Form Mcir 150 – Fill Out and Use This PDF

MD Department of Transportation

Motor Carrier Division

MOTOR CARRIER IDENTIFICATION REPORT

7491 Connelley Drive

(Application for Maryland D.O.T. Number)

Hanover, Maryland 21076

1 (800) 543-4564

Fax : 410-787-2863

NEW

Biennial Update

Out of Business

Re- Application (after

visit our website at www.sha.state.md.us

(Renewal)

revocations of New Entrant)

Download this form at http://www.marylandroads.com/businesswithsha/trucking/oots/Mcir150_all_1.pdf

IF THE SPACE ABOVE IS BLANK OR THE INFORMATION THEREIN IS INCORRECT, PLEASE IDENTIFY YOUR COMPANY’S PRINCIPAL OFFICE IN THE SPACES BELOW.

1. NAME OF MOTOR CARRIER / HM SHIPPER

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

3. PRINCIPAL STREET ADDRESS / ROUTE NUMBER

4. MAILING ADDRESS (P.O.BOX)

5. CITY

6.

STATE

7.

ZIPCODE+4

8. MAILING CITY

9. STATE

10. ZIP CODE+4

11. COUNTY

12. PRINCIPAL PHONE NUMBER

13. COUNTY

14. PRINCIPAL FAX NUMBER

15. USDOT NO.

16. MC OR MX NO.

17. DUN & BRADSTREET NO.

18. IRS/TAX ID NO.

19. INTERNET E-MAIL ADDRESS

20. CARRIER OPERATION(CIRCLE ONE)

A. Intrastate Only (Hazardous Materials)

B. Intrastate Only (Non-Hazardous Materials)

21. SHIPPER OF HAZARDOUS MATERIALS OPERATION

22. CARRIER MILEAGE(to nearest 10,000 miles for last calendar year) YEAR

(circle one)

A. INTERSTATE

B. INTRASTATE

23. OPERATION CLASSIFICATIONS(Circle all that apply)

A. AUTHORIZED FOR HIRE

D. PRIVATE PASSENGERS(BUSINESS)

G. OTHER (SPECIFY) ________________________

B. EXEMPT FOR-HIRE

E. PRIVATE PASSENGERS(NON-BUSINESS)

C. PRIVATE(PROPERTY)

F. U.S. MAIL

24. CARGO CLASSIFICATIONS (Circle all that apply)

A. GENERAL FREIGHT

F. LOGS,POLES

J. FRESH PRODUCE

P. GRAIN,FEED,HAY

V. COMMODITIES DRY BULK

AA. FARM SUPPIES

B. HOUSEHOLD GOODS

BEAMS, LUMBER

K. LIQUIDS/GASES

Q. COAL/COKE

W. REFRIGERATED FOOD

BB. CONSTRUCTION

C. METAL: SHEETS

G. BUILDING MATERIALS L. INTERMODAL CONT. R. MEAT

X. BEVERAGES

CC. WATER WELL

COILS, ROLLS

H. MOBILE HOMES

M. PASSENGERS

S. GARBAGE,REFUSE,TRASH

Y. PAPER PRODUCTS

DD. OTHER

D. MOTOR VEHICLES

I. MACHINERY,

N. OIL FIELD EQUIP.

T. U.S.MAIL

Z. UTILITY

(SPECIFY)

E. DRIVE AWAY/TOWAWAY LARGE OBJECTS

O. LIVESTOCK

U. CHEMICALS

__________________ __

25. HAZARDOUS MATERIALS CARRIED OR SHIPPED (CIRCLE ALL THAT APPLY) C-CARRIED S-SHIPPED, B(BULK) IN CARGO TANKS NB(NON-BULK)- IN PACKAGES

C S A. DIV 1.1

B NB

C S K. DIV 2.2A(AMMONIA)

