Hsmv 61518 Form – Fill Out and Use This PDF

Florida DOT Number Application Instructions

PLEASE COMPLETE AND RETURN THE ATTACHED APPLICATION TO:

Florida Highway Patrol - Commercial Vehicle Enforcement

2900 Apalachee Parkway, MS 41

Tallahassee, FL 32399

Telephone: (850) 617-2282; Fax: (850) 617-5150

(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 street address for the principal place of business where all safety records are kept.

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

5.Enter mailing address if different from the physical address, otherwise leave blank.

6.Enter the city corresponding with the mailing address.

7.Enter the two-letter postal abbreviation for the State or the name of the Canadian Province/Territory or Mexican State corresponding with the physical address.

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

9.Mexico Only.

10.Enter the two-letter postal abbreviation for the State corresponding with the mailing address.

11.Enter the zip code + 4 digit number corresponding with the physical address.

12.Mexico Only.

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

14.Enter the cellular number of the principal contact.

15.Enter the fax number, including area code, of the principal place of business.

16.Enter the USDOT number assigned to your motor carrier operation by the U.S. Department of Transportation, if previously issued, If this is an UPDATE of your Carrier record the USDOT number must be included.

17.MX or MC number (Not Applicable to Intrastate Operations).

18.Enter the Dun & Bradstreet number.

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

20.Enter your Internet e-mail address, if you have one.

21.Circle the appropriate type of carrier operation.

A.Interstate Carrier: A carrier that transports property, passengers or hazardous materials between or through two or more states or countries.

B.Intrastate Hazmat Carrier: A carrier that transports hazardous materials from one point in a state to another point within the same state, excluding any interstate movement.

C.Intrastate Non-Hazmat Carrier: A carrier that ONLY transports property or passengers from one point in a state to another point within the same state, excluding any interstate movement.

D.Interstate Shipper: A shipper that arranges transportation ACROSS STATE LINES of materials, substances or wastes which may be toxic, harmful or fatal to the environment, humans or animals that are accidentally exposed to them.

E.Intrastate Shipper: A shipper that arranges transportation ONLY WITHIN one state of materials, substances or wastes which may be toxic, harmful or fatal to the environment, humans or animals that are accidentally exposed to them.

F.Registrant: A company that registers commercial motor vehicles with a state office but is not a motor carrier, such as a company that rents or leases vehicles, or a for-hire operator that operates under another company's authority.

"Registrant USDOT Number" does not allow you to operate as a motor carrier and cannot, under any circumstances, be marked on the side of commercial motor vehicles!

22.Enter the carrier’s total mileage to nearest 10,000 miles for the past calendar year, and the year for which the mileage is being reported.

23.Circle appropriate classification. Circle all that apply. If “L. If Other” is circled, enter the type of operation in the space provided.

A.AUTHORIZED FOR HIRE - transportation for compensation as a common or contract carrier of property, owned by others, or passengers under the provisions of the FHWA.

B.EXEMPT FOR HIRE - transportation for compensation of property or passengers exempt from the economic regulation by the FHWA.

C.PRIVATE (PROPERTY) - transportation of property by commercial motor vehicle that is not a for-hire motor carrier.

D.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).

E.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) (e.g., church buses).

F.MIGRANT - interstate transportation, including a contract carrier, but not a common carrier of 3 or more migrant workers to or from their employment by any motor vehicle other than a passenger automobile or station wagon.

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 an Indian tribal government.

L.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 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 of some of the lettered codes:

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 10-24 people, typically built on a small truck chassis. LIMOUSINE - a passenger vehicle usually built on a lengthened automobile chassis.

27.Enter the number of interstate/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 drivers and the total number of drivers who have a Commercial Drivers License (CDL).

INTERSTATE - driver transports people 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.

FLORIDA (INTRASTATE) - driver transports people or property wholly within Florida.

100-MILE RADIUS DRIVER - driver operates only with a 100 air-mile radius of the normal work reporting location.

28.Is your USDOT Number Registration currently revoked by the Federal Motor Carrier Safety Administration?

29.Print or type name in the space provided, of the individual authorized to sign documents on behalf of the entity listed in Block 1, sole proprietor, officer or partners and titles (e.g., President, Treasurer, General Partner, Limited Partner, Owner). That individual must sign, date, and show his or her title in the spaces provided (Certification Statement, see 49 CFR 390.19).

30.Certification Statement to be signed by authorized official (i.e., Owner or President).