California Dca Form Gsr 1 PDF Details

Ensuring vehicles meet California's emissions standards is a task that requires a network of qualified Smog Check stations across the state. The Bureau of Automotive Repair (BAR) Licensing Unit provides a pathway for Smog Check stations to elevate their service capabilities through the Gold Shield Program. The essence of this initiative is captured within the Gold Shield Station Certification Application (GSR-1 form), a critical document outlining the requirements and application process for stations striving for Gold Shield status. This form serves as the initial step for stations seeking certification, emphasizing the necessity to read and comply with the Gold Shield Qualification Requirements (GSR-2), submit the form without any associated fee, and adhere to timelines specified by the bureau. Gold Shield stations offer essential services, such as state-subsidized emissions-related repairs and certifications for vehicles identified as gross polluters, which highlights the program's role in supporting California's environmental goals. The GSR-1 form requires applicants to disclose any criminal or disciplinary history, ensuring integrity within the program. However, achieving certification is contingent upon meeting stringent eligibility criteria, including repair performance metrics and a clean enforcement record. Stations must pass a comprehensive quality assurance inspection, which assesses everything from licensure compliance to the capabilities of licensed technicians. For stations located in specific areas, different criteria apply, underscoring the tailored approach the BAR takes to address various regional needs. The detailed application process, spelled out in the GSR-1 form, underscores the program's commitment to high standards and environmental stewardship.

QuestionAnswer
Form NameCalifornia Dca Form Gsr 1
Form Length3 pages
Fillable?No
Fillable fields0
Avg. time to fill out45 sec
Other namesGold_Shiel_Stat ion_Application bureau of automotive repair licensing unit form

Form Preview Example

Bureau of Automotive Repair

Licensing Unit – Gold Shield Program

10240 Systems Parkway, Sacramento, CA 95827

P 916.255.3145 F 916.255.4482 |

www.smogcheck.dca.ca.gov

GOLD SHIELD STATION CERTIFICATION APPLICATION

INSTRUCTIONS:

1.There is no fee required with this application.

2.Read all information contained on this application including the Gold Shield Qualification Requirements (GSR-2).

3.Complete and sign the application.

4.Mail the completed application to the address above.

Please note: This application is only valid for the quarter in which you’ve applied.

STATION NAME

 

 

PHONE NUMBER

 

 

 

 

 

 

STREET ADDRESS

 

CITY

STATE

ZIP CODE

 

 

 

CA

 

 

 

 

 

 

SMOG CHECK STATION

OWNERSHIP TYPE:

 

OWNER(S) NAME(S):

 

____________________________

LICENSE NUMBER:

 

 

 

SOLE PROPRIETOR

PARTNERSHIP

____________________________

________________

CORPORATION

LLC

____________________________

 

____________________________

 

 

 

 

 

 

 

 

Gold Shield stations shall provide the following services to the public:

State subsidized emissions-related repairs, except stations located in a Change of Ownership area.

Certification of vehicles identified as gross polluters.

After repair certification of vehicles that were directed to, initially tested, and failed inspection at a Test-Only station.

Inspections for new and used car dealers on vehicles registered in Enhanced areas that have been wholesaled to car dealers who subsequently offer them for retail sale in Basic and Change of Ownership areas.

Initial inspection of vehicles directed to Test-Only station.

Please answer the following questions. If “YES,” please provide an explanation in the space provided; attach additional paper if necessary.

Have you or any of your partners, corporate officers, directors, trustees, LLC members, or your Smog Check station managers or technician(s),

1.

Ever been convicted of a crime?

(For the purposes of this question, “crime” does

YES

NO

 

not apply to minor traffic violations.)

 

 

2.

Been found liable in a civil proceeding for any act or any omission as an Automotive Repair

YES

NO

 

Dealer, Smog Check Station, or Smog Check Technician, or in a related business?

 

 

3.

Ever had any license denied, suspended, revoked, or placed on probation by the Bureau of

YES

NO

 

Automotive Repair?

 

 

 

4.

Been issued a citation by the Bureau of Automotive Repair within the last year?

YES

NO

 

 

 

GSR-1 (Rev. 12/08)

C:\Documents and Settings\hqsarms\My Documents\Dev\PUB

 

WEB\gs_app.doc

 

 

 

IMPORTANT INFORMATION:

YOU MUST PASS ALL THE REQUIREMENTS TO BE CERTIFIED AS A GOLD SHIELD STATION. FAILURE TO MEET ANY ONE OR MORE OF THE REQUIREMENTS WILL RESULT IN A DEFICIENT APPLICATION AND YOU WILL RECEIVE A NOTICE LISTING THE DEFICIENCIES. IF YOU RECEIVE A DEFICIENCY NOTICE FOR REQUIREMENTS 1, 2, 3, OR 8 AND HAVE CORRECTED THE DEFICIENCY, YOU MUST REAPPLY AT THE BEGINNING OF THE NEXT QUARTER.