B NB

C S U. DIV 4.2

B NB

C S EE. HRCQ

B NB

C S B. DIV 1.2

B NB

C S L. DIV 2.3A

B NB

C S V. DIV 4.3

B NB

C S FF. CLASS 8

B NB

C S C. DIV 1.3

B NB

C S M. DIV 2.3B

B NB

C S W. DIV 5.1

B NB

C S GG. CLASS 8A

B NB

C S D. DIV 1.4

B NB

C S N. DIV 2.3C

B NB

C S X. DIV 5.2

B NB

C S HH. CLASS 8B

B NB

C S E. DIV 1.5

B NB

C S O. DIV 2.3D

B NB

C S Y. DIV 6.2

B NB

C S II. CLASS 9

B NB

C S F. DIV 1.6

B NB

C S P. CLASS 3

B NB

C S Z. DIV 6.1A

B NB

C S JJ. ELEVATED TEMP MAT

B NB

C S G. DIV 2.1

B NB

C S Q. CLASS 3A

B NB

C S AA. DIV 6.1B

B NB

C S KK. INFECTIOUS WASTE

B NB

C S H. DIV 2.1 LPG

B NB

C S R. CLASS 3B

B NB

C S BB. DIV 6.1 POISON

B NB

C S LL. MARINE POLLUTANTS

B NB

C S I. DIV 2.1 (METHANE)

B NB

C S S. COMB LIQ

B NB

C S CC. DIV 6.1 SOLID

B NB

C S MM. HAZARDOUS SUB (RQ)

B NB

C S J. DIV 2.2

B NB

C S T. DIV 4.1

B NB

C S DD.CLASS 7

B NB

C S NN. HAZARDOUS WASTE

B NB

C S OO. ORM

B NB

26. Equipment

Straight

Truck

Trailers

Hazmat Cargo

Hazmat Cargo

PASSENGER

Trucks

Tractors

Tank Trailers

Tank Trucks

Motor Coach School Bus

Mini-Bus/Van

Limousine

OWNED

TERM LEASED

TRIP LEASED

27. DRIVER INFORMATION

LESS THAN 150- AIR MILE RADIUS ____________

TOTAL DRIVERS_____________

BEYOND 150- AIR MILE RADIUS _______________

TOTAL CDL DRIVERS_________

28. Certification State (To Be Completed By An Authorized Official)

I _______________________________________, certify that I am familiar with the Federal Motor Carrier Safety Regulations, the Federal Hazardous Materials Regulations

(if applicable) and the Maryland Motor Vehicle Laws pertaining to commercial vehicles. 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______________________________________________

Date Received__________________

Date Processed_____________________

Initials_______________________

Form MCIR-150 (Rev. 03/23/05) TMS

NOTICE

As of July 1, 2002, every truck, truck tractor, and bus must display either a U.S. DOT number or a Maryland DOT number.

A motor carrier participating in any interstate commerce is considered an interstate carrier and must display a U.S. DOT number in accordance with federal regulations. To obtain a U.S. DOT number, contact the Federal Motor Carrier Safety Administration at 1-800-832-5660.

All Maryland Intrastate Motor Carriers (exceptions noted below) are required to display a Maryland DOT number as prescribed in Maryland Vehicle Law (Title 22-404.3). To obtain a Maryland DOT number, a completed Form MCIR-150, Motor Carrier Identification Report, must be submitted to the Motor Carrier Division of the Office of Traffic and Safety by mail to 7491 Connelley Drive, Hanover MD 21076, or by fax to 410-787-2863. After July 1, 2002, a new motor carrier must file Form MCIR-150 before beginning Intrastate operations in Maryland.

Exceptions:

Trucks with a registered weight of 10,000 pounds or less;

Farm trucks, farm truck tractors, and farm area vehicles registered under 13-921,924, and 935, respectively, of the Transportation Article;

Emergency vehicles;

Vehicles used primarily to transport money or commercial paper;

School vehicles operating under contract to the State or any of its political subdivisions to transport school children, but not used in charter service for any other purpose;

Vehicles owned or operated by the State or any of its political subdivisions; or Vehicles within 15 days of their purchase.

If you are a Hazardous materials shipper, but not a motor carrier, you are not required to file this report. Intrastate Carriers must update information using this report every 2 years.

