Form Mcs 150A PDF Details

The MCS-150A form, officially titled "Safety Certification for Application for U.S. DOT Number" and issued by the U.S. Department of Transportation Federal Motor Carrier Safety Administration, constitutes a critical document for motor carriers operating in the United States. It calls for detailed information from carriers, including the name of the motor carrier, trade names, contact details, and critical identifiers like USDOT and MC or MX numbers, among others. Importantly, the form requires carriers to certify their compliance with a broad range of safety standards and operational procedures. These include maintaining up-to-date knowledge and adherence to Federal Motor Carrier Safety Regulations, Federal Motor Vehicle Safety Standards, and Hazardous Materials Regulations when applicable. Carriers must attest to their processes for ensuring driver qualifications, managing hours of service, conducting drug and alcohol testing, maintaining vehicle conditions, and implementing an accident monitoring program. For carriers transporting hazardous materials, specific certifications regarding knowledge, training, and equipment maintenance under the pertinent regulations are required. By signing the MCS-150A form, carriers not only affirm their commitment to safe operations but also acknowledge their responsibility to comply with a comprehensive set of regulatory requirements. This document thus plays a pivotal role in upholding safety and regulatory standards within the trucking industry.

QuestionAnswer
Form NameForm Mcs 150A
Form Length2 pages
Fillable?No
Fillable fields0
Avg. time to fill out30 sec
Other namesmn school bus safety certification forms, mcs150 org, mcs 150 form pdf, dot mcs150a

Form Preview Example

OMB No. 2126-0013

 

 

 

Safety Certification for Application

 

U.S. Department of Transportation

 

(Safety Certification for Application for U.S. DOT Number)

 

Federal Motor Carrier Safety Administration

 

 

 

 

 

 

 

 

1. NAME OF MOTOR CARRIER

 

 

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

 

 

 

 

 

 

 

 

 

3. PRINCIPAL STREET ADDRESS/ROUTE NUMBER

4. MAILING ADDRESS (P 0 BOX)

 

 

 

 

 

 

 

 

 

 

5. CITY

6. STATE/PROVINCE

 

7. ZIP CODE+4

8. MAILING CITY

 

9. STATE/PROVINCE

10. ZIP CODE+4

 

 

 

 

 

 

 

 

11. PRINCIPAL PHONE NUMBER

 

 

12. PRINCIPAL FAX NUMBER

 

 

 

 

 

 

 

 

 

13. USDOT NO.

14. MC OR MX NO.

15. DUN & BRADSTREET NO.

16. IRS/TAX ID NO.

 

 

17. INTERNET E-MAIL ADDRESS

 

 

 

 

EIN#

SSN#

 

 

 

 

 

 

 

 

 

 

 

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

A.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),

Yes

No

understands and will comply with such regulations, and has ensured that all company personnel are aware of the

 

 

current requirements.

 

 

B.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:

a) 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

Yes

No

each driver and procedures for identifying drivers who are not complying with the safety regulations.

 

 

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

 

 

 

 

 

2.

Hours of Service:

 

 

 

 

 

 

 

 

 

a) 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

Yes

 

No

 

with all operations requirements.

 

 

 

 

 

 

 

 

 

b) 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,

Yes

 

No

 

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.

 

 

 

 

 

 

 

 

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.

Yes

No

N/A

4. Vehicle condition:

a)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

Yes

 

No

in accordance with the Federal Motor Carrier Safety Regulations and the Hazardous Materials Regulations.

 

 

 

b)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 (3-24-2005)

 

 

Expiration Date: 07/31/2007

OMB No. 2126-0013

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

6.Production of records:

a)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.

Yes

No

7.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 Yes

 

No

N/A

CFR 177.816.

 

 

 

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 Yes

 

No

N/A

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.

 

 

 

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

documents.

Yes

No

N/A

d)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.

Yes

No

N/A

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.

Yes

No

N/A

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.

Yes

No

N/A

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

Yes

No

 

Transportation, including operational regulations, safety fitness requirements, motor vehicle safety standards,

 

 

 

and minimum financial responsibility requirements.

 

 

 

 

 

 

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

Yes

No

 

Transportation, including the Federal Motor Carrier Safety Regulations, Federal Motor Vehicle Safety Standards

 

 

 

and Hazardous Materials Regulations, within 48 hours of any written request.

 

 

 

 

 

 

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)

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.

 

Signature ____________________________________

Date _________________________________ Title ____________________________________________

 

 

 

Form MCS-150A (3-24-2005)

Expiration Date: 07/31/2007