BE ADVISED OF THE FOLLOWING:

IF THE DEFICIENCIES ARE FOR REQUIREMENTS 1- 3, YOU MUST REAPPLY AT THE BEGINNING OF THE NEXT QUARTER.

IF THE DEFICIENCY IS FOR REQUIREMENT 4, YOU MUST REAPPLY AFTER THE ONE-YEAR TIME FRAME FROM THE DATE OF YOUR CITATION.

IF THE DEFICIENCY IS FOR REQUIREMENTS 5-6, YOU MUST REAPPLY AFTER THE THREE-YEAR TIME FRAME FROM THE DATE OF ACTION.

IF THE DEFICIENCY IS FOR REQUIREMENT 7, YOU MUST REAPPLY UPON THE DECISION OF YOUR HEARING ON THIS MATTER.

IF THE DEFICIENCY IS FOR REQUIREMENT 8, YOU MUST REAPPLY AT THE BEGINNING OF THE NEXT QUARTER.

I understand that my station will be evaluated according to the qualification requirements.

I certify under penalty of perjury under the laws of the State of California that all statements made in this application and all the attached supporting documents pertaining to this application are true and correct.

SIGNATURE (all partners and all members of a LLC must sign)

TITLE (Sole Proprietor, Partner, Corporate Officer, Trustee,

DATE

 

LLC Member, etc.)

 

 

 

 

SIGNATURE (all partners and all members of a LLC must sign)

TITLE (Sole Proprietor, Partner, Corporate Officer, Trustee,

DATE

 

LLC Member, etc.)

 

 

 

 

SIGNATURE (all partners and all members of a LLC must sign)

TITLE (Sole Proprietor, Partner, Corporate Officer, Trustee,

DATE

 

LLC Member, etc.)

 

 

 

 

SIGNATURE (all partners and all members of a LLC must sign)

TITLE (Sole Proprietor, Partner, Corporate Officer, Trustee,

DATE

 

LLC Member, etc.)

 

 

 

 

SIGNATURE (all partners and all members of a LLC must sign)

TITLE (Sole Proprietor, Partner, Corporate Officer, Trustee,

DATE

 

LLC Member, etc.)

 

 

 

 

SIGNATURE (all partners and all members of a LLC must sign)

TITLE (Sole Proprietor, Partner, Corporate Officer, Trustee,

DATE

 

LLC Member, etc.)

 

 

 

 

SECTION BELOW FOR BUREAU OF AUTOMOTIVE REPAIR USE ONLY

ENHANCED AREA STATION

BASIC AREA STATION

 

 

 

CHANGE OF OWNERSHIP AREA STATION

 

 

 

 

 

 

 

 

 

 

 

MET GOLD SHIELD PERFORMANCE CRITERIA

YES

NO

 

INITIAL

 

 

 

DATE

 

PASSED ENFORCEMENT RECORD CHECK

YES

NO

 

INITIAL

REAPPLY DATE

 

DATE

 

PASSED QUALITY ASSURANCE INSPECTION

YES

NO

 

INITIAL

 

 

 

DATE

 

 

 

 

 

 

 

 

 

FINAL APPROVAL

YES

NO

 

INITIAL

 

 

 

DATE

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

GSR-1 (Rev. 12/08)

C:\Documents and Settings\hqsarms\My Documents\Dev\PUB

WEB\gs_app.doc

 

GOLD SHIELD QUALIFICATION REQUIREMENTS

A licensed Smog Check Test-and-Repair station seeking Gold Shield certification shall complete and file a Gold Shield Station Certification Application form (GSR-1 (Rev. 07/08)) and shall, as of the date the application is received by the Bureau of Automotive Repair, meet all of the following eligibility requirements:

1.The station’s Comparative Failure Rate (CFR) over the preceding quarter must meet or exceed the industry-wide failure rate for Test-Only stations, by Smog Check Program area, as calculated quarterly by the Bureau.

2.The station must have conducted a minimum of 10 successful emissions repairs in the preceding quarter. For the purposes of this section, a “successful emission repair” means:

A.The vehicle must have failed the emissions portion of a Smog Check in official test mode or pre-test mode at any Smog Check station within 60 days prior to the repair;

B.The Smog Check station must have repaired the vehicle and entered repair data into the Vehicle Information Database; and

C.The vehicle must have been issued a Certificate of Compliance at any Smog Check station within 10 days following the repairs made by the applicant Smog Check station.