INSTRUCTIONS FOR COMPLETING THE MOTOR CARRIER IDENTIFICATION REPORT (MCIR-150)

(Please Print or Type All information)

1.Enter the legal name of the business entity (i.e., corporation, partnership, or individual) that owns/controls the motor carrier/shipper operation.

2.If the business entity is operating under a name other than that in Block 1, (i .e., "trade name") enter that name. Otherwise, leave blank.

3.Enter the principal place of business street address where safety records are kept.

4.Enter mailing address if different from the physical address, otherwise leave blank. Also, applies to #8, #9, #10 &13.

5.Enter the city where the principal place of business is located.

6.Enter the two-letter postal abbreviation for the State where the principal place of business is located.

7.Enter the zip code + 4 number corresponding with the physical street address.

8.Enter the city corresponding with the mailing address.

9.Enter the two-digit postal abbreviation for the State corresponding to the mailing address.

10.Enter the zip code + 4 number corresponding with the mailing address.

11.Enter the County where the principal place of business is located.

12.Enter the telephone number, including area code, of the principal place of business.

13.Enter the county corresponding to the mailing address.

14.Enter the Fax number, including area code, of the principal place of business.

15.Enter the identification number assigned to your motor carrier operation by the U.S. Department of Transportation, if applicable.

16.Enter the motor carrier "MC" or "MX" number under which the Federal Motor Carrier Safety Administration (FMCSA), or Interstate Commerce Commission (ICC) issued your operating authority, if appropriate.

17.Enter your Dun & Bradstreet business number (used as a secondary identifier; if you do not have one, leave blank).

18.Enter the employer identification number (EIN #) or social security number (SSN #) assigned to your motor carrier operation by the Internal Revenue Service.

19.Enter the e-mail address for the official point of contact, if you have one.

20.Circle the appropriate type of carrier operation.

A. Intrastate Only, transporting hazardous materials (49 CFR 100-180) B. Intrastate Only, NOT transporting hazardous

materials.
•	Interstate-transportation of persons or property across State lines, including international boundaries, or wholly within one
•	State as part of a through movement that originates or terminates in another State or country.
	Intrastate-transportation of persons or property wholly within one State.
21. If you are both a motor carrier and a hazardous materials shipper, circle the type of operation
	A. Interstate	B. Intrastate

22.Enter the carrier's total mileage to nearest 10,000 miles for the past calendar year, and the year of the mileage.

23.Circle appropriate classification. Circle all that apply. If "G. Other" is circled, enter the type of operation in the space provided. Authorized For Hire - transportation for compensation as a common or contract carrier of property, owned by others, or passengers

under the provisions of the FMCSA.

Exempt For Hire - transportation for compensation of property or passengers exempt from the economic regulation by the

FMCSA.

Private (Property) - means a person who provides transportation of property by commercial motor vehicle and is not a for-hire motor carrier.

Private Passengers (Business) - a private motor carrier engaged in the interstate transportation of passengers which is provided in the furtherance of a commercial enterprise and is not available to the public at large (e.g., bands).

Private Passengers (Non-Business) - a private motor carrier involved in the interstate transportation of passengers that does not otherwise meet the definition of a private motor carrier of passengers (business s) (e.g., church buses).

U.S. Mail - transportation of U.S. Mail under contract with the U.S. Postal Service.

Other - transportation of property or passengers by an operation classification not described above.

24.Circle all the letters of the types of cargo you usually transport. If "Other" is circled, enter the name of the commodity in the space provided.

25.Circle all types of hazardous materials (HM) you transport/ship. In the columns before the HM types, circle C for a carrier of HM and S for a shipper of HM. In the columns following the HM types, circle B if the HM is transported in bulk (over 119 gallons) and NB if the HM is transported in non-bulk (119 gallons or less). The HM types correspond to the classes and divisions listed in 49 CFR 173.2. Below are clarifications for the lettered codes:

