FORM MCS-150 OMB No.: 2126-0013 Expiration: 10/31/2025 FORM MCS-150 • Page 1 of 3 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): new Application Biennial Update or Changes Out of Business Notification Reapplication (aſter revocation of new entrant) Reactivate 1. LEGAL BUSINESS NAME: 22. COMPANY OPERATIONS (check all that apply): 2. DOING BUSINESS as NAME (if different from Legal Business Name): 20. E-MAIL ADDRESS: 21. CARRIER MILEAGE (to nearest 10,000 miles for the previous 12 months): 3-7. PRINCIPAL PLACE OF BUSINESS (see 49 CFR 390.5T ): 8-12. MAILING ADDRESS: 13-15. CONTACT NUMBERS: 16-19. IDENTIFICATION NUMBERS: 3. STREET ADDRESS/ROUTE NUMBER 8. STREET ADDRESS/ROUTE NUMBER 13. PRINCIPAL BUSINESS PHONE NUMBER 16. USDOT NUMBER 4. CITY 9. CITY 14. PRINCIPAL CONTACT CELL PHONE NUMBER 17. MC or MX NUMBER 5. STATE/PROVINCE 10. STATE/PROVINCE 15. PRINCIPAL BUSINESS FAX NUMBER 18. DUN & BRADSTREET NUMBER 19. IRS/TAX ID NUMBER (see instructions before completing this section) 6. ZIP CODE 11. ZIP CODE 7. COLONIA (Mexico only) 12. COLONIA (Mexico only) Same as Principal Address Mailing address below: A. Interstate Carrier B. Intrastate Hazmat Carrier C. Intrastate Non-Hazmat Carrier D. Interstate Hazmat Shipper E. Intrastate Hazmat Shipper Rev 10/24/2024 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. is 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.
FORM MCS-150 OMB No.: 2126-0013 Expiration: 10/31/2025 FORM MCS-150 • Page 2 of 3 24. CARGO CLASSIFICATIONS (check all that apply): 26(a). NUMBER OF COMMERCIAL MOTOR VEHICLES (CMV) THAT WILL BE OPERATED IN THE U.S.: 26(b). NUMBER OF NON-COMMERCIAL MOTOR VEHICLES (NON-CMV) THAT WILL BE OPERATED IN THE U.S.: 25. HAZARDOUS MATERIALS (Carrier or Shipper) (check all that apply): (C=Carrier; S=Shipper; B=Bulk, in cargo tanks; NB=Non-Bulk, in packages) A. General Freight B. Household Goods C. Metal: Sheets, Coils, Rolls D. Motor Vehicles E. Drive Away/Towaway F. Logs, Poles, Beams, Lumber I. Machinery, Large Objects Q. Coal/Coke R. Meat S. Garbage, Refuse, Trash Y. Paper Product Z. Utility AA. Farm Supplies BB. Construction CC. Water Well DD. Other listed below: T. U.S. Mail U. Chemicals V. Commodities Dry Bulk W. Refrigerated Food X. Beverages J. Fresh Produce K. Liquids/Gases L. Intermodal Container M. Passengers N. Oil Field Equipment O. Livestock P. Grain, Feed, Hay G. Building Materials H. Mobile Homes DIV 1.1 DIV 1.2 DIV 1.3 DIV 1.4 DIV 1.5 DIV 1.6 DIV 2.1 (Flam. Gas) DIV 2.1 LPG DIV 2.1 (Methane) DIV 2.2 DIV 2.3D DIV 6.2 (Infect. Substance CLASS 7 DIV 6.2 (Select Agents and Toxins) HRCQ CLASS 8 CLASS 8A CLASS 8B CLASS 9 ELEVATED TEMP. MAT. INFECTIOUS WASTE MARINE POLLUTANTS HAZARDOUS SUB (RQ) HAZARDOUS WASTE LTD. QTY. CLASS 3 COMB LIQ DIV 4.1 DIV 4.2 DIV 4.3 DIV 5.1 DIV 5.2 DIV 6.1A DIV 6.1B DIV 6.1 LIQUID DIV 6.1 SOLID DIV 2.3A DIV 2.3B DIV 2.3C C C C S S S B B B NB NB NB A. B. C. D. E. F. G. H. I. J. N. Z. BB. AA. CC. DD. EE. FF. GG. HH. II. JJ. KK. LL. MM. O. P. Q. R. S. T. U. V. W. X. Y. K. L. M. Own/ Lease Straight Trucks Truck Tractors Trailers Hazmat Cargo Tank Trucks Hazmat Cargo Tank Trailers Motor– coach Number of vehicles carrying number of passengers (including the driver) School Bus Bus Passenger Van Limousine 1-8 9-15 16+ 16+ 1-8 9-15 1-8 9-15 16+ Owned Term Leased Trip Leased 23. OPERATION CLASSIFICATIONS (check all that apply): A. Authorized For-Hire B. Exempt For-Hire C. Private Property F. Migrant G. U.S. Mail H. Federal Government K. Indian Tribe I. State Government J. Local Government D. Private Motor Carrier of Passengers (Business) E. Private Motor Carrier of Passengers (Non-Business) Non- CMV
FORM MCS-150 OMB No.: 2126-0013 Expiration: 10/31/2025 FORM MCS-150 • Page 3 of 3 29. PASSENGER CARRIER 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. 31. CERTIFICATION STATEMENT (to be completed by one of the authorized company officials listed in #30): I, , certify that I am familiar with the Federal Motor Carrier Safety Regulations and/or Federal (please type or print name) (please type or print names) (please type or print titles) 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. Signature: Date: Title: (please type or print) 27. DRIVER INFORMATION: DRIVER INFORMATION INTERSTATE INTRASTATE TOTAL DRIVERS TOTAL CDL DRIVERS Within 100-Mile Radius Beyond 100-Mile Radius 28. IS YOUR USDOT NUMBER REGISTRATION CURRENTLY REVOKED BY THE FMCSA? Yes No If yes, enter your USDOT Number:
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