3.The station’s repair performance in the preceding quarter must rate within the top 75% of test-and-repair stations in the same Smog Check Program area. A station’s repair performance is computed by comparing the final emission readings of each successful emission repair to the average passing emission readings for the same model-year and emission standards category of the vehicle repaired.

4.The station must not have been issued any citations pursuant to Section 44050(a) of the Health and Safety Code within the preceding one-year period, nor employ any technicians who have been issued any citations pursuant to Section 44050(b) of the Health and Safety Code within the preceding one-year period. Click here to verify a license.

5.Neither the current nor any previous registration nor license of the station owner, manager or licensed Smog Check technicians employed by the station:

Been issued an order of suspension, a probationary order, or any other disciplinary order within the preceding three-year period. Be currently subject to suspension, probation or other disciplinary order. Click here to verify a license.

6.The station owner, manager and licensed Smog Check technicians or other employees of the station:

Must not have been convicted of a crime within the preceding three-year period that is substantially related to the duties of a licensed Automotive Repair Dealer, Smog Check station, or Smog Check technician.

Must not be serving a probationary period as a result of any such criminal proceeding.

Must not have been found liable in a civil proceeding, excluding small claims matters, within the preceding three-year period, for acts or omissions that are substantially related to the duties of a licensed Automotive Repair Dealer, Smog Check station, or Smog Check technician.

7.The station must not have engaged in any conduct that would be cause for discipline of the station’s Automotive Repair Dealer registration or Smog Check station license.

8.The station must pass a Quality Assurance inspection administered by Bureau representative as part of the certification process. A Quality Assurance inspection consists of the following:

A.A verification of compliance with all licensure and license posting requirements.

B.A verification of compliance with all signage requirements.

C.A verification of compliance with all estimate, repair order, invoice and record keeping requirements.

D.A verification of possession of all required manuals and publications.

E.A verification of possession of all required tools and equipment and a verification of their proper working order.

F.Evaluations of licensed Smog Check technicians’ ability to perform complete Smog Check inspections, diagnoses, and repairs of failed vehicles.

Smog Check stations located in Change of Ownership areas need only meet requirements 4-7, to obtain Gold Shield certification.

GSR-2 (Rev. 07/08)

C:\Documents and Settings\hqsarms\My Documents\Dev\PUB

WEB\gs_app.doc

 

How to Edit California Dca Form Gsr 1 Online for Free

We used the top web programmers to set-up the PDF editor. Our software will let you prepare the California Dca Form Gsr 1 form without difficulty and won't take up too much of your energy. This straightforward procedure will assist you to get started.

Step 1: Click the button "Get Form Here".

Step 2: Once you have entered the California Dca Form Gsr 1 editing page you'll be able to find every one of the options you may perform concerning your file at the upper menu.

Enter the data demanded by the program to fill out the document.

portion of fields in California Dca Form Gsr 1

Make sure you complete the Been found liable in a civil, YES, Dealer Smog Check Station or Smog, Ever had any license denied, YES, Automotive Repair, Been issued a citation by the, YES, and GSR Rev CDocuments and area with the appropriate information.

part 2 to completing California Dca Form Gsr 1

You're going to be demanded specific important particulars to fill out the SECTION BELOW FOR BUREAU OF, ENHANCED AREA STATION, BASIC AREA STATION, CHANGE OF OWNERSHIP AREA STATION, MET GOLD SHIELD PERFORMANCE, PASSED ENFORCEMENT RECORD CHECK, PASSED QUALITY ASSURANCE INSPECTION, FINAL APPROVAL, YES, YES, YES, YES, INITIAL INITIAL REAPPLY DATE, DATE DATE DATE DATE, and GSR Rev CDocuments and field.

California Dca Form Gsr 1 SECTION BELOW FOR BUREAU OF, ENHANCED AREA STATION, BASIC AREA STATION, CHANGE OF OWNERSHIP AREA STATION, MET GOLD SHIELD PERFORMANCE, PASSED ENFORCEMENT RECORD CHECK, PASSED QUALITY ASSURANCE INSPECTION, FINAL APPROVAL, YES, YES, YES, YES, INITIAL INITIAL REAPPLY DATE, DATE DATE DATE DATE, and GSR Rev  CDocuments and blanks to fill

Step 3: Press "Done". You can now transfer the PDF document.

Step 4: Generate minimally several copies of your document to stay clear of any potential complications.

Please rate California Dca Form Gsr 1

1 Votes
If you believe this page is infringing on your copyright, please familiarize yourself with and follow our DMCA notice and takedown process - click here to proceed .