A.	Div 1.1 Explosives (with mass explosion hazard)	AA.	Div 6.1 B (Poison Liquid which is a PIH Zone B)
B.	Div 1.2 Explosives (with projection hazard)	BB.	Div 6.1 Poison (Poisonous liquid with no inhalation
C.	Div 1.3 Explosives (with predominantly fire hazard)		hazard)
D.	Div 1.4 Explosives (with no significant blast hazard)	CC.	Div 6.1 Solid (Meets the definition of a poisonous
E.	Div 1.5 VERY insensitive explosives; blasting agents		solid)
F.	Div 1.6 Extremely insensitive detonating substances	DD.	Class 7 Radioactive material
G.	Div 2.1 Flammable gas	EE.	HRCQ (Highway Route Controlled Quantity of
H.	Div 2.1 LPG (Liquified Petroleum Gas)		Radioactive Material)
I.	Div 2.1 Methane Gas	FF.	Class 8 Corrosive material
J.	Div 2.2 Non-flammable compressed gas	GG.	Class 8 A (Corrosive liquid which is a PIH Zone A)
K.	Div 2.2 A (Anhydrous Ammonia)	HH.	Class 8 B (Corrosive liquid which is a PIH Zone B)
L.	Div 2.3 A (Poison Gas which is Poison	I I.	Class 9 Miscellaneous hazardous material
	Inhalation Hazard (PIH) Zone A)	JJ.	Elevated Temperature Material (Meets definition in 49 CFR
M.	Div 2.3 B (Poison Gas which is PIH Zone B)		171.8 for an elevated temperature material.
N	Div 2.3 C (Poison Gas which is PIH Zone C)	KK.	Infectious Waste (Meets definition in 49 CFR 171.8 for an
O.	Div 2.3 D (Poison Gas which is PIH Zone D)		infectious waste)
P.	Class 3 Flammable and combustible liquid	LL.	Marine Pollutants (Meets definition in 49 CFR 171.8 for a
Q.	Class 3 A (Flammable liquid which is a PIH Zone A)		marine pollutant)
R.	Class 3 B (Flammable liquid which is a PIH Zone B)	MM.	Hazardous Sub(RQ) (Meets definition in 49 CFR 171.8 of a
S.	Combustible Liquid (Refer to 49 CFR 173.120(b)		reportable quantity of a hazardous substance)
T.	Div 4.1 Flammable solid	NN.	Hazardous Waste (Meets definition in 49 CFR 171.8 of a
U.	Div 4.2 Spontaneously combustible material		hazardous waste)
V.	Div 4.3 Dangerous when wet material	00.	ORM (Meets definition in 49 CFR 171.8 of Other
W.	Div 5.1 Oxidizer		Regulated Material)

X.Div 5.2 Organic peroxide

Y.Div 6.2 Infectious substance (Etiologic agent)

Z.Div 6.1 A (Poison Liquid which is a PIH Zone A)

Note: Information on Poison Inhalation Hazards is found in column 7 of the Hazardous Materials table, (49 CFR 172.101).

26.Enter the total number of vehicles owned, term leased and trip leased, that are, or can be, operational the day this form is completed. Passenger vehicles are defined as:

Motor coach-a vehicle designed for long distance transportation of passengers, usually equipped with storage racks above the seats and a baggage hold beneath the passenger compartment.

School Bus-a vehicle designed and/or equipped mainly to carry primary and secondary students to and from school, usually built on a medium or large truck chassis.

Mini-bus/Van-a multi-purpose passenger vehicle with a capacity of 9-15 people, typically built on a small truck chassis. Limousine-a passenger vehicle usually modified or stretched for transportation of passengers.

27.Enter the number of intrastate drivers used on an average workday. Part-time, casual, term leased, trip leased and company drivers are to be included. Also, enter the total number of intrastate drivers and the total number of drivers who have a Commercial Drivers License (CDL). Intrastate-drivers transport people or property wholly within one State.

150-mile radius driver-driver operates only within a 150 air-mile radius of the normal work reporting location.

28.Print or type the name, in the space provided, of the individual authorized to sign documents on behalf of the entity listed in Block. That individual must sign, date, and show his or her title in the spaces provided.

Once Application is completed mail or fax back to:

Office of Traffic & Safety

Motor Carrier Division

7491 Connelley Drive

Hanover, Maryland 21076

Phone – 410-582-5734

Fax - 410-787-2863