Form Mcs150 – Fill Out and Use This PDF

INSTRUCTIONS MCS-150 OMB No.: 2126-0013  Expiration: 07/31/2022

United States Department of Transportation

Federal Motor Carrier Safety Administration

Motor Carrier Identification Report

(Application for USDOT Number)

INSTRUCTIONS for FORM MCS-150

TOPICS

FEDERAL MOTOR CARRIER SAFETY ADMINISTRATION 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) that 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 financial responsibility. The Agency’s focus on both concerns 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-150B, or MCS-150C) 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 site (www.fmcsa.dot.gov/registration) to determine all FMCSA registration requirements. For applicants without 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-150 form must be submitted.

FILING OPTIONS

There are two options for filing the necessary forms to obtain a USDOT Number:

•Completing and filing the required MCS-150 forms online; or

•Completing a printed copy and mailing to the FMCSA.

FMCSA strongly encourages applicants to use the electronic online application 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 online is approximately 20 minutes.

• Option 1: Filing Online (recommended).

oWe encourage you to print all related form instructions prior to completing the online forms.

oTo complete and submit application form(s), go to: www.fmcsa.dot.gov/registration.

oUpon submission, a USDOT Number for the company is issued immediately, if the application is approved.

oFMCSA suggests that you record the USDOT Number that is assigned.

•Option 2: Filing Paper by Mail.

oSubmit all required MCS and/or OP forms together.

oOnce the application is completed, FMCSA suggests making a copy for the company’s files.

oMailed applications, on average, take four to six weeks processing time.

oNotification of USDOT Number will be sent to the mailing address provided in items 8-11 of submitted MCS-150 or MCS-150B form. o Mail completed application form(s) to:

Federal Motor Carrier Safety Adminisration Attention: USDOT Number Application

1200 New Jersey Avenue SE, Room W65-206 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.

STEP-BY-STEP INSTRUCTIONS

These instructions will assist in preparing a complete and accurate MCS-150 application. The instruction numbers below correspond to the numbered items on the MCS-150 form. When completing the application, please print clearly in ink or type all information.

Reason for Filing (Top of Form) — The information in the table below represents the valid reasons for filing the MCS-150 form. Select one of the four reasons and mark its corresponding box at the top of the form under “Reason for Filing,” and complete all the items on the form that are mandatory for the selected reason.

NOTE: If the company was previously assigned a USDOT Number, do NOT submit this form to obtain a new USDOT Number. That is, if the company

currently has or has had at any time a USDOT Number, then the only valid reasons for completing this form are: reapplication after revocation of a new entrant registration; out of business notification; or biennial update or other interim change to the company’s MCS-150 application information.

See instructions labeled “To find out if a company already has a USDOT Number ” on page viii of this document.

If a sole proprietor owner/operator submits personal information for registration purposes to obtain a USDOT number or operating authority, this information will be publicly available on FMCSA websites. This published information may include, but is not limited to, the sole proprietor owner/ operator’s home address, telephone number, and email address when the contact information serves as the business contact information.

1.Legal Business Name — This is the legal name of the business entity that owns/controls the Motor Carrier operation. The name entered here should be the full legal business name (the name on the incorporation certificate, partnership agreement, tax records, etc.).

For example, if the company is a:

•Sole Proprietorship/Individual, enter the legal name, e.g., “John A. Doe”

•Partnership, enter the legal names of all partners, e.g., “John A. Doe and Jane B. Smith”

•Corporation, enter the name on the incorporation certificate (this name must include the type of corporation), e.g., “John Doe INC”, “John Doe LLC”.

2.Doing Business As Name — Enter the company’s trade name if it is different from the company’s official business name (the name entered in item 1). For example, if you entered “John A. Doe” in item 1 as the company’s official business name, but the trade name, or “Doing Business As” name, is “John’s Trucking Company”, you would enter “John’s Trucking Company” in this item.

3-6. Principal Place of Business — Enter the physical address of where the company is engaged in business operations related to the transportation of persons or property and where safety records are regularly maintained. This address will be used by FMCSA for on-site visits to Motor Carriers for the purpose of conducting safety audits, investigations, and other activities. A P.O. Box is not acceptable as a Principal Place of Business, nor is the address of a consultant, service agent, or attorney of a Motor Carrier unless the Motor Carrier engages in operations related to the transportation of persons or property at that location.

