducting this testing and
inspection must be registered with the DOT to conduct these activities as required by 49 CFR Part 107,
Subpart F. Registration is required for persons engaged in the manufacture, assembly, inspection and
testing, certification, or repair of a cargo tank or a cargo tank motor vehicle manufactured in accordance with
a DOT specification.

18C. General certifications —
1.

Applicants must certify that they can and will provide the type of operations or service that they are identifying in
the accompanying MCS-150 or MCS-150B and that they will comply with statutory and regulatory requirements
and regulations issued or administered by the U.S. Department of Transportation.

2.

Applicants must certify that they can and will produce all documents requested to evaluate their compliance with
Federal statutes and regulations. All records and documents must be made available for inspection within 48
hours of a request by a special agent or authorized representative of the Federal Motor Carrier Safety
Administration, as required by 49 CFR § 390.29.

3.

Applicants must be able to certify that they are currently qualified to operate commercial vehicles in the United
States. An applicant’s “YES” response to this certification verifies that they are not presently disqualified from
operating commercial vehicles.

19. Certification statement — An authorized official of the company must complete Section 19, including date and
typed/printed title and corresponding signature. Use the following guidelines for determining who must sign this certification as
an “authorized official” for the applicant.
x

If the company is a sole proprietorship, then the owner must sign.

x

If the company is a partnership, then one of the partners must sign.

x

If the company is a corporation, then an official of the corporation must sign (President, Vice President, Secretary,
Treasurer, etc.).

Note: An applicant’s attorney or any other representative who may be assisting with the completion of the application is
NOT permitted to sign on the company’s behalf.

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OMB No. 2126-0013 Expiration Date: 1/31/2008
A federal agency may not conduct or sponsor, and a person is not required to respond to, nor shall a person be subject to a penalty for failure to comply with a collection of information subject to the requirements of the
paperwork Reduction Act unless that collection of information displays a current valid OMB Control Number. The OMB Control Number for this information collection is 2126-0013. Public reporting for this collection of
information is estimated to be approximately 9 minutes per response, including the time for reviewing instructions, gathering the data needed, and completing and reviewing the collection of information. All responses to this
collection of information are mandatory, and will be provided confidentiality to the extent allowed by the Freedom of Information Act (FOIA). Send comments regarding this burden estimate or any other aspect of this collection
of information, including suggestions for reducing this burden to: Information Collection Clearance Officer, Federal Motor Carrier Safety Administration, MC-RRA, 1200 New Jersey Avenue, SE, Washington, D.C. 20590.

U.S. Department of Transportation
Federal Motor Carrier Safety Administration

Safety Certification for Application

(Safety Certification for Application for USDOT Number)

1. NAME OF MOTOR CARRIER

2. TRADE OR D.B.A. (DOING BUSINESS AS) NAME

3. PRINCIPAL STREET ADDRESS/ROUTE NUMBER

4. CITY

5. STATE/PROVINCE

6. ZIP CODE+4

7. MAILING ADDRESS (P 0 BOX)

8. CITY

9. STATE/PROVINCE

10. ZIP CODE+4

11. PRINCIPAL PHONE NUMBER

12. PRINCIPAL FAX NUMBER

16. IRS/TAX ID NO.

13. USDOT NO.

14. MC OR MX NO.

15. DUN & BRADSTREET NO.

17. INTERNET E-MAIL ADDRESS

EIN#

18. SAFETY CERTIFICATIONS (Applicants subject to FMCSRs must complete certification item(s) 18A through 18C).
A.

B.

Applicant maintains current copies of all U.S. DOT Federal Motor Carrier Safety Regulations, Federal Motor Vehicle
Safety Standards, and the Hazardous Materials Regulations (if a property carrier transporting hazardous materials),
understands and will comply with such regulations, and has ensured that all company personnel are aware of the
current requirements.

Yes

No

Applicant certifies that the following tasks and measures will be fully accomplished and procedures fully implemented before it commences
operations in the United States.
1. Driver qualifications:
The carrier has in place a system and procedures for ensuring the continued qualification of drivers
to operate safely, including a safety record for each driver, procedures for verification of proper licensing of
each driver and procedures for identifying drivers who are not complying with the safety regulations.

Yes

No

b)

The carrier has procedures in place to review drivers’ employment and driving histories for at least the last 3
years to determine whether or not the individual is qualified and competent to drive safely.

Yes

No

c)

The carrier has established a program to review the records of each driver at least once every 12 months
and will maintain a record of the review.

Yes

No

d)

The carrier will ensure that all of its drivers are at least 21 years of age and if applicable possess a valid
Commercial Drivers License (CDL).

Yes

No

The carrier has in place a recordkeeping system and procedures to monitor the hours-of-service performed
by drivers, including procedures for continuing review of drivers’ log books, and for ensuring compliance
with all operations requirements.

Yes

No

The carrier has ensured that all drivers are knowledgeable of the hours-of-service requirements, and has
clearly and specifically instructed the drivers concerning their responsibility to comply with applicable 10/11,
14/15, and 60/70-hour rules as well as the requirement for preparing daily log entries in their own
handwriting for each 24-hour period.

Yes

No

Yes

No

a)

2. Hours of Service:
a)

b)

3.

Drug and alcohol testing:
a)

The carrier is familiar with the alcohol and controlled substance testing requirements of 49 CFR part 382
and 49 CFR part 40 and has in place a program for systematic testing of drivers.

4. Vehicle condition:
a)

b)

The carrier has established a system and procedures for inspection, repair and maintenance of its vehicles
in a safe condition, and for preparation and maintenance of records of inspection, repair and maintenance
in accordance with the Federal Motor Carrier Safety Regulations and the Hazardous Materials Regulations.

Yes

No

The carrier will ensure that all violations and defects noted on inspection reports are corrected
before vehicles and drivers are permitted to continue operation.

Yes

No

5. Accident monitoring program:
Form MCS-150A (06/29/2007)

N/A

OMB No. 2126-0013 Expiration Date: 1/31/2008

6.

a)

The carrier has in place a program for monitoring vehicle accidents and maintains an accident register in
accordance with 49 CFR 390.15.

Yes

No

b)

The carrier has established an accident countermeasures program and driver training program to reduce
accidents.

Yes

No

Yes

No

Production of records:
a)

7.

The carrier can and will produce records demonstrating compliance with the safety requirements within 48
hours of receipt of a request from a representative of the USDOT/FMCSA or other authorized Federal or
State official.

Hazardous Materials (to be completed by carriers of hazardous materials only).
a)

The HM carrier has full knowledge of the U.S. DOT Hazardous Materials Regulations and has established
programs for the thorough training of its personnel as required under 49 CFR part 172, Subpart H, and 49
CFR 177.816.

Yes

No

N/A

b)

The carrier has established a system and procedures for inspection, repair and maintenance of its reusable
hazardous materials packages (cargo tanks, portable tanks, cylinders, intermediate bulk containers, etc.) in
a safe condition, and for preparation and maintenance of records of inspection, repair and maintenance in
accordance with the U.S. DOT Hazardous Materials Regulations.

Yes

No

N/A

c) The HM carrier has established a system and procedures for filing and maintaining HM shipping
documents.

Yes

No

N/A

d)

Yes

No

N/A

Yes

No

N/A

Yes

No

N/A

The HM carrier has a system in place to ensure that all HM trucks are marked and placarded as required by
49 CFR part 172, Subparts D and F.

e) The carrier will register under 49 CFR part 107, Subpart G, if transporting any quantity of hazardous
materials requiring the vehicle to be placarded.
8.

For Cargo Tank (CT) Carriers of HM
a)

The carrier has a system in place to ensure that its cargo tanks are inspected and tested as required by 49
CFR 180 by a facility registered with the U.S. DOT under part 107, Subpart F.

By signing these certifications, the carrier official is on notice that the representations made herein are subject to verification through inspections in the
United States and through the request for and examination of records and documents. Failure to support the representations contained in this application
could form the basis of a proceeding to assess civil penalties and/or lead to the revocation of the authority granted.
C.

All applicants must certify as follows:
1. Applicant is willing and able to provide the proposed operations or service and to comply with all pertinent
statutory and regulatory requirements and regulations issued or administered by the U.S. Department of
Transportation, including operational regulations, safety fitness requirements, motor vehicle safety standards,
and minimum financial responsibility requirements.

Yes

No

2. Applicant is willing and able to produce for review or inspection documents which are requested for the purpose
of determining compliance with applicable statutes and regulations administered by the U.S. Department of
Transportation, including the Federal Motor Carrier Safety Regulations, Federal Motor Vehicle Safety Standards
and Hazardous Materials Regulations, within 48 hours of any written request.

Yes

No

3. Applicant is not presently disqualified from operating commercial vehicles in the United States pursuant to the
Motor Carrier Improvement Act of 1999 or any other law.

Yes

No

NOTE:
All motor carriers must comply with all pertinent Federal, State, local and tribal statutory and regulatory requirements when operating within the United States. Such
requirements include, but are not limited to, all applicable statutory and regulatory requirements administered by the U.S. Department of Labor, or by a State agency
operating a plan pursuant to Section 18 of the Occupational Safety and Health Act of 1970 (“OSHA State plan agency”). Such requirements also include all applicable
statutory and regulatory environmental standards and requirements administered by the U.S. Environmental Protection Agency or a State, local or tribal environmental
protection agency. Compliance with these statutory and regulatory requirements may require motor carriers and/or individual operators to produce documents for review
and inspection for the purpose of determining compliance with such statutes and regulations.

19. Certification Statement (to be completed by an authorized official)
I, _________________________________________________ , certify that I am familiar with the Federal Motor Carrier Safety Regulations and/or the Federal Hazardous
(Please print Name)

Signature

____________________________________

Form MCS-150A (06/29/2007)

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.
Date _________________________________

Title ____________________________________________