7.Colonia (Mexico Only) — If the company’s principal address (and safety records location) is in Mexico, enter the “Colonia” or “Barrio” in Mexico.

8-11. Mailing Address — Enter the mailing address where the company wants all its FMCSA correspondence to be sent (this may be a P.O. Box). If all parts of this address are the same as the “Principal Place of Business” (items 3-6), check the “Same as Principal Address” button and skip items 8-11. However, if any parts of the mailing and principal addresses differ, check the “Mailing address below” button and complete all items 8-11.

12.Colonia (Mexico Only) — If the company’s mailing address is in Mexico, enter the “Colonia” or “Barrio” in Mexico.

13.Principal Business Phone Number — Enter the primary telephone number, including area code, for the “Principal Place of Business” (items 3-6). This may be a cell phone number.

14.Principal Contact Cell Phone Number — Enter the cell phone number, if any, including area code. If this is the same as the “Principal Business Phone Number” (item 13), enter “Same”.

INSTRUCTIONS MCS-150 • Page ii of viii

15.Principal Business Fax Number — Enter the company’s fax number, if any, including area code. If this is the same as the “Principal Business Phone Number” (item 13), enter “Same”.

16.USDOT Number — If the company is not a new applicant (that is, if it already has a USDOT Number) enter the company’s USDOT Number.

17.MC or MX Number — If the company has already been assigned an “MC” or “MX” identification number for Interstate FMCSA Operating Authority, enter the number. This includes MC or MX numbers that are pending.

18.Dun & Bradstreet Number — If the company has a Dun & Bradstreet identifier number, enter it. If you do not know the number, visit www.dnb.com, or call Dun & Bradstreet at 1-800-999-3867.

19.IRS/Tax ID Number — Enter the Employer Identification Number (EIN) assigned to the Motor Carrier company by the Internal Revenue Service. (Sole proprietor owner/operators who do not have an EIN may submit their SSN instead of EIN, but are encouraged to obtain an EIN rather than using an SSN to register for a DOT number.)

20.E-Mail Address — Enter the e-mail address, if the company has one, for the official point of contact.

21.Carrier Mileage — Enter the total mileage of all Commercial Motor Vehicles (CMV) in the company’s operation to the nearest 10,000 miles for the previous 12 months. If the company has been in operation less than 12 months, enter mileage operated to date. If the company has not operated within the last 12 months, enter 0.

22.Company Operations — The company operation type will tell FMCSA what type(s) of Motor Carrier or Hazardous Materials Shipper operations the company plans to provide. If you select only Hazmat Shipper (no carrier operation) from the list, the company is not required to obtain a USDOT Number, so no filing is needed. Read the instructions and definitions below before responding. These selections will determine if this business is regulated by the FMCSA.

NOTE: The Pipeline and Hazardous Materials Safety Administration (PHMSA) regulates Motor Carriers and Shippers of hazardous materials. If the company will carry or ship hazardous materials it may need to be registered with PHMSA (https://www.phmsa.dot.gov/hazmat/registration) in addition to FMCSA.

Select all that apply:

A.Interstate Carrier — The company is an Interstate Carrier if any part of its operation transports property or passengers in support of interstate commerce, i.e., the property or passengers cross State lines either before the company received them, while the company is transporting them, or after the company has transferred the property or passengers. The transportation of the property or passengers may include transport by plane, train, or boat in addition to the company’s commercial motor vehicle. For example: if the origination and destination indicated on the bill of lading — when one exists

— are not in the same State, then the shipment is interstate and the company needs to be registered as an Interstate Carrier.

The company is also considered to be an Interstate Carrier if the property or passengers being transported will ever do ANY of the following:

•Cross State lines (including a place outside the United States)

•Move from the United States or a U.S. territory to a foreign country, or vice versa

•Have origination and destination points within a State, but pass through another State or foreign country during transport.

B.Intrastate Hazmat Carrier — The company is an Intrastate Hazardous Materials Carrier if any part of its business operation meets ALL of the following criteria:

•Transports Hazardous Materials in quantities that are regulated by the Department of Transportation (DOT)

•Never crosses State lines (including a place outside the United States)

•Never moves from the United States or U.S. territory to a foreign country, or vice versa

•Never passes through another State or foreign country during transport.

The company is required to comply with FMCSA Safety Regulations and Hazardous Materials Regulations.

C.Intrastate Non-Hazmat Carrier — The company is an Intrastate Non-Hazardous Materials Carrier if its business operation meets ALL of the following criteria:

•Does NOT transport Hazardous Materials in quantities that are regulated by the DOT

•Never crosses State lines (including a place outside the United States)

•Never moves from the United States or U.S. territory to a foreign country, or vice versa

•Never passes through another State or foreign country during transport.

D.Interstate Hazmat Shipper — The company is an Interstate Hazardous Materials Shipper if any part of its business operation offers, or makes Hazardous Materials available to a carrier for, transportation in interstate or foreign commerce. If the company makes the Hazardous Materials available AND also transports the Hazardous Materials, then the company is considered to be both an Interstate Hazmat Shipper and an Interstate or Intrastate Motor Carrier. Companies that are Hazmat Shippers only (don’t provide carrier transport) do not need a USDOT Number to operate and therefore are not required to file this form. Interstate Hazmat Shippers must, however, still comply with the Hazardous Materials Regulations.

INSTRUCTIONS MCS-150 • Page iii of viii

E.Intrastate Hazmat Shipper — The company is an Intrastate Hazardous Materials Shipper if it exclusively tenders or makes Hazardous Materials available to an Intrastate Hazmat Carrier for actual transport. If the company offers or makes available Hazardous Materials AND transports Hazardous Materials, then it is considered as both an Intrastate Hazmat Shipper and an Interstate or Intrastate Motor Carrier (both options should be selected in response to this item). If the company never operates as a carrier, but only operates as a Hazmat Shipper, it is not required to obtain a USDOT Number and need not file this form. However, it will be required to comply with the Hazardous Materials Regulations.

23.Operation Classifications — Operation classification is based on the type of business the company is engaged in and will help determine the FMCSA regulations the company is subject to. It will also determine if the company requires Interstate Operating Authority. The company’s operations may place it under multiple operation classifications, so selections should be made carefully. Definitions of Classifications:

A.Authorized For-Hire — A non-exempt (exempt Motor Carriers are defined in part B below) Motor Carrier who receives compensation for transporting passengers, FMCSA-regulated goods, or household goods that are owned by others.

NOTE: If you select “Authorized For-Hire Carrier” as one of the company’s operation classifications, the company will also be required to obtain Interstate Operating Authority (MC or MX Number) by filing the appropriate OP form with the FMCSA.

B.Exempt For-Hire — A Carrier who receives compensation for transporting ONLY exempt goods (commodities that are NOT regulated by the FMCSA); or an Interstate Carrier transporting exclusively within a commercial zone that is exempt from FMCSA operating authority rules. Carriers are also exempt if they ONLY transport employees of their company (e.g., a company shuttles its own employees to and from a work station). Exempt status typically excuses a carrier from the Operating Authority requirement, but a USDOT Number is still required.

NOTE: Administrative Ruling No. 119 (www.fmcsa.dot.gov/registration/administrative-ruling-119) provides additional guidance for identifying EXEMPT commodities (those NOT regulated by the FMCSA). If all the commodities that the company transports appear on this list, then the commodities are considered exempt. Information about commercial zone exemptions may be found at 49 CFR 372 (www.ecfr.gov/cgi-bin/ retrieveECFR?gp=1&ty=HTML&h=L&mc=true&=PART&n=pt49.5.372).

C.Private Property — A company that transports its own cargo, usually as a part of a business that produces, uses, sells, and/or buys the cargo that is being hauled.

D.Private Motor Carrier of Passengers (Business) — Private Motor Carrier of Passengers (Business) means 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. Examples include companies that use buses to transport their employees without collecting a fee from them, or professional entertainers who use buses to transport themselves to or from performances. Commercial businesses that provide passenger transportation to the general public are NOT Private Motor Carrier of Passengers (Business).

E.Private Motor Carrier of Passengers (Non-Business) — Private Motor Carrier of Passengers (Non-Business) means a private motor carrier involved in the interstate transportation of passengers which is NOT provided in the furtherance of a commercial enterprise and is NOT available to the public at large. Examples include churches, private schools, civic organizations, scout groups, and other organizations that own or lease a vehicle for the private transportation of their membership. If any of these organizations makes passenger transportation available to non-members and charges a fee for such service, it is operating as a for-hire carrier and is NOT a Private Motor Carrier of Passengers (Non-Business).

F.Migrant — Interstate transportation provided by a Contract Carrier, but not a Common Carrier, of three or more migrant workers to or from their employment using any motor vehicle other than a passenger automobile or station wagon. A Contract Carrier provides transport service to one or more companies on a contract basis. Contract carriers do not maintain a regularly scheduled service. A Common Carrier transports persons or property for pay to anyone at any time and to any place within its operating authority.

G.U.S. Mail — Transportation of U.S. mail under contract with the U.S. Postal Service.

H.Federal Government — Transportation of property or passengers by a U.S. Federal Government Agency.

I.State Government — Transportation of property or passengers by a U.S. State Government Agency.

J.Local Government — Transportation of property or passengers by a local municipality.

K.Indian Tribe — Transportation of property or passengers by a federally recognized Indian tribal government.

L.Other — Transportation of property or passengers by an operation classification not described above; or if a broker, indicate what kind of transportation is arranged, Property or Household Goods.

NOTE: If the carrier’s vehicles are sometimes leased to another motor carrier, select the appropriate options (A-K) indicating all types of operations performed.

INSTRUCTIONS MCS-150 • Page iv of viii

24.Cargo Classifications — Refers to the types of materials the company transports or ships (offers for transport). The company may transport/ship materials from multiple categories. Select all the letters corresponding to the types of cargo the company transports/ships. If “Other” is selected, enter the name of the commodity in the space provided.

NOTE: If you indicate that the company transports passengers, it means that the company uses a motorcoach, school bus, mini-bus, van, or limousine to transport passengers. Do not select this item if someone rides along to assist the driver when the company’s primary business is to transport property. If you check this option, you will also have to indicate the number of each type of passenger vehicle that is owned or leased under the motorcoach, school bus, mini-bus, van, or limousine headings provided in item 26 of this form.

25.Hazardous Materials (Carrier or Shipper) — Complete this item only if the company transports or ships (offers for transport) Hazardous Materials. Otherwise, proceed to item 26.

•The letters “C” and “S” in the columns refer to “Carrier” and “Shipper.” Select “C” or “S” next to the Hazardous Materials that the company carries or ships. If the company is both a Carrier and a Shipper of the Hazardous Materials, select both “C” and “S.”

•The letters “B” and “NB” refer to “Bulk” and “Non-bulk.” Select “B” or “NB” next to the appropriate Hazardous Materials if the company transports/ships in Bulk or Non-Bulk as defined under 49 CFR 171.8.

The Hazardous Materials Classes and Divisions listed below correspond to those listed in 49 CFR 173.2. (Short descriptions are provided. For more information see the Hazardous Materials guide at www.fmcsa.dot.gov/regulations/hazardous-materials.)

W.Div 6.1 B (Poison Liquid which is a PIH Zone B)

NOTE: Information on Poison Inhalation Hazards is found in column 7 of the Hazardous Materials table (49 CFR 172.101). Specific Hazardous Materials information can be obtained by accessing the Hazmat Table at www.fmcsa.dot.gov/regulations/hazardous-materials.

INSTRUCTIONS MCS-150 • Page v of viii

26.Number of Vehicles that will be Operated in the U.S. — Provide the number of each type of CMV that the company uses in its U.S. operations broken out by the method used to acquire the vehicle (owned, term-leased, or trip-leased). Owned means the company holds title to the CMV, term leased means the vehicle is leased for a specific time period or term of contract, and trip leased means the CMV is leased on a trip-by-trip basis as needed. If the company owns or leases a commercial motor vehicle that is used to transport passengers rather than property within the U.S. (includes motorcoach, school bus, bus, passenger van, or limousine only), then indicate the number of each type of passenger-carrying CMV (by its passenger-carrying capacity) that is owned, term-leased, or trip-leased. For passenger-carrying vehicles, count the driver as a passenger when determining a vehicle’s passenger-carrying capacity. Reference the definitions for each type of passenger-carrying vehicle below. For example, if the company owns 3 straight trucks and 1 trailer and term leases 2 additional trailers, the table would be filled out like this:

Passenger vehicles are defined as:

•Motorcoach — 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.

•Bus, 16+ — A motor vehicle that is designed or constructed to transport 16 or more passengers (including the driver) that does not meet the definition of a motorcoach or a school bus of any size. Bus includes a mini-bus (which is typically built on a

small truck chassis), a low-floor bus, and any other 16 or more passenger capacity vehicle not otherwise defined on this form.

•Passenger Van — A small motor vehicle designed or used to transport 15 or fewer passengers, including the driver. (If the company uses a van to transport something other than passengers, enter the number of vehicles under “straight trucks.”)

•Limousine — A passenger vehicle usually built on a lengthened automobile chassis.

27.Driver Information — Enter the number of interstate and intrastate drivers who operate CMVs for the company on an average workday. Part-time, casual, term-leased, trip-leased, and company drivers should be included in the company’s total driver headcount. Also, enter the total number of drivers (regardless of employment status) used in the company’s operations (interstate and intrastate) and the total number of drivers that hold a valid Commercial Driver’s License (CDL). Also, see the “100-mile-radius driver” consideration below.

NOTE: The total number of drivers should be equal to all interstate plus all intrastate drivers. The total number of CDL drivers should be equal to or less than the total number of drivers.

100-mile radius driver— Driver operates exclusively within a 100 air-mile radius of the normal work-reporting location. For example, the company has 10 drivers, 5 that operate in interstate commerce and 5 that operate in intrastate commerce. Of the

5 that are intrastate, 2 stay exclusively within the 100-mile radius of their work location and 3 go beyond the 100-mile radius. All of the 5 interstate drivers are operating beyond a 100-mile radius. Of the 10 drivers, 8 have their CDL. This is how the form would be completed:

INSTRUCTIONS MCS-150 • Page vi of viii

28.If the company’s USDOT Number and registration are currently revoked by FMCSA — Enter the company’s assigned USDOT Number in the space provided.

29.Compliance Certification — All Passenger Carrier applicants must complete this section. Read the statement and select the “YES” response only if the statement is true. Private entities that are primarily in the business of transporting people, whose operations affect commerce, and that transport passengers in an over-the-road bus (defined as a bus characterized by an elevated passenger deck over a baggage compartment) are subject to the U.S. Department of Transportation’s Americans with Disabilities Act regulations located at 49 CFR Part 37, Subpart H. For a general overview of these regulations, go to the Federal Motor Carrier Safety Administration’s website at www.fmcsa.dot.gov/regulations/americans-disabilities-act-reporting-and-other-requirements- over-road-bus-companies.

30.Enter name(s) of sole proprietor(s), officers, or partners and their titles — If the company’s legal business structure is “Sole Proprietor,” then enter the owner’s name and title in the spaces provided; otherwise, enter the name of two company partners (if the company is a partnership) or two corporate officers and their titles if the company is a corporation (for example, corporate officers might include Vice President , Secretary, Treasurer, President).

31.Certification Statement — Print or type the name of the individual authorized to sign documents on behalf of the entity listed in item 1 (Name of Motor Carrier). This individual must sign, date, and print or type his/her name and title in the spaces provided. The individual’s signature must match his/her name. The authorized signer in this item should match one of the names provided in response to item 30.

NOTE: If this form is not signed and dated with a printed/typed name and title of an authorized individual, the application will be rejected and a USDOT Number will NOT be assigned.

INSTRUCTIONS MCS-150 • Page vii of viii

WHERE CAN I GET ADDITIONAL HELP AND INFORMATION?

For your convenience, the following is a list of helpful links, most of which are referenced in this instructions document. Information is provided in English-only unless otherwise specified.

1.FMCSA Registration & Assistance Web page: www.fmcsa.dot.gov/registration

2.Printable Registration Forms: www.fmcsa.dot.gov/mission/forms

3.To find out If a company already has a USDOT Number:

Call FMCSA toll-free at 1-800-832-5660 or go to www.fmcsa.dot.gov/safety:

a.Under the section “Company Safety Records” select “Snapshot.”

b.Select the option labeled “Name” and enter either the company’s “D.B.A. Name” (Doing Business As Name) or its Legal Name.

c.Click on the “Search” button.

d.The system will inform you whether a USDOT Number is assigned to the name entered.

4.Mexico-based carriers should use the following site to determine which forms are required to operate in the U.S.: www.fmcsa. dot.gov/safety/new-entrant-safety-assurance-program (English) or www.fmcsa.dot.gov/mission/español (Spanish).

5.Hazardous Materials Table/Hazardous Materials section of the FMCSA website: www.fmcsa.dot.gov/regulations/hazardous-materials.

6.Pipeline and Hazardous Materials Safety Administration (PHMSA) registration: https://www.phmsa.dot.gov/registration/registration-overview.

7.To get a Dun & Bradstreet number or find out if a company already has one: www.dnb.com.

8.To determine if the company’s commodities are exempt (Administrative Ruling 119): www.fmcsa.dot.gov/adminrule119.

If any commodity the company is transporting does not appear on these lists as exempt, then it is regulated.

9.49 CFR 390.5 “Definitions” for more information on Private motor carrier of passengers (business) and Private motor carrier of passengers (nonbusiness): www.ecfr.gov/cgi-bin/retrieveECFR?gp=1&ty=HTML&h=L&mc=true&=PART&n=pt49.5.390.

INSTRUCTIONS MCS-150 • Page viii of viii

FORM MCS-150 OMB No.: 2126-0013  Expiration: 07/31/2022

Please note, the expiration date as stated on this form relates to the process for renewing the Information Collection Request for this form with the Office of Management and Budget. This requirement to collect information as requested on this form does not expire. For questions, please contact the Office of Registration and Safety Information, Registration, Licensing, and Insurance Division.

The collection of this information is authorized under the provisions of 49 CFR, Parts 390-399.

Public reporting for this collection of information is estimated to be 20 minutes (and 7.5 minutes for the biennial updates) per response, including the time for reviewing the instructions and completing and reviewing the data inserted on the form electronically. All responses to this collection of information are mandatory, and will be provided in confidence to the extent allowed by law. Notwithstanding any other provision of law, no person is 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 valid OMB Control Number for this information collection is 2126-

0013. 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-MBI, U.S. Department of Transportation, Washington, D.C. 20590.

United States Department of Transportation

Federal Motor Carrier Safety Administration

Motor Carrier Identification Report

(Application for USDOT Number)

FORM MCS-150

REASON FOR FILING (select only one):

1.LEGAL BUSINESS NAME:

2.DOING BUSINESS AS NAME (if different from Legal Business Name):

3-7. PRINCIPAL PLACE OF BUSINESS:

20.E-MAIL ADDRESS:

21.CARRIER MILEAGE (to nearest 10,000 miles for the previous 12 months):

22.COMPANY OPERATIONS (check all that apply):

25.HAZARDOUS MATERIALS (Carrier or Shipper) (check all that apply): (C=Carrier; S=Shipper; B=Bulk, in cargo tanks; NB=Non-Bulk, in packages)

Owned

Term

Leased

Trip

Leased

FORM MCS-150 • Page 2 of 3

FORM MCS-150 OMB No.: 2126-0013  Expiration: 07/31/2022

29. COMPLIANCE CERTIFICATION:

ALL MOTOR PASSENGER CARRIER APPLICANTS must certify as follows:

Applicant is fit, willing, and able to provide the proposed operations and to comply with all pertinent statutory and regulatory requirements, including the U.S. Department of Transportation’s Americans with Disabilities Act regulations for over-the-road bus companies located at 49 CFR Part 37, Subpart H, if applicable.

YES

Private entities that are primarily in the business of transporting people, whose operations affect commerce, and that transport passengers in an over-the-road bus (defined as a bus characterized by an elevated passenger deck over a baggage compartment) are subject to the U.S. Department of Transportation’s Americans with Disabilities Act regulations located at 49 CFR Part 37, Subpart H. For a general overview of these regulations, go to the Federal Motor Carrier Safety Administration’s Web site at www.fmcsa.dot.gov/ rules-regulations/bus/company/ada-guidelines.htm.

30.PLEASE ENTER NAME(S) OF SOLE PROPRIETOR, PARTNERS, OR OFFICERS AND TITLES (e.g., president, treasurer, general partner, limited partner)

1.

2.

(please type or print names)

31.CERTIFICATION STATEMENT (to be completed by authorized official):

Hazardous 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.

(please type or print)

FORM MCS-150 • Page 3